You sat down in the exam room ready to tell them what was going on.
You had thought about it for days. Maybe weeks.
If most of what you came in to say, you never got to say — this article is for you.
Read the Full Video Transcript
DISCLAIMER:
Transcript lightly edited for clarity and readability. The views expressed are intended to explore the full range of clinical considerations in spine care and do not constitute medical advice. Outcomes vary by patient and pain pattern. For guidance specific to your situation, consult a spine specialist.
TRANSCRIPT TEXT:
There is a particular thought patients often have on the drive home from a medical appointment, and most of them never say it out loud: “Most of what I came in to say, I never got to say.”
Welcome to this Vertrae® 360 explainer on the unheard patient story — and why listening is one of the most powerful diagnostic tools in spine medicine.
That quiet realization is an incredibly relatable and deeply frustrating experience for many people dealing with chronic back pain. You may have sat down in the exam room after thinking for days, maybe even weeks, about exactly how to explain what is happening in your body. But the pace of the appointment simply did not allow for it.
Modern medical visits are often short, and the questions tend to come quickly: “On a scale of one to 10, how bad is your pain?” “Does it shoot down your leg?” “Have you tried physical therapy?” These closed-ended questions may help fill out a medical chart, but they do not always leave room for the patient’s full story.
The boxes get checked. The visit ends. And suddenly, you are out the door. It can feel abrupt, overwhelming, and deeply unsatisfying — especially for an appointment you may have waited weeks to get.
Here is the underlying problem: you came in with a story. You wanted to explain how the pain changed over time, what had quietly disappeared from your life, what you were trying to get back to, and how the pain affected ordinary things like picking up a grandchild, tending to a garden, sleeping through the night, or simply getting through a normal day.
That nuanced, human reality does not always fit into closed-ended questions.
And here is the most validating part: that experience is not in your head. It has been studied for decades. Your sense of being rushed is not just a feeling. It reflects a documented challenge in modern healthcare.
In one widely cited study, researchers found that patients were interrupted within an average of about 11 seconds after they began describing their concerns. Just 11 seconds before the conversation was redirected.
The same research showed that fewer than four out of 10 patients were given the chance to complete their opening statement. In other words, the structure of the system itself can make listening difficult.
This matters in spine care more than many people realize. The patient’s story is not a warm-up to the evaluation. It is part of the evaluation. It is a fundamental clinical tool.
To understand why, we have to look at the limitations of medical tools. An MRI shows anatomy. It shows what the structures physically look like. But the patient’s story shows function, reality, and goals.
Two people can have the same MRI report but experience very different levels of pain and limitation. The scan matters, but the patient’s story helps a specialist understand whether the anatomy actually matches the pain being experienced.
What triggers the symptoms? What eases them? What has failed? What activities have been lost? What is the patient hoping to get back to? All of that is diagnostic information. It helps direct the medical workup.
When a doctor rushes through an appointment without fully listening, those vital data points may be lost. Imaging often cannot answer those questions. The patient is the only one who can.
So if an MRI report says “normal,” but your back still hurts every day, the most useful next step may not be simply staring harder at the scan. It may be listening more carefully to what the patient is trying to say.
Fortunately, there are specialists who are working to close this gap. At Vertrae® in Miamisburg, Ohio, Dr. Kamal Woods has built the visit around this exact principle. He directly addresses the widespread problem of the unheard patient by changing the structure of the consultation itself.
The history, physical exam, imaging, and patient goals are all read together — not treated as separate pieces, and not placed in a hierarchy where the patient’s story comes last.
In fact, Dr. Woods gathers records and imaging before the patient even steps into the office, so the time in the exam room is not spent on data entry alone. It is spent on the patient’s story and physical exam — the crucial parts of medicine that cannot be completed from a chart.
The takeaway is powerful: a different kind of visit does not always require more time. It requires a different opening question.
Asking, “Tell me what’s going on,” opens a different door than asking only, “Where is your pain, from one to 10?”
It allows the patient to become the storyteller, not just a respondent checking boxes.
We have covered some eye-opening ideas in this explainer, but the final thought is simple: if your last appointment ended before you got to say what you came to say, a different kind of visit at Vertrae® in Miamisburg, Ohio may be worth considering.
Quick Answer:
Listening matters in spine care because the patient’s story helps determine whether an MRI finding actually matches the pain. The history reveals what triggers symptoms, what has failed, what activities have been lost, and what the patient hopes to regain. A good spine evaluation connects the story, the exam, the imaging, and the patient’s goals before recommending treatment.
Snippet — Why the patient story matters in spine diagnosis
In spine medicine, the patient history is part of the diagnosis. The story — in the patient’s own words — reveals how the pain behaves, what makes it better or worse, and how it has reshaped daily life. Imaging shows anatomy. The story shows whether that anatomy matches the pain.
“Tell Me What’s Going On”: Why the Patient’s Own Words Are Still the Most Powerful Tool in Spine Medicine
You wanted to explain how the pain had changed — how it sat differently in your hip on bad mornings, how the garden had gone to seed because bending over was too much, how your Saturday round of golf had quietly disappeared.
But the questions came first.
“On a scale of one to ten?”
