Treatment Philosophy

Medicine is an art and a science.

A doctor must know his limitations.

There are many important facts that are learned in medical school. As difficult and varied as the practice of medicine is, even situations which seem "obvious" may not be so. The doctor must muster the skills and resources to help the patient. If a doctor doesn't know the answer, the doctor should find the answer through another and be able to say honestly, "I don't know." Likewise, the doctor should protect the patient from their limitations of understanding, fears, and biases.

The patient, once educated, bears the responsibility to do the right thing and follow through with the plan. Patients will sometimes put themselves outside of the reach of the physician's ability to help. They may do this in any number of ways, such as second guess the diagnosis, miscalculate the contribution of other practitioners, or by adding their own interventions (such as improperly timed exercises, or certain types of nutritional interventions).

Medicine may be an art and a science, but it is not a religion. The imposition of convictions without background may be harmful and interfere with a proper diagnosis or the proper healing of known mechanisms. Dr. Stark will always try to help the patient understand to the degree that he can. If the patient pursues harmful habits (such as smoking), uses medication unwisely (such as narcotics), or deviates from necessary protections (such as work restrictions), he will draw limits and sometimes withdraw from treatment.

The care situation is a stressful one, both for the patient and for the doctor. The patient and the doctor should work together to solve problems, including those of communication and access. Together they will accomplish the goal of improving the patient's medical condition.

We are obligated to serve the patient's needs over all others.
The successful practice of medicine should be a winning situation for all-the patient, the doctor and the payer. This comes from a fair assessment of the facts leading to the diagnosis, the causal association of the problem (if it can be determined), and the responsible use of resources. No one benefits in any lasting way if these principles are violated.

We enable all those involved in the process to assist to the benefit of the patient.

Dr. Stark knows the environment in which we practice. Financial pressures, technological pressures and sociological ones all come together to change the decision-making process from the historical doctor-patient relationship. In order for this to happen, the parties involved must communicate within an atmosphere of trust. Dr. Stark wants to establish and preserve that trust by maintaining a sense of integrity within his practice. He will contribute the energy necessary to educate, inform, and enable all parties to help the patient.

We will do what we can to secure resources and take care of those who need us. Not everyone who needs care these days can afford it or know where to turn for help. To the degree possible, we will try to help the patient find the care they need.

The goal is to be so successful at treating each patient that the subjective benefits of reputation and trust accrue, resulting in patients finding their way to the office. "Trust me, I'm a doctor" is still an appropriate statement for us to use. We use it and believe it.

Many problems in orthopedics overlap in their presentation.
This is particularly true in low back care. Degenerative disc disease may hurt in the same area as the pinched nerve they cause. Mechanical back problems that are not disc-related (such as sacroiliac problems or hip joint arthritis) can initially look like the same thing and must be separated out.

The low back has been very difficult to treat because of these many overlaps, their concurrent presentations, and their spontaneous comings and goings. Separating all this out takes tremendous experience. Dr. Stark will study the patient's individual situation and provide expert assessment and treatment. The treatment will be the simplest and safest that can reasonably be expected to work.

A back problem is a moving target.
Each of the related elements of the lumbar spine, the discs, the nerves, the motor control and muscles have injury patterns and recovery patterns. The symptoms of their failure can mimic the symptoms of adjacent structures. This process should not be oversimplified. The patient's situation is constantly evolving, and the action to take at any given time must be constructed from available information. Only after a consistent picture results can the treatment recommendation be advanced with confidence.

Dr. Stark's experience will play into the expected benefits of all the decisions that must be made. He will not simply label you with pejorative syndromes, like "low back pain" or "chronic pain". He will want to arrive at an anatomic diagnosis.

For example, a "knee sprain" is not a knee sprain to an orthopedist. It is a "grade two midsubstance strain of the medial collateral ligament, near the femoral insertion, without associated cruciate tear." It is this level of data and thought which allows the adequate understanding of the problem, establishment of treatment options, and prognosis.

This practice believes it is our responsibility to track down the cause of the pain, hopes for recovery, and impact on other structures and provide solutions. Often, just understanding what's really wrong will be a form of relief to the patient. Injections and treatment that focus on the pain (rather than on the underlying problem) is not what we're primarily about. We'll treat the pain, but in a context of providing real solutions with or without reduced use of pain medication.

We're very cautious with pain medication.
Pain medication is a tool that we use as a temporary benefit. Narcotics, even when administered by high tech means, are not a permanent answer to chronic pain. We use them early on when the problem is most severe or after surgery. Our main goal is to protect the patient from the side effects and dangers of narcotic overuse and dependence.

A patient's expectations will determine much of the outcome.
When outcomes are studied, the strongest correlation of satisfaction is the patient's expectations at the start of treatment. We will work to make you aware of the diagnosis, decision-making process, risks, and rewards to the greatest extent possible. Only in this manner will you be truly satisfied and be able to go on with the rest of life's challenges.

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