Low Risk Consultation

Introduction

Patients in the low risk category can be effectively managed in primary care. The success of this depends on getting a few simple things right from the start.

Key points for success

  • Make sure your assessment includes biomedical (physical), psychological (distress) and social (impact) aspects.
  • Explicitly enquire about patient concerns and expectations. Be sure to then address these when forming a management plan.
  • Use the SB tool to help you identify and tackle psychosocial barriers to recovery.
  • Think very carefully before investigating or referring patients with simple low back pain. It rarely is of benefit to anyone.
  • Avoid unhelpful diagnostic labels (spondylosis, disc rupture, degeneration).
  • Promote self-management as a priority

Content of consultation

  • A good history taking for diagnosis and to connect with patient
  • Focused clinical examination
  • Exclude potential red flags
  • Use SB tool to support clinical judgement
  • Explanation, re-assurance and dealing with distress
  • Optimize pain control but avoid inappropriate medication usage.
  • Activity promotion
  • Back up your explanation with advice in written or visual forms (links)
  • Keep an open mind and review the diagnosis if the back problem is persistent – consider physical, psychological and social aspects.