“Does it shoot down your leg?”
“Have you tried physical therapy?”
You answered. The boxes got checked. The visit ended.
And as you walked back to your car, the thought sat with you: most of what you came in to say, you never got to say.
That experience is not in your head. It is one of the most studied gaps in modern medicine. And in spine care, it can change what gets diagnosed, what gets missed, and what plan gets offered.
In spine medicine, the patient story is part of the diagnosis
This is not a soft idea. It is a clinical one.
In spine medicine, the patient story is not a warm-up before the “real” evaluation. It is part of the evaluation. The way the symptoms started, what makes them worse, what makes them better, what has changed, what has stayed the same, and what the pain has cost in daily life — all of that is diagnostic information. In many areas of medicine, the patient history contributes more to diagnostic accuracy than the physical exam or testing alone (Connor et al., 2025).
In spine care, that does not mean imaging is unimportant. It means imaging needs context. The MRI shows anatomy. The patient story helps reveal whether that anatomy matches the pain. Two patients can have similar MRI reports and very different treatment plans. The scan matters — but the story tells us what the scan means for this person.
That is why the story is foundational. Not the survey form. Not the symptom checklist. The patient’s own words — in their own order, on their own timeline, about their own life.
What gets lost when the visit becomes a questionnaire
There is a subtle but important difference between two kinds of conversations.
In the first, the doctor asks: “Tell me what is going on.” The patient answers in their own words. They start where they want to start. They describe the pain the way they actually experience it. They mention things that turn out to matter — the way it wakes them at three in the morning, the way it has changed how they pick up their grandson, the fact that their spouse has started doing the grocery runs.
In the second, the doctor asks specific, closed questions in the order needed to fill out the chart. “On a scale of one to ten?” “Does it radiate?” “Any numbness or tingling?” The patient answers each question, in turn. The chart fills up. The visit moves forward.
Both produce information. Only the first produces the patient’s story.
Here is what that difference can look like in spine care. A checklist may capture “back pain, no leg pain.” But the story may reveal that the pain appears after ten minutes of standing, eases when leaning forward over a grocery cart, worsens with backward extension, disappeared briefly after one injection two years ago, or began only after months of compensating for a hip that had never been formally evaluated. Each of those details can point the work-up in a different direction. None of them lives on the checklist.
When the visit becomes a structured interview led by the provider’s questions, the patient stops being the storyteller and becomes a respondent. The medical chart fills up. The human picture stays empty.
And the human picture is where the diagnosis often hides. Because the questions a doctor knows to ask come from a medical perspective — ruling things in, ruling things out. The story a patient tells comes from the perspective of a life that has been reshaped by pain. Those are not the same lens.
Pain reshapes the entire ecosystem of a life — and the story is what reveals it
Back pain is rarely just back pain. It is a thread that runs through everything.
It is the grandchild you cannot lift onto your lap. The garden you used to tend, now overgrown along the back fence. The round of golf left unscheduled. The kitchen counter you keep one hand on because bending over the dishwasher has become a calculation.
It is the way it changes a marriage. The spouse who has started carrying the laundry baskets and asking, gently, whether you slept. The kids who have stopped suggesting the long walks at the holidays because they have noticed you wincing on the short ones. The way the family has reorganized itself, quietly, around something no one is naming.
It is sleep. Most people do not realize how loud back pain becomes at three in the morning, when there is nothing else in the room with you and rolling over has become a project.
It is work. The job you are not sure you can keep doing. The promotion you have stopped putting yourself forward for, because you do not trust your body to perform under pressure. The mental math of how many hours you can sit at a desk before the day ends in a fog.
It is the hobbies that quietly disappear — not all at once, but one by one.
None of that lives in a one-to-ten pain scale. None of it shows up on imaging. The only place it lives is in the patient’s story — if there is room to tell it.
And here is what makes that story clinically important: it does not just describe what the patient has lost. It describes what the patient is trying to get back. Whether soon or far. Whether realistic or not. The hopes, fears, and goals that should shape every decision that comes after.
Snippet — Pain affects the whole life
Back pain rarely stays in the back. It changes sleep, work, hobbies, family roles, and relationships. The grandchildren the patient cannot lift, the garden left untended, the round of golf abandoned, the spouse quietly carrying more than their share — all of this is part of the clinical picture, and the only place it appears is in the patient’s own words.
What the research actually shows about listening
If the patient story is so important, the question becomes: how often does it actually get told?
In a 2019 secondary analysis of recorded clinical encounters published in the Journal of General Internal Medicine, researchers found that clinicians elicited the patient’s agenda in only thirty-six percent of visits. When clinicians asked, they interrupted the patient after a median of 11 seconds (Singh Ospina et al., 2019).
Eleven seconds.
The same study found that uninterrupted patients took a median of six seconds to begin stating their concern.
This is not a new finding. A 1999 study published in JAMA documented the same problem. Physicians redirected patients’ opening statements after a mean of about twenty-three seconds. The most striking finding from that paper, though, was the comparison: patients who were allowed to complete their statements of concern used only about 6 seconds more, on average, than patients who were redirected before they could finish (Marvel et al., 1999).
Six seconds.
