While watching the Red Sox-Milwaukee baseball game on TV last Saturday, the announcers were discussing Julio Lugo, the Red Sox shortstop who had missed 5 games with a concussion. One of them noted that the team had done baseline neuroimaging testing on all the players so if they had a concussion during the season they would have a baseline to compare to their post-concussion tests. I assume that they also did non-imaging neurological testing, such as reflexes and memory, etc., and this was an extension of all the other evaluations the players went through.
The reason I found this interesting is that it highlights the importance of having an understanding of both a patient’s baseline and their goals. For example, the ability of someone to play the piano after a hand injury is healed depends upon whether or not they could play the piano before the injury. (Sorry – that’s from a very old joke.)
Obviously after a professional baseball player has a concussion, the important factors include reflexes and visual focus since hitting a 90+mph fastball and catching a rocketed ground ball requires precise physical abilities. But for the rest of us – and overall healthcare quality – baseline functioning and goals are important because they are different for every patient, and should be a crucial component of the conversation between a patient and their clinical team. Only when the clinician understands what the patient’s abilities were before the illness or injury, can they work with the patient to develop a treatment plan that they hope will get the patient to their goals.
This may all sound silly or simplistic, but too often I have heard stories about patients who complain that their physician has given them the treatment plan without considering their desires or perspectives – as in “this is what where going to do.” Unfortunately, physicians sometimes only see one reasonable treatment course. But patients are as different as baseball parks – and I mean globally from sandlots to Yankee stadium – and their perspectives, concerns and treatment goals really are just as diverse.
I’m ready for blasts from physicians and others on this one, so let me know what you think.