What to Do | Dr. Sam

Establish some basic criteria

For instance, you need someone who will be your advocate and not just be "the doctor in charge."

It is important to find a health care provider who can be both your consultant and coordinator of more extensive diagnosis and treatment, if needed.

Also, your provider should be an advisor who can educate and counsel you on both:

Conventional (Western) medicine

CAM (complementary and alternative medicine)

This way you will learn what is available to you - both the pros and cons - as you consider the best treatment plan.

Find a provider who can communicate with you. As a practicing doctor, I find it curious that patients actually make excuses for doctors who do not respond to their needs.

Choose a specialty

Lower back pain, while sometimes disabling, is not life-threatening, and you do not need to make quick decisions in most cases. There is time for thought and discussion with your family. You can consult several kinds of specialist and doctors for lower back pain - including primary care physicians, osteopaths, chiropractors, naturopaths, nurse practitioners, physician assistants, physiatrists, pain specialists, and more.

Consider your insurance

You may need to consider coverage options for more alternative methods, as not all insurance policies provide coverage for care from these providers.

Check out your provider's credentials

Learn more about each specialty that interests you on the Internet. Especially pay attention to issues such as training, licensure, or certifications. After you pick a provider, ask about his or her credentials.

If your primary care doctor refers you to an orthopedic surgeon or neurosurgeon - or if you choose to see one on your own - be mindful of the doctor's training and scope of knowledge. Something to strongly consider is whether or not the doctor is board certified by the American College of Orthopedic Surgeons or the American College of Surgeons, with subspecialty certification in neurosurgery.

This may mean that you'll have to travel to an area where this specialty is an option, since it may not be available in more rural areas. Board certification does confirm some degree of credibility to the surgeon's training and basic knowledge. Remember, however, that expertise and judgment varies from individual to individual, and the doctor's credentials mean that he or she has met minimum standards.

Take an inquisitive approach

It is in your best interest to put the same level of thought into your health care provider as you would when buying a new car or washer and dryer.

Investigate the specialist as much as you can even before you have a first encounter. Call the provider's office and ask about his or her credentials. Get a "feel" from the staff about the personality of the doctor and the office staff because, if you require more than one visit or if you need additional information, it is likely that the office staff will be more in contact with you than the doctor. Often, the office "personality" reflects on the doctor's personality.

This same "inquisitive" approach should be applied to choosing any doctor. I am often dumbfounded to hear someone say, "Dr. X is a great doctor but he has an awful bedside manner."

In my opinion, a great doctor should be both technically and socially capable. A good doctor has an obligation to communicate his or her thoughts and knowledge honestly, objectively, patiently, and with as much empathy as possible. We doctors have an obligation, I believe, to advise you of the pros and cons of various decisions you might make.

Ask what treatment will involve

You'll find that as you learn how to manage your back pain, you will generally require less frequent provider visits. But, in your first appointment with your chosen provider, you need to ask up front what treatments will involve.

Most lower back pain is not a sign of a medical emergency and is responsive to very conservative care. However, you should cover some basics to be sure that your lower back pain is musculoskeletal in nature and not a sign of other problems that your body may be signaling. Prescription medications such as muscle relaxants, sedatives, anti-anxiety pills, and anti-inflammatory agents may play a role in all but the most extreme circumstances. Most lower back pain does not require surgery. Just because an orthopedist is also a surgeon does not always mean that a surgical procedure is the best course.

Your challenge is to minimize your dependence on these specialists whose treatment and diagnostic plans can often be based on subjective, rather than evidence-based medicine. Factor in the cost of visits and therapies, too.