Your Most Difficult Patient: The One with Nothing Wrong

Timothy J. Birney, MD; and Frederic Platt, MD

Patient A.B. has “never been the same” since her auto accident 9 years ago. While stopped at a red light, her SUV was hit from behind by a slow-moving small car. Although the SUV was equipped with high seat backs, Ms. A.B. was wearing her seat belt, and neither vehicle sustained significant damage, she has suffered from neck and thoracic spine pain ever since the accident. The constant pain, she said, is exacerbated by movement and prolonged sitting.

Ms. A.B. consulted several spine specialists. Although the examinations did not reveal any serious injuries, many diagnostic tests and therapeutic procedures—including radiographs and magnetic resonance imaging (MRI) of her spine, facet injections, medial branch blocks, steroid injections, chiropractic manipulations, and eventually a three-level fusion at C4-C7—were performed. After the surgery, she claimed she was “no better, in fact, worse.”

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