The point is not that every visit should become an hour-long conversation. The point is that the first uninterrupted minute often changes the direction of the entire visit. The first question matters. “Tell me what’s going on” opens a different door than “Where is your pain from one to ten?”
Researchers have studied what makes a medical visit feel truly present. The findings are not complicated, but they are easy to lose in a rushed system. In 2020, a JAMA study from a Stanford team led by Dr. Abraham Verghese identified five evidence-based practices that foster real presence and connection in the clinical encounter (Zulman et al., 2020):
- Prepare with intention. Take a moment before greeting the patient — not to check the next box, but to focus.
- Listen intently and completely. Sit down. Lean forward. Avoid interruption.
- Agree on what matters most. Find out what the patient cares about. Build the visit around their priorities, not just the chart’s.
- Connect with the patient’s story. Consider the life circumstances shaping the patient’s health. Acknowledge what they are doing well.
- Explore emotional cues. Notice, name, and validate the patient’s emotions — because emotion and pain are not separable in the body.
For a patient with chronic spine pain, those practices are not bedside manner. They are how the doctor discovers what the pain is doing to the body and to the life around it.
The fact that the standard has become structurally hard to meet in modern healthcare is not the fault of any individual provider. The system has gotten faster, more crowded, more documentation-heavy. The visit has gotten shorter as the demands have multiplied.
It is not that providers do not want to listen. It is that the system has made listening structurally difficult.
What a spine specialist is listening for
A good spine consultation is not just open-ended conversation. It is careful listening with a clinical purpose.
A spine specialist is listening for patterns:
- Where the pain lives and where it travels. Does it stay in the back, or move into the buttock, the hip, the thigh, the calf, the foot? The pattern points toward different structures.
- What positions and movements change it. Does it worsen with sitting, standing, walking, bending forward, leaning back, lifting, twisting? Position-dependent patterns are clinical signatures.
- Whether there is anything neurologic. Numbness, tingling, weakness, foot drop, balance changes, bladder or bowel changes — each of these can change the urgency and direction of the work-up.
- What treatments helped, even briefly. Each response — partial, short-lived, or absent — is information. A brief response to a particular injection or therapy may point toward a specific source of pain.
- What the patient has stopped doing. Activities lost, abandoned, or quietly worked around. The functional cost of the pain shapes the urgency and the goals of care.
- What outcome would actually feel meaningful. The grandchildren they want to be able to lift. The round of golf they want to put back on the calendar. The work they want to return to. The night of unbroken sleep. These are not extras. They are the outcome the patient is hoping for, and they shape what success means.
These details are how the patient’s story connects to the exam and the imaging. They can also reveal when the imaging report is not telling the whole story — when the MRI lists three findings but only one of them matches the pattern in the patient’s actual life.
Snippet — What a spine specialist listens for
A spine specialist listens for clinical patterns: where the pain travels, what positions change it, whether there are neurologic signs, what treatments have helped or failed, what activities have been lost, and what outcome would actually feel meaningful. These details connect the patient’s story to the exam and the imaging.
In spine surgery, listening is part of the outcome
There is a particular reason the patient story matters even more in spine surgery than in many other clinical settings: surgical outcomes are not only determined by what happens in the operating room. They are shaped, in measurable ways, by whether the surgeon and the patient are aligned on what success means.
A 2022 cohort study published in Neurosurgery, drawing on the Canadian Spine Outcomes and Research Network registry, looked at the relationship between preoperative expectations, fulfillment of those expectations, and patient satisfaction after spine surgery (Rampersaud et al., 2022). The findings were striking. Disability improvement and pain improvement both predicted satisfaction — as one would expect. But the strongest predictor by far was whether the patient’s expectations had been fulfilled. The statistical effect was very large.
In practical terms, the lesson is simple: if the surgeon and patient have not agreed on what success should realistically look like before treatment begins, even technically excellent care can leave the patient disappointed.
A technically excellent surgery that does not match what the patient was hoping for can leave that patient feeling the surgery was unsuccessful. A surgery that hits a goal the patient cared about — even if the imaging looks similar to a less-satisfied patient’s — can leave that patient deeply satisfied. The difference is not in the operating room. It is in whether the conversation before surgery actually reached agreement on what “better” means.
If the surgeon does not know what the patient is hoping to get back — the round of golf, the ability to lift a grandchild, the pain-free night of sleep, the return to work — the surgical plan can be technically right and still feel wrong.
Other research has reached related conclusions. A 2013 study in Physical Therapy found that the therapeutic alliance between clinicians and patients was a consistent predictor of clinical outcomes in chronic low back pain — not just satisfaction, but pain, disability, and function (Ferreira et al., 2013). A 2019 editorial in the Global Spine Journal described trust, communication, and patient education as the three pillars of expectation management in spine surgery (Wiechert et al., 2019).
The pattern is consistent across the literature. Listening is not soft. It is part of the surgical outcome.
And listening is the only way the surgeon can find out what “getting better” actually means to this specific patient — and whether that goal is realistic for this specific situation. Sometimes the conversation reveals that what the patient hopes for and what surgery can deliver are well aligned. Sometimes the conversation reveals that they are not, and that an honest discussion before surgery is what protects the patient from disappointment afterward.
