AANEM Connect

I'm not sure about other AANEM members, but for me it is not uncommon to need to commuicate to patients, at the end of the exam, that EDx studies are normal.  I generally don't look forward to that discussion.   

This can leave patients feeling frustrated and sometimes invalidated at the end of the visit and even though we don't say this, they can hear "there is nothing wrong with you - it's all in your head".  They came seeking answers for their symptoms and don't have an answer at the end of testing.  Sometimes an explanation, even if it's not actionable or has a great deal of certainty attached, can be helpful. 

My current strategies, and I'd be interested to hear from others include:

• Looking for musculoskeletal issues during the initial H&P.  Particularly commenting to the patient upon finding muscle tenderness or other MSK findings so that I can loop back to that later in the discussion "Your nerves look good today, but I think it's your muscles that are causing pain"
• Setting expectations at the start of the study.  "We are good at detecting damage to the nerve fibers (axons) or their insulation (myelin) but generally are not able to detect nerve irritation that does not cause nerve damage."
• Validating their symptoms and indicating I believe they are really feeling what they are.
• Most of us know early on when the study will be normal.  I often start discussing results when I'm about 80% done (and indicate we are not done yet - things could change), so the patient has time to process information mentally and ask questions and doesn't feel rushed all at the end of the study. "We are not quite done yet, but so far things are looking really good for your nerves..."
• At the end I come back to the MSK findings and "nerve irritation" possibilities discussed earlier, and sometimes discuss central sensitization as a possibility. 
• I will reassure patients that we found nothing serious and that's good news.
• Often for patients with chronic pain I give them a handout with links to Andrea Furlan's YouTube channel on chronic pain - she covers basic pain education, as well as both pharmacologic and non-pharmacologic treatments. https://www.youtube.com/@DrAndreaFurlan

I'd be interested to hear from others what strategies they use.