Open Your Mouth and say...Wha?

July 27, 2009 11:35 AM

So I went into the ER for lower back pain, and the doctor checked my ears and throat....what was the point of that?

My back has been bothering me lately and it all came to a head on Thursday when I couldn't move without my back spasming...and sometimes even not moving didn't help. I went to a Chiropractor, but he didn't even look at me, he just sent me straight on to the Urgent Care (which was closed so I ended up in the ER instead). The doctor came in, checked my ears and throat....then gave me a shot and sent me home with a vicodin prescription. She didn't order x-rays, check my range of motion, or barely ask me any questions.

Is checking ears, throat, etc standard procedure? Is there some mysterious throat ailment that gives you back pain? Was there any point to that whatsoever?

posted by Caravantea to health & fitness (13 comments total)

It's possible he was checking for signs of some sort of infection, I guess (kidney infections hurt, and they're in the area of your lower back.)

What questions did she ask?
posted by restless_nomad at 11:45 AM on July 27

I have heard the saying, "Fingers and tubes in every orifice," with regards to ER workups.
posted by Midnight Skulker at 11:48 AM on July 27

It's possible he was looking for signs of meningitis, a potentially fatal medical emergency that frequently presents with symptoms in the ears and throat. The doctor wasn't looking for a "mysterious throat ailment that gives you back pain" as much as a known back ailment that can cause inflammation elsewhere. In the absence of such signs, the doctor probably concluded that it was run-of-the-mill lower back pain, gave you a prescription for painkiller, and sent you on your way.

As lower back pain is one of the conditions that modern medicine has been largely unable to rectify, this isn't an entirely surprising series of events. Once your doctor was convinced that you weren't in immediate danger, she moved on to treat your symptoms, as they don't seem to add up to any disease for which she's going to have any real treatment to offer.

If this is a chronic problem, you should make an appointment with a GP to get yourself thoroughly checked out. That isn't what the emergency room is for, and the emergency physician rightly acted as such. If there isn't a life-threatening condition or an immediately obvious solution to a non-life-threatening condition, emergency medical practitioners tend to choose to spend their time on people who do fall into one of those categories.
posted by valkyryn at 11:54 AM on July 27 [3 favorites has favorites]

Someone can probably give you a better answer, but: It takes very little effort to have a look inside your ears/throat. But maybe it'll yield a clue down the road? I doubt he was looking for anything specific as much as he was looking for something amiss in general. Just because your back hurts doesn't mean your back is the problem. Given the lowlowlow cost of time/effort/expense involved in checking ears/throat, it certainly seems worth the cost
posted by GilloD at 11:55 AM on July 27

When you go to an Emergency Room, you're going to get two bills - the hospital bill and the bill from the doctor who saw you. Based on a number of different factors (what kind of tests were performed, how likely your illness or injury was to kill you, etc), the doctor typically charges one of five Evaluation and Management levels (99281-99285, respectively). Depending on the level you're at, the ER doctor has to document a certain number of body areas/organ systems his exam in order to charge you X amount.

They usually do a fairly complete exam to avoid having to deal with charging a lower level of service because of incomplete documentation.
posted by Pragmatica at 12:05 PM on July 27 [1 favorite has favorites]

IANAD, but I work for them. The national quality measure for care of patients with a primary diagnosis of lower back pain looks for the following: a diagnosis of lower back pain in either an outpatient or ER setting with no imaging studies in the next 28 days. (You exclude patients who have had recent trauma, IV drug aburse, neurological impairment, cancer, things for which an xray, MRI, whatever, would be appropriate.)

Over a population, you aren't supposed to be doing imaging studies for lower back pain. I have no idea how widely accepted this is, but there you have it. They are not evidence based, or so I have been told. Dunno why they'd check out your ears and throat, but evidently you don't do an xray for lower back pain without trauma or such.
posted by teragram at 12:06 PM on July 27

Dunno what he was looking for, but clenching your jaw tightens muscles in your lower back (presumably part of the human body's delicate balancing act). Believe it or not, I rid myself of chronic lower back pain by learning to relax my jaw.
posted by Billegible at 12:15 PM on July 27

teragram: That's just weird. Two years ago, I had a bad lower-back muscle spasm that shifted suddenly into a nerve pain from my lower back down my left leg. Fortunately, my doctor ordered an MRI, which revealed that one of my disks had ruptured and a piece of it was sitting on my left sciatic nerve. I was in absolute agony, and would have remained that way if I hadn't had surgery a few days after the diagnosis, which could never have happened without the MRI.
posted by cerebus19 at 12:18 PM on July 27

Wikipedia's Vicodin entry lists a few side effects that affect the ears, throat and respiration. Perhaps the doctor was checking for any problems, related to your back pain or not, that the Vicodin might exacerbate?
posted by reegmo at 12:22 PM on July 27

There are aches and pains that actually originate in areas of the body that are different from the location of the pain.

For example, pain in the right shoulder can be a symptom for gall stones. I also thought he might possibly be checking for an infection, as was mentioned above, for that same reason - pain in one area can be caused by things that don't seem to correlate with the location of the pain. Maybe an ENT-related condition could cause the type of back pain you described?
posted by DrGirlfriend at 12:51 PM on July 27

cerebus19, yeah, I don't know. My sense is that, sure, there will patients who should have imaging studies done, sounds like you are a perfect example, but on the whole, it's not good medicine. And any medical recommendation will have anecdotal counter examples. It's like people swearing that they don't wear their seatbelt because they heard about a story where a seatbelt resulted in a death in a car crash. Still, you should wear your seatbelt: odds are it will save you, not kill you. But I am speaking out of turn here: I help my organization measure these for ourselves, internally, but I don't know anything about the medicine.

From the AHRQ site:

"Low back pain is a common cause of lost productivity and work days in the U.S. Half of American adults will experience low back pain in any given year; 2 in 3 will suffer low back pain at some point in their life. Low back pain is a common reason for patient visits to the physician. According to the American College of Radiology, uncomplicated acute low back pain is usually benign and self-limiting, and does not call for imaging studies, such as X-rays, magnetic resonance imaging (MRIs) or computed tomography (CT) scans. Most patients return to their usual activities in a month. However, a small portion of this large patient population will need to be evaluated further to investigate more serious health problems.

Imaging studies are frequently overused in the evaluation of patients with acute low back pain. While imaging may be appropriate for patients at risk for more serious conditions, for most patients low back pain is nonspecific with no identifiable cause."
posted by teragram at 12:56 PM on July 27 [1 favorite has favorites]

(cerebus19, or, maybe your shift to leg pain is the "complicated" to "uncomplicated acute low back pain." These doctory things, who knows.)
posted by teragram at 12:58 PM on July 27

No idea. I'm a ER doctor, see lower back pain constantly, and ears and throat are not on my list. It's usually a history, looking for back pain red flags, and then a belly, back, extremity, and neuro exam.

Another thought: perhaps your vitals were off--either a fast heart rate or elevated temperature/fever and he/she was looking for a source.
posted by gramcracker at 3:14 PM on July 27