Snippet — Aligned expectations improve surgical outcomes
Research on spine surgery outcomes has consistently shown that when the surgeon and the patient are aligned on realistic expectations, satisfaction and clinical outcomes are both better. A technically excellent surgery that does not match what the patient hoped for can feel like a failure. Listening is the only way to know what the patient is actually hoping for.
At Vertrae®, listening is built into the visit
Dr. Kamal Woods is a dual fellowship–trained neurosurgeon and spine surgeon specializing exclusively in minimally invasive spine surgery, with advanced training that includes Cedars-Sinai. Vertrae®, a comprehensive, spine-only center led by Dr. Woods, serves patients in Miamisburg, Dayton, and across Southwest Ohio.
The way new-patient visits are structured at Vertrae® is intentional. Whenever possible, Vertrae® gathers imaging and prior medical records before the visit so Dr. Woods can review the case before the patient walks into the exam room. By the time the patient sits down, the imaging has been read, the history is on file, and the questions Dr. Woods has are not the questions a doctor would ask if they were starting from scratch. They are the questions of someone who has already studied the case and now wants to hear it from the patient.
That structural choice changes what the visit is for. It is not for data entry. It is for the patient’s story and the physical exam — the two parts of medicine that cannot be done from a chart.
Concretely, this is what the Vertrae® approach looks like:
- We protect new-patient evaluations long enough to hear the full story. The visit is scheduled to give the patient room to talk. The exact length of a given visit may vary, but the principle does not.
- The goal is not to interrupt the story at eleven seconds. The goal is to let the patient begin in their own words — then ask better questions because of what was heard.
- We read the full treatment history, not just the most recent notes. What did previous physical therapy involve? What medications were tried, and how did the patient respond? Which injection helped briefly? Which one helped not at all? Treatment history read carefully is part of the diagnosis.
- We look at the actual imaging, not only the radiologist’s narrative. Woods reviews the patient’s actual studies in the context of what the patient is describing and what the exam shows. Imaging interpreted in clinical context is different from imaging summarized in a paragraph.
The result, by the time the conversation in the exam room actually starts, is that the medical groundwork has already been done. So the time with Dr. Woods can be spent on what only the patient can provide — the story — and on what only an in-person exam can reveal.
Many patients searching for a “spine doctor who listens” or a “second opinion for back pain” are not looking for flattery. They are looking for someone who will connect the MRI, the exam, the failed treatments, and the life they are trying to get back.
This is the through-line of MotionFirst™ spine care: a thorough evaluation, the full range of options laid out clearly, and the patient — not the procedure menu — at the center of the decision. Whether the path forward is a structured rehabilitation plan, a targeted procedure, or a careful watch-and-reassess, the plan is built around what the patient is trying to get back to.
How to prepare your story before a spine consultation
If the patient story matters this much to a good evaluation, it is worth a few minutes to prepare it. Before a spine consultation, it can help to write down a few things:
- When the pain started, and whether there was a clear trigger — a fall, a lift, a twist, a slow build with no obvious cause.
- Where the pain is and where it travels. Back only? Into the buttock or hip? Down the leg? Into the foot? On one side or both?
- What makes it worse. Sitting, standing, walking, bending, lifting, twisting, rolling over in bed, the first few minutes in the morning, the end of a long day.
- What makes it better, even briefly. A position, a stretch, a particular medication, an injection that helped for a while, lying down, leaning forward over a grocery cart, walking it out.
- Which treatments you have tried, and what happened after each. Physical therapy, medications, injections, chiropractic care, prior surgeries. Not just the names — the responses.
- What the pain has taken away from daily life. Activities, hobbies, sleep, work, family roles. The shape of the day, before and after.
- What you most want to get back to. Be specific. The grandchild you want to lift. The hike you want to plan. The work you want to keep. The night of unbroken sleep.
This is not overexplaining. It is giving the physician the information imaging cannot provide. It also helps the patient walk into the visit grounded in what matters most to them — which makes it less likely that the conversation drifts and more likely that the time gets used well.
What this does not mean
This blog is not saying that every spine consultation should be unhurried, that every doctor who ever interrupted a patient was failing them, or that the only thing that matters is conversation.
Imaging matters. A careful exam matters. Surgical skill matters enormously. Listening does not replace any of those. It is the lens through which all of those become useful.
And listening is not a guarantee of a particular outcome. It is the practice that makes the right next step more findable — whatever that next step turns out to be. Sometimes that is non-surgical care. Sometimes it is a procedure. Sometimes it is the honest conversation that the goal a patient is hoping for is not realistic in their specific situation, and that adjusting that hope before any decision is made is the best thing a doctor can do for them.
Listening is not soft. It is foundational. And in modern medicine, it has become rare.
Key Takeaway
In spine medicine, the patient’s story is part of the diagnosis. It is how the doctor connects the MRI, the exam, the treatment history, and the life the patient is trying to get back. Research consistently shows the story is the most powerful diagnostic tool in medicine — and that modern healthcare has made it harder to tell. At Vertrae® in Miamisburg, Ohio, time is protected for the patient’s words because that is where the next right step is usually found.
