First visit · What to expect
Nothing is injected on the first visit. The first visit exists to work out what should be.
Nothing is injected at the first visit: it is a diagnostic evaluation of an hour or more, covering history, examination, imaging reviewed from the study itself, bloodwork where indicated, and a plan that names what is suspected and what would test it.
A patient sent here is evaluated as a patient. Knowing the shape of the visit in advance is useful for you, because the record it produces is the record the matter will rest on.
What happens at the first visit?
- History, including the mechanism in the patient’s own words, the timeline, what they have stopped doing, and any gap in care with the reason recorded at the time rather than reconstructed later.
- Examination, mapping symptoms to anatomy — distribution, reflexes, strength, sensation, provocative movements.
- Imaging reviewed against the patient, from the study itself rather than the report.
- Bloodwork where indicated, for the metabolic terrain.
- A plan with the reasoning attached, naming what is suspected and what would test it.
What should the patient bring to the first visit?
Imaging on disc or portal access, a current medication list, prior records including unfavorable ones, and the names of everyone who has treated the injury. Patients should be told to say everything, including things they think sound bad. Editing the history is the single most common way a record gets weakened.
When is a diagnostic injection scheduled?
A diagnostic block is scheduled only where the examination raises a specific structural question. It is performed under fluoroscopic guidance, recorded against timed measurements, and repeated before anything irreversible follows — see diagnostic nerve blocks.
This practice is not aligned to a side. Its obligation runs to the patient’s health and safety, which is the same reason it is not beholden to any position that would keep it from seeing what is actually there. We do not offer opinions on liability, we do not accept a referral or a review conditioned on reaching a particular conclusion, and we will say plainly when the evidence does not support the claim — whichever party was hoping otherwise.
Frequently asked questions
Will a procedure be done the first day?
No. The first visit is for diagnosis.
How long does it take?
Plan on an hour or more for a first evaluation.
Should the patient bring someone?
They may. If interpretation is needed, tell us in advance and it is arranged at no cost.
What if the patient is already treating elsewhere?
Say so. A referral for a specific diagnostic question can coexist with existing care, and we will say if it would fragment it.
Does the doctor look at the actual MRI or just the report?
The imaging is reviewed from the study itself, not only from the radiologist’s report, and it is read against the patient: the symptom distribution, reflexes, strength, sensation and provocative movements found on examination. Bring the imaging on disc or through portal access so the study can be opened at the visit.
Is bloodwork part of the first visit?
Bloodwork is ordered where indicated, to look at the metabolic terrain. Not every patient needs it. When it is part of the evaluation, it joins the history, the examination and the imaging review in the same diagnostic record, and it feeds the plan that names what is suspected and what would test it.
Will the doctor give an opinion on who is at fault?
No. The practice does not offer opinions on liability and is not aligned to a side. It does not accept a referral or a review conditioned on reaching a particular conclusion. Its obligation runs to the patient’s health and safety, and it will say plainly when the evidence does not support the claim, whichever party was hoping otherwise.
What does the patient leave the first visit with?
A plan with the reasoning attached, naming what is suspected and what would test it. Nothing is injected that day. If the examination raises a specific structural question, the next step may be a diagnostic block, scheduled later, performed under fluoroscopic guidance and recorded against timed measurements.
Related reading
Tell the patient to bring everything, including the bad parts
A history that has been edited before it arrives is the hardest thing to repair later.
12166 Natural Bridge Rd
St. Louis, MO 63044
Monday to Friday, 8:00 a.m. to 5:00 p.m. Nothing on this page is legal advice, and nothing on it is medical advice.
Sources
- Cohen SP et al. Multicenter, randomized, comparative cost-effectiveness study comparing 0, 1, and 2 diagnostic medial branch block treatment paradigms before lumbar facet radiofrequency denervation. Anesthesiology, 2010. PubMed 20613471
- Brinjikji W et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 2015. PubMed 25430861
- Raja SN et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain, 2020. PubMed 32694387
- O’Hearn M et al. Trends and disparities in cardiometabolic health among U.S. adults, 1999–2018. Journal of the American College of Cardiology, 2022. PubMed 35798448