The re-exam: how to tell whether the plan is working

Key takeaways

• A treatment plan is a prediction: this is what we expect to change, and roughly when. The re-exam checks the prediction.
• Good re-exams repeat the measurements from the first visit, so the comparison is against numbers and findings, not a mood.
• You are part of the measurement. Keep track of what you can do, not just how much it hurts.
• If progress stalls, the plan should change, or you should be referred somewhere else. Ask which.

This desk runs one column on repeat: get examined this week, and get it written down. The desk's page on the record explains why the first dated exam matters. This column is about what that first exam is for, weeks later. A baseline no one ever compares against is just paperwork. The re-exam is the comparison.

What a plan should have promised

Pull out the plan from the first visit. A useful one answers four questions, even roughly:

1. What was found. The findings, in words you could repeat.
2. What the treatment is. What happens at visits and what you do at home.
3. What should change. Less pain, more motion, back to a specific task.
4. When to check. A point, often a few weeks out, when the clinician will re-examine and compare.

If your plan does not answer the fourth question, ask at your next visit: when do we re-check, and what are we comparing? That is a reasonable question and a good clinician will have an answer.

What a good re-exam measures

The re-exam should look a lot like the first exam, on purpose. The same tests, repeated, are how anyone can say something changed. Depending on the injury, that usually includes some of these:

• Range of motion. How far the neck turns or the back bends, compared with the first visit.
• The provocative tests. The movements or pressure that reproduced your pain at the start. Do they still?
• Neurological checks, where they applied. NIAMS describes a typical back exam as including tests of reflexes, muscle strength and sensation. If any of those were off at the start, they get checked again.
• Your pain report. Often a number on a scale, recorded the same way both times.
• Your function. What you can do now that you could not do then.
• For the head, if it was involved. The symptoms that brought you into the concussion lane, such as headaches, screen tolerance, dizziness or sleep, compared with where they started.

Your half of the measurement

Pain numbers are useful, but they wobble with sleep, weather and the day you had. Function is steadier. Before the re-exam, write a short list of real tasks and whether each is better, the same or worse than at the first visit:

Fill in your own tasks. Bring the list. It turns "I think it's a bit better?" into something a clinician can write down.

Three possible answers, and what each should mean

Better, as expected

The plan is working. Ask what the next phase is, whether visit frequency changes, and what the next checkpoint is. Plans have shapes, and one of the shapes is an ending.

Better, but slower than expected

Common, and not a failure. Ask whether the plan changes, whether the timeline changes, and why. The answer should be specific to your findings.

Not better, or worse

This is the one the skeptic watches. A plan that is not producing change should not simply continue unchanged. Reasonable next steps include changing the treatment, ordering imaging, or referring you to a physician or specialist. Ask directly: what would make you send me somewhere else, and are we there? A clinician who can answer that plainly is doing the job. The desk's skeptic's column puts it this way: open-ended care with no endpoint is not a plan.

The re-exam is where a plan stops being a promise and becomes a result, in either direction.

Keep the re-exam in the record

Every visit after the first is a new dated entry, and the re-exam is the most important one after the first. Ask for a copy of the findings, or at least write down what you were told and the date. If you ever change clinicians, move, or need care for something related later, the comparison between the first exam and the re-exam is what the next person will want to see.

Service desk. Past the first visit already? Bring your plan and your task list to the re-check. See a clinician this week, or call South County, the desk's default office, at (314) 530-5480. Closed daily 12 to 2.

Getting worse in a way that involves the emergency list, such as spreading numbness, a worsening headache or trouble with bladder or bowels, is not a re-exam question. It is an emergency room trip. This column is educational and is not medical advice.