Listen to This Topic: Why Listening Is Still the Most Powerful Tool in Spine Medicine
Prefer to listen? This episode explores why the patient’s own words remain the most powerful diagnostic tool in spine medicine — and why modern clinic visits often leave the most important things unsaid. In a clear, conversational format, we discuss how a complete patient story shapes the diagnosis, what a spine specialist actually listens for, and how Vertrae® protects the time for the conversation that drives the rest of the visit.
Read the Full Podcast Transcript
DISCLAIMER:
Transcript lightly edited for clarity and readability. The conversational format is designed to explore concepts and tradeoffs, not to provide medical advice or apply to any individual patient. Outcomes vary by patient, pain pattern, technology used, and study population, and findings from one clinical trial may not generalize to every situation. For guidance specific to your situation, consult a spine specialist.
TRANSCRIPT TEXT:
Speaker 1:
When is the last time a doctor asked you what was going on and waited until you were finished?
Actually, let’s sit with that for a second and reframe it slightly. We are not talking about whether the visit went well or whether you got answers. We are talking specifically about being given the space to finish your answer.
Speaker 2:
That question lands harder than it may sound, because many patients have been there.
Speaker 1:
Exactly. It is a quiet but deeply frustrating reality of modern medicine. Patients often feel rushed, and that frustrating reality is exactly what we are discussing today.
Our source material for this deep dive is a clinical blog from Vertrae®, a comprehensive, spine-only center in Ohio led by Dr. Kamal Woods. The blog argues a point that may sound almost old-fashioned at first: the patient’s own words are among the most powerful diagnostic tools in spine medicine.
Speaker 2:
That is a bold claim, given that there are advanced MRI machines down the hall.
Speaker 1:
It is. So our mission today is to explore why being heard is not just about good bedside manner. It is part of the foundation of an accurate diagnosis. And most importantly, we will talk about how patients can ensure their story is actually told.
Speaker 2:
To understand why this is such a challenge in spine care, we need to look at what is happening in exam rooms right now.
Speaker 1:
Yes — the structural issue.
There are two studies, published about 20 years apart, that tell a similar story.
A 2019 study by Singh Ospina and colleagues analyzed recorded clinical encounters and found that patients were interrupted, on average, within about 11 seconds of beginning to describe their concerns.
Speaker 2:
Eleven seconds.
Speaker 1:
Eleven seconds. That is barely enough time to explain that your back hurts. It certainly is not enough time to explain how a symptom is affecting your life.
Speaker 2:
That is discouraging.
Speaker 1:
It is. And this is not a sudden development.
A researcher named Marvel published a similar study in 1999.
Speaker 2:
So about 20 years earlier.
Speaker 1:
Exactly. That study found that fewer than four in 10 patients were given the chance to complete their opening statement. Back then, the interruption happened at about the 23-second mark.
Speaker 2:
So it may have gotten worse — from 23 seconds down to 11 seconds.
Speaker 1:
Yes. And that shift tracks with the digitization of medicine.
Speaker 2:
What do you mean by that?
Speaker 1:
Between 1999 and 2019, electronic health records became widely adopted. Screens entered the exam room. Documentation requirements expanded. Billing codes required more specific clicks and drop-down menus.
Speaker 2:
So this is not necessarily about clinicians who do not care.
Speaker 1:
Not at all. Many physicians care deeply. But they are operating under immense pressure to see high volumes of patients, document properly, and meet the demands of the system.
Closed-ended questions — questions that require a simple yes or no — are much faster to chart than open-ended narratives.
Speaker 2:
That makes sense, but it creates a major blind spot.
Speaker 1:
Exactly.
It is like a mechanic cutting you off while you are trying to mimic the strange engine noise your car is making, just so they can run through a checklist and ask whether you checked the oil.
Speaker 2:
The mechanic may be following protocol, but they could be talking over the exact diagnostic clue they need.
Speaker 1:
Right. And one of the most interesting findings from the 1999 study was what happened when clinicians allowed patients to finish their opening statement.
Speaker 2:
Let me guess — the patients talked for 30 minutes.
Speaker 1:
No. That is the fascinating part. When patients were allowed to finish completely uninterrupted, they usually needed only a few more seconds.
Speaker 2:
That is significant.
Speaker 1:
It is. The system can fracture a patient’s narrative to save only a small amount of time, but the hidden cost is the information the patient never gets to volunteer.
Speaker 2:
Because once you are cut off, you may shut down.
Speaker 1:
Exactly. Patients can become passive respondents. They answer the closed questions and hold back the context.
Speaker 2:
So if the medical system is built around rapid-fire checkboxes to survive the schedule, that methodology can break down when a condition does not fit neatly into a yes-or-no box.
Speaker 1:
It can. And that helps explain why Dr. Woods focuses on this so intensely.
At Vertrae®, an 11-second interruption is not just inconvenient. In spine care, it can be especially damaging.
Speaker 2:
Why is that?
Let me play devil’s advocate here. Isn’t an MRI the ultimate truth-teller?
Speaker 1:
That is the common assumption.
Speaker 2:
You slide into the MRI machine, it takes high-resolution images, it spots a bulging disc, and there is the problem. Why is that not enough?
