Phase 1: Getting to know you
The first phase of care involves getting to know you as a patient as well as your problems and goals. In addition to a detailed history and physical examination, we will review medical records and imaging studies to help us make a diagnosis. We will ask questions and order imaging as needed to help us understand the medical basis of your problems and to guide us in developing a pathway to achieving your goals.
Phase 2: Spine-alysis
Spine-alysis is our own formula for determining the cause of a patients spinal problems and represents an algorithm developed from caring for thousands of patients. Some patients have had multiple surgeries without accurate identification of the actual problem or a co-existing pathology which needs to be addressed. Some patients develop new problems after spinal surgery. We take the time to seek out all possible causes of a patient's problems. Once we have comprehensive diagnostic information, we review your case in a multi-disciplinary conference where a variety of opinions are sought from specialists within Hudson Neurosurgery, from collaborating physicians and from trusted colleagues from around the world! The internet is a wonderful tool for seeking out expertise and opinions. The key is knowing who to ask. Professor Choudhri receives requests for his opinion from colleagues around the country and around the world multiple times per day. This gives him a broad perspective on what does and does not work and also allows him to keep up with the latest developments and seek opinions for his patients as well.
Phase 3: Developing a plan
Two patients with the same symptoms or the same MRI findings might require completely different treatment plans. We believe that all care should be customized to reflect the goals and desires of each patient. Some patients prioritize spending the least amount of time in pain while others want to absolutely minimize the time they are out of work. Some patients wish to avoid surgery at all costs while others are concerned about becoming dependent on narcotics. Some patients have medical problems which make surgery less likely to succeed while others have conditions which, if left untreated, could result in chronic pain or paralysis. The right answer for each patient is different. We endeavor to educate patients about the risks, benefits and alternatives to all reasonable treatment plans and to help the patients make informed decisions. Treatment recommendations must also reflect a given surgeon's personal success record in similar situations.
Phase 4: Education of Patient/Family & Discussion of Options
We spend a lot of time discussing and analyzing cases between office visits. This makes us different from many traditional spine practices. We have had cases which required us to spend 5-6 hours on analyzing the care of a single patient! Once we do develop a plan of care or narrow down a list of options, we need to share this information with the patients and their families. This is where we make illustrations and describe the problems and potential solutions in great detail and using non-medical terms as appropriate (this may not be necessary in all cases because Professor Choudhri has operated on a large number of health care practitioners including multiple spine surgeons who have entrusted him with their care!)
Once the patient has all the information about the plan of care which is being recommended, we will facilitate and encourage them to gather more opinions. We do not restrict our patients from seeking additional opinions or seeking care from another surgeon.
Phase 5: Initiating custom plan of care
We believe that there are many ways of treating spine pain and problems. Medications, rest, exercise, injections, physical therapy, massage, prayer and surgery. We feel that surgery should be the last resort. If a patient tries everything, and nothing works and we offer surgery and the patient gets better, we can agree that surgery was needed. If a patient tries everything and nothing works and surgery does not relieve the problem, we will agree that nothing was going to make the patient better. At least no stone was left unturned in an attempt to make them better however, at least surgery was left as a last resort.
Despite many successes over the years in cases which were deemed hopeless or inoperable, we understand that not all problems can be fixed with or without surgery. When a non-surgical treatment plan is developed, we will manage the aspects of care which we excel at and will refer patients to trusted practitioners who may be better than us at some of these modalities.