What happens at your first consultation

Booking, and knowing where to come

I see patients by appointment only, so the first step is to book and wait for a confirmed time before you travel. Walk-ins cannot be seen, and the confirmation also tells you which clinic to come to.

There are two. Kharar, in Mohali, runs Monday to Saturday and is where most consultations happen. Solan runs on the first and third Thursday of each month, and the Kharar clinic is closed on those two days. If Solan is easier for you, say so when you book and you will be given one of those dates.

A video consultation works well for a first assessment, for a second opinion, or for going through an MRI or X-ray report if you live far away. Some problems cannot be settled without examining the joint, and if yours is one of them I will tell you so.

What to bring

The most useful thing you can bring is the imaging itself, not only the report on it.

• The films, or the CD. A radiologist's report is one person's reading of the pictures. I want to see the pictures.
• Previous prescriptions, and a list of what you take regularly, including anything for blood pressure, diabetes or thinning the blood.
• The discharge summary if you have had an operation before, on this joint or any other.
• Imaging taken at the time, if your problem followed an injury. A knee scanned the week it was hurt often shows more than the same knee months later.
• Any plan you have already been given, if you are coming for a second opinion. Bring it as it was written.

You do not need to bring a folder of every record you have ever had. The history is better talked through, and the five things above are the parts I use.

The consultation itself

It runs in the order you would expect, and the first part is the longest.

Most of the answer comes from what you tell me. When it started, what you were doing at the time, what makes it worse, what you have stopped doing because of it, whether it wakes you at night. A knee that hurts going downstairs and a knee that gives way are different problems, and the history usually separates them before I touch the joint.

Then I examine it. That means moving it, and some of that may be briefly uncomfortable. For knee pain and shoulder pain alike, the examination is what narrows a long list of possibilities down to one or two.

We look at your imaging together, and I explain what it shows in plain language. If you need a scan you do not have, I will tell you what question it would answer before asking you to get it.

What you should leave with

By the end you should be able to say three things back to me: what the problem is, what the options are, and what happens next.

Most orthopaedic problems do not end in an operation. Physiotherapy, a change in activity, time and sometimes an injection settle a great deal of knee and shoulder pain, and for most people they are the right first treatment, not a way of putting off the real one.

Where surgery is the right answer, you should leave knowing which operation, roughly when, and what the recovery will ask of you. For something like a rotator cuff repair the recovery is the bigger commitment of the two. I see a lot of second opinions, and plenty of them end with me telling the patient the first surgeon was right.

On cost: eligibility under ESI, ECHS, a Punjab or Himachal Pradesh Government scheme, or a private insurer is confirmed, and pre-authorisation started, before a date is fixed. It is never left to the day. Paying directly is just as straightforward, and you get a written estimate before anything is scheduled.

Common questions