Speaker 1:
Because an MRI shows anatomy. It provides a static picture of the spine at one moment in time.
A landmark 2018 paper by Hartvigsen and colleagues highlighted an important reality: for many people with low back pain, no single specific structural cause can be definitively identified on imaging alone.
Speaker 2:
So someone can have severe back pain and the MRI may not clearly show why.
Speaker 1:
Exactly. And the reverse can also be true. Someone can have a difficult-looking MRI and very little or no pain.
As humans age, our spines undergo normal wear and tear. If you took MRI scans of many healthy adults walking down the street with no back pain, a large number of them would show disc bulges, disc degeneration, or spinal narrowing.
Speaker 2:
But they may not feel it.
Speaker 1:
Right. Those findings can reflect normal age-related changes. So if a clinician treats the MRI instead of the patient, they might focus on a finding that is not actually causing the pain, while missing the true source of the patient’s symptoms.
Speaker 2:
So the medical chart, imaging reports, and yes-or-no checklists may be helpful, but they do not tell the whole story.
Speaker 1:
Exactly. Imaging can help rule out important red flags, such as fractures, tumors, infections, or severe nerve compression. But the fuller diagnosis often lives in the human picture.
Two patients can have similar MRI reports but need very different treatment plans based on how pain affects daily life.
Speaker 2:
The patient’s story reveals whether the anatomy shown on MRI actually matches the pain they are feeling.
Speaker 1:
Yes. And this is supported by research on diagnostic reasoning. Patient history often contributes significantly to diagnostic accuracy, sometimes more than physical testing alone.
Speaker 2:
So in spine medicine, the patient’s story is not just a polite warm-up before the real evaluation begins.
Speaker 1:
No. The story is part of the evaluation.
Speaker 2:
If the checklist is the enemy of the story, what does a different kind of visit actually sound like?
Speaker 1:
Based on the Vertrae® approach, it starts with a deliberate shift at the beginning of the visit — specifically, the first 90 seconds.
Speaker 2:
The first 90 seconds?
Speaker 1:
Yes. Instead of immediately asking closed questions like, “Rate your pain from one to 10,” the clinician begins with an open invitation:
“Tell me what is going on.”
Speaker 2:
That is simple.
Speaker 1:
It is simple, but it requires restraint from the clinician not to interrupt.
A doctor’s superpower is pattern recognition. When a physician hears certain phrases — like leg pain, numbness, or weakness — the brain immediately starts narrowing down possibilities. So the impulse is to ask closed questions quickly.
Speaker 2:
But in that first minute, the clinician has to suppress that impulse and let the patient shape the narrative.
Speaker 1:
Exactly.
When you remove the interruption, different details emerge.
A patient may not just say, “My lower back hurts.” They may say, “My back pain becomes unbearable after 10 minutes of standing, but it improves when I lean forward on the handle of a grocery cart.”
Speaker 2:
That grocery cart detail is extremely specific.
Speaker 1:
It is. Or a patient may mention that a steroid injection two years ago worked beautifully for three days. Or that they are developing hip pain because they changed the way they walk to avoid triggering their back.
Speaker 2:
They are compensating.
Speaker 1:
Exactly.
And none of that comes directly from an imaging machine, but all of it can shape the diagnosis.
Speaker 2:
Let’s look at the clinical value of the grocery cart detail. Why does that matter so much?
Speaker 1:
An MRI cannot capture the dynamic relief of leaning over a cart. But to a spine specialist, that narrative detail can be a strong clue for spinal stenosis.
Speaker 2:
What is stenosis?
Speaker 1:
Spinal stenosis is a narrowing of the spaces within the spine, which can place pressure on the nerves. When a person stands upright, the space may become more compressed. When they lean forward, such as over a grocery cart, the spinal canal can open slightly and relieve pressure.
Speaker 2:
So the MRI may show the narrowing, but the story about the grocery cart helps confirm whether that narrowing is clinically meaningful.
Speaker 1:
Exactly.
Treating the spine without understanding the patient’s daily environment is like trying to fix a ship’s engine without knowing whether it is sailing on a calm lake or through a hurricane. The environment affects the necessary repair.
Speaker 2:
And creating space to understand that environment is not just a philosophy. There is science behind being present in the exam room.
Speaker 1:
Yes. In 2020, Dr. Abraham Verghese’s team at Stanford, with Zulman as the lead author, published an important study on presence in the clinical encounter. They identified five clinician practices that can improve presence during a visit.
We do not need to cover all five here, but one is especially relevant: listen intently and completely.
Speaker 2:
That sounds like more than just being quiet while the patient talks.
Speaker 1:
It is. It involves a physical and emotional posture. It may mean putting down the laptop, pulling up a stool, and matching the patient’s eye level.
Speaker 2:
That breaks the traditional authority dynamic.
Speaker 1:
Exactly. When a clinician sits down and makes eye contact, it signals that the patient is not being rushed. It shifts the visit from an authority figure interrogating a patient to two partners examining a problem.
By listening completely, the physician can discover the full ecosystem of the pain.
Speaker 2:
The ecosystem — I like that word.
Speaker 1:
Chronic pain is rarely just an isolated biological event. It affects the entire structure of a person’s life.
When a doctor creates presence, they stop hearing only about nerve compression and start hearing about the ecosystem: the untended garden, the 3 a.m. wake-ups, the spouse who has quietly started carrying the laundry basket, and the family that has reorganized itself around invisible pain.
Speaker 2:
That is the true cost of back pain. It is not just a number on a one-to-10 scale. It is the slow loss of parts of life.
Speaker 1:
This brings us to one of the most empowering parts of the source material.
Knowing that modern medical appointments are often rushed, how can patients prepare so their story is actually heard?
Speaker 2:
Before the visit, patients can arrive with their narrative already organized.
The Vertrae® blog outlines a practical framework called “Prepare Your Story.”
Speaker 1:
Let’s walk through that. If someone has a spine consultation coming up, what should they write down?
Speaker 2:
First, establish the timeline. When did the pain start? Was there a specific trigger?
Second, document the variables. What makes the pain worse? What makes it better? For example, if leaning on a grocery cart helps, write that down.
Third, list the exact activities that have changed. Have you stopped gardening? Can you no longer sit at your desk for more than an hour? Are you avoiding travel, golf, lifting, or sleep positions because of the pain?
And fourth, bring your goals.
Speaker 1:
That may be the most important piece.
Speaker 2:
It is. Patients should articulate what they are trying to get back to doing.
The goal is not always just “make the pain stop.” Functional success looks different for everyone. One person may want to lift a grandchild without fear. Another may want to play a round of golf. Someone else may simply want to sleep through the night without waking up in pain.
Speaker 1:
Defining that goal changes the direction of care.
Speaker 2:
Exactly.
A 2022 study published in Neurosurgery by Rampersaud and colleagues looked at patient satisfaction after spine surgery. It found that meeting preoperative expectations was strongly associated with patient satisfaction.
Speaker 1:
That distinction between biological success and functional success matters.
A surgery or procedure could look technically successful, but if it does not help the patient return to what matters most, the patient may not experience it as success.
Speaker 2:
Exactly. And the opposite is also true. If the patient’s goal is to sit through a workday without disabling pain, and the treatment helps them achieve that, then it may be a meaningful success.
That alignment of expectations is impossible if the clinician does not know what the patient values.
Speaker 1:
So preparing your timeline, triggers, functional losses, and goals directly combats the problem we have been talking about.
Speaker 2:
It does.
You are not making the visit longer by preparing your story. You are making the visit more useful.
Speaker 1:
That is the perfect framing.
You are providing high-value context that an imaging machine cannot generate.
And this is why clinics like Vertrae® structure their intake process around gathering imaging and records before the patient walks through the door.
Speaker 2:
That structural choice changes the purpose of the in-person visit.
The patient is no longer sitting on exam paper doing verbal data entry. The doctor is not spending the visit transcribing medication lists.
The visit can focus on the two things that cannot be extracted from a chart: the hands-on physical exam and the uninterrupted story of the patient’s lived experience.
Speaker 1:
It elevates the patient to the role of primary expert on their own life — which they are.
As we wrap up, we want to leave listeners with an invitation to expect a different kind of medical visit. Many of us have been conditioned to accept the rushed interruption as the standard of care.
Speaker 2:
We have. We have accepted the checkboxes.
Speaker 1:
But the data suggests an effective visit does not always require more time on the clock. It requires a different approach to the time available.
A visit where the first question is not only, “On a scale of one to 10,” but, “Tell me what is going on.”
Speaker 2:
Exactly.
And this raises a bigger question about the future of medicine. As artificial intelligence and machine learning move into clinics to help with charting and coding, will that technology give doctors more time to sit and listen?
Or will the healthcare system use that efficiency to squeeze even more patients into the day?
Speaker 1:
That is the tension of modern medicine.
But if you have spent years walking back to your car after appointments thinking, “Most of what I came in to say, I never got to say,” you are not imagining that deficit.
It is a documented systemic flaw.
But you do not have to accept it as the only way.
Speaker 2:
There is another way.
Think about how much your care could change if your treatment plan was built around the reality of your daily life, not only the anatomical snapshot in your medical chart.
Speaker 1:
If you are ready to stop being only a respondent and start being the storyteller, you can learn more and begin a conversation built around your narrative at Vertrae.com.
That is where a visit centered on your actual life can begin.
Direct CTA — Request a consultation
If you have ever left a spine consultation feeling that most of what you came in to say, you never got to say — you are not imagining the gap. The patient’s story is still the most powerful tool in medicine. It just deserves a visit built around it.
The next visit should not feel like starting over. It should feel like finally being understood in context.
Dr. Kamal Woods, MD, MBA, sees patients at Vertrae®, a comprehensive, spine-only center in Miamisburg, Ohio, serving Dayton and the wider Southwest Ohio community.
Frequently Asked Questions
Why does the patient’s story matter so much in spine diagnosis?
In spine medicine, the patient history is part of the diagnosis. The story reveals how the pain behaves, what makes it better or worse, and how it has changed daily life. Imaging shows what the spine looks like; the story shows whether what the imaging shows actually matches the pain.
I felt rushed at my last spine appointment. Was that just me?
It was almost certainly not just you. A 2019 study found that clinicians elicited the patient’s agenda in only about a third of visits, and when they did, they interrupted patients after a median of eleven seconds. The experience of feeling unheard in a short visit is one of the most documented gaps in modern healthcare.
What should I bring to a spine consultation?
Bring prior imaging and radiology reports, injection records, physical therapy notes if available, and a medication history. It also helps to write down what makes the pain better or worse, what the pain has stopped you from doing, and what you most want to get back to.
How do I explain my back pain clearly to a doctor?
Start with the pattern: where the pain is, where it travels, when it started, what makes it worse, what helps, and what has changed over time. Then explain the life impact — sleep, work, family, hobbies, activity. Those details help connect the story to the exam and imaging.
How does Vertrae® structure new-patient visits differently?
Whenever possible, Vertrae® gathers imaging and prior records before the visit so Dr. Woods can review the case before the patient walks in. The time in the exam room is not spent on data entry. It is spent on the patient’s story and the physical exam, the two parts of medicine that cannot be done from a chart.
Does it really matter whether my surgeon understands my goals?
Yes. A 2022 study in Neurosurgery, drawing on a national spine surgery registry, found that whether a patient’s expectations were fulfilled was the strongest predictor of satisfaction after spine surgery — stronger than disability or pain improvement alone. A surgical plan that does not match what the patient hoped for can feel unsuccessful even when technically excellent.
What is the therapeutic alliance and why does it matter?
Therapeutic alliance describes the working relationship between a clinician and a patient — trust, agreement on goals, and shared engagement in the plan. A 2013 study in Physical Therapy found that a stronger therapeutic alliance was a consistent predictor of clinical outcomes in chronic low back pain, including pain, disability, and function.
What kinds of things should I tell the doctor that I might not think are medical?
The pieces of life that have changed because of the pain. The activities you have stopped. The grandchildren you cannot lift. The hobbies that have quietly disappeared. The work you are worried about. The sleep that has become unreliable. These are not extras. They are part of the clinical picture.
What does “listening” actually look like in a clinical visit?
A 2020 JAMA study identified five evidence-based practices: prepare with intention, listen intently and completely without interruption, agree on what matters most to the patient, connect with the patient’s story and life context, and explore emotional cues. These practices have been shown to enhance presence and connection in the clinical encounter.
Is this just about being nice, or does it actually change outcomes?
It actually changes outcomes. Research has shown that aligned expectations between surgeon and patient predict satisfaction after spine surgery, and that the therapeutic alliance predicts clinical outcomes in chronic low back pain. Listening is not a soft skill bolted onto care. It is part of the care.
References (APA 7th Edition)
Connor, D. M., Lypson, M. L., & Gonzalez, C. M. (2025). Advancing diagnostic excellence through medical education in diagnostic equity. New England Journal of Medicine, 393(12), 1202–1214. https://doi.org/10.1056/NEJMra2411882
Ferreira, P. H., Ferreira, M. L., Maher, C. G., Refshauge, K. M., Latimer, J., & Adams, R. D. (2013). The therapeutic alliance between clinicians and patients predicts outcome in chronic low back pain. Physical Therapy, 93(4), 470–478. https://doi.org/10.2522/ptj.20120137
Marvel, M. K., Epstein, R. M., Flowers, K., & Beckman, H. B. (1999). Soliciting the patient’s agenda: Have we improved? JAMA, 281(3), 283–287. https://doi.org/10.1001/jama.281.3.283
Rampersaud, Y. R., Canizares, M., Perruccio, A. V., Abraham, E., Bailey, C. S., Christie, S. D., Evaniew, N., Finkelstein, J. A., Glennie, R. A., Johnson, M. G., Nataraj, A., Paquet, J., Phan, P., Weber, M. H., Thomas, K., Manson, N., Hall, H., & Fisher, C. G. (2022). Fulfillment of patient expectations after spine surgery is critical to patient satisfaction: A cohort study of spine surgery patients. Neurosurgery, 91(1), 173–181. https://doi.org/10.1227/neu.0000000000001981
Singh Ospina, N., Phillips, K. A., Rodriguez-Gutierrez, R., Castaneda-Guarderas, A., Gionfriddo, M. R., Branda, M. E., & Montori, V. M. (2019). Eliciting the patient’s agenda — Secondary analysis of recorded clinical encounters. Journal of General Internal Medicine, 34(1), 36–40. https://doi.org/10.1007/s11606-018-4540-5
Wiechert, K., Wang, J. C., & Chapman, J. R. (2019). Three pillars of expectation management in spine surgery: Trust, communication, and patient education. Global Spine Journal, 9(6), 573–574. https://doi.org/10.1177/2192568219861641
Zulman, D. M., Haverfield, M. C., Shaw, J. G., Brown-Johnson, C. G., Schwartz, R., Tierney, A. A., Zionts, D. L., Safaeinili, N., Fischer, M., Thadaney Israni, S., Asch, S. M., & Verghese, A. (2020). Practices to foster physician presence and connection with patients in the clinical encounter. JAMA, 323(1), 70–81. https://doi.org/10.1001/jama.2019.19003
