What Happens During My Initial Consultation?

Key Takeaways

• Dr. Williams conducts every consultation personally and attempts to always end with a clear concrete next step – whether it be diagnostic or therapeutic
• Bring your records, imaging, and medical history—the more information available, the faster a plan can be made.
• Within 24 to 36 hours, a clinical summary is sent to your medical team.

You have been living with pain for months, maybe years. You have seen multiple providers. You have tried medications that dulled the edges but never got to the root of the problem. At some point, you may have started to wonder if anyone truly understands what you are going through—or if relief is even possible. That feeling is more common than you might think, and it is exactly why so many patients seek out a peripheral nerve specialist.

Eric H. Williams MD is a peripheral nerve surgeon in Baltimore who focuses on identifying and surgically treating the underlying causes of chronic neuropathic pain. His approach goes beyond symptom management. When a nerve is compressed, trapped, or damaged, treating the source directly can change a patient's life. That process begins with a thorough initial consultation—one designed to give both you and Dr. Williams the information needed to chart a real path forward.

What to Bring to Your First Consultation

A little preparation goes a long way. The items below will help Dr. Williams conduct the most thorough evaluation possible during your visit.

• Photo ID and insurance card. These are required at check-in. Having these ready speeds up the intake process so your time with Dr. Williams can focus entirely on your care.
• Co-pay or self-pay fee. An insurance co-pay or self-pay fee will be collected when you arrive. You may contact our office if you have any questions about the cost of your initial consultation. 
• Completed patient summary form. This form will be sent to you before your visit. Fill it out as thoroughly as possible, including a detailed description of your symptoms, their location, and how they have changed over time. Do not minimize what you are experiencing. Every detail is potentially useful.
• Prior medical records. Bring notes from relevant doctor visits, imaging reports, EMG results, operative reports, and a list of medications you have tried or are currently taking. Written reports alone are often not enough—if you have had an MRI or nerve conduction study, request the actual files, not just the summary. Dr. Williams reviews the source material directly.
• A written description of your pain. Vague terms like "my foot hurts" or "my leg bothers me" make it harder to identify which nerve is involved. Before your visit, practice describing your symptoms with precision. Where exactly does it hurt? What does it feel like—burning, electric, stabbing, numb? When is it worst? Does anything make it better or worse? The more specific you can be, the more useful the information.
• A list of your specific goals. Think about what you want to be able to do that you cannot do now. Most patients say they want to feel better, but that is hard to measure. Do you want to walk to the end of the block? Sleep through the night without waking in pain? Return to work? Stop taking medication? Concrete goals help Dr. Williams understand what a successful outcome looks like for you specifically.
• A support person (optional). Consultations cover a significant amount of information in a short period of time. Some patients find it useful to bring a family member or close friend who can help remember what was discussed, ask follow-up questions, and provide support during the visit. 

What to Expect When You Arrive

When you check in, a member of the team will collect your copay or self-pay fee and verify your insurance information. Basic vitals will be taken before Dr. Williams comes in. This is standard procedure and helps establish a clinical baseline.

Then Dr. Williams will come in himself. He personally reviews each patient's case and conducts the consultation directly. You will not be handed off to a nurse practitioner or assistant for this evaluation. 

Plan to be at the office for at least an hour if not longer. Time is built into the visit intentionally. Dr. Williams is not moving between exam rooms every 15 minutes. He is focused on you and your case for the duration of the consultation. 

Peripheral nerve problems are frequently missed or mischaracterized precisely because providers do not take enough time to understand the full picture. A compressed nerve can look like many other conditions. Sorting out what is actually happening requires time, attention, and a willingness to ask the next question rather than reach for the nearest explanation.

What Happens During the Consultation

The consultation begins with a detailed history. Dr. Williams will want to hear when your pain started, what it feels like, where it is located, and what makes it better or worse. 

Descriptive language matters here. Instead of "my foot hurts," try to say something like "I feel a burning sensation along the bottom of my heel that gets worse at night" or "there is an electric shooting pain from the outside of my knee to the top of my foot." Specific descriptions help identify specific nerves.  It is not uncommon for patients to have pain in more than one location. For instance, if a patient has pain in their heel, we need to determine the specific area.  The heel consists of four main areas: the bottom, the outside, the inside, and the back of the heel.  Each one of those areas is clinically important.  

After reviewing your history, Dr. Williams will conduct a physical examination. He will assess sensation, strength, range of motion, and look for signs of nerve involvement. 

One key test is the Tinel sign, which involves gently tapping along the path of a nerve to see if it produces a tingling or electrical sensation. A positive result in a patient with diabetic peripheral neuropathy, for example, suggests roughly an 85% chance that a surgically treatable nerve compression is present. (You can test for a Tinel sign at home using the video tutorials on our website, but Dr. Williams may be able to find one even if you are unsuccessful in producing the response at home. )

Dr. Williams will also review any imaging or electrodiagnostic studies you have had. MRI, MR neurography, ultrasound, and EMG nerve conduction studies all provide valuable information. If you have had these tests done elsewhere, bring the records and the actual images if possible—not just the written reports.

In cases where a diagnostic nerve block is indicated and can be performed during the visit, the appointment may last up to an hour and a half. Some nerve blocks are performed in the office; others require a specialist or a different clinical setting, and in those cases Dr. Williams will refer you to the appropriate provider.

A diagnostic nerve block is one of the most useful tools available for identifying the source of nerve pain. The procedure involves injecting a small amount of local anesthetic near a specific nerve. The anesthetic temporarily quiets that nerve—and if your pain decreases significantly while the block is active, that suggests that the nerve being blocked is contributing to your symptoms. 

This is valuable because nerve pain can be difficult to pinpoint through imaging and physical examination alone. Two patients can describe similar symptoms but have completely different nerves involved. A diagnostic nerve block often improves the diagnostic accuracy.  If blocking nerve “A” reduces your pain by 80 percent and blocking nerve “B” does nothing, that is meaningful clinical data—the kind that shapes the treatment plan going forward.

Most nerve blocks are temporary and diagnostic. The anesthetic wears off within hours, and your baseline symptoms will return. But the information gathered during that window can have a lasting impact on your care. For some patients, it provides the confirmation Dr. Williams needs to move forward with a surgical recommendation. For others, it rules out a suspected nerve and points the evaluation in a different direction. Either way, you leave knowing more than you did when you arrived.  Some nerve blocks can be therapeutic as well and may need to be performed more than once to try to treat the pain problem rather than just diagnose it. 

Oftentimes, if pain has been present for long periods of time, “therapeutic” blocks are not very effective in curing the problem. But even a "failed" therapeutic block can help act as a diagnostic block.

Ruling Out Other Causes for Your Pain

One of the most valuable aspects of this consultation is what it determines about what is not causing your pain—as much as what is. Chronic pain has many possible sources, and Dr. Williams takes care not to jump to conclusions.

If there is a question about whether an orthopedic issue has been fully addressed, Dr. Williams may recommend a second opinion from an orthopedic specialist. Is the hardware from a prior surgery intact? Has a fracture fully healed? Is there a structural problem that still needs attention? These questions need real answers before surgery on a peripheral nerve makes sense.

Dr. Williams may also order nerve conduction studies, imaging studies, or referrals to other providers if he needs more information before forming a treatment plan. These are not delays—they are steps that lead to better outcomes. The more complete the picture, the more targeted the treatment.

Dr. Williams does not recommend surgery unless he is confident that it may help. And he will tell you honestly if he does not think he can help. That kind of clarity—even when the answer is not what a patient hoped for—is something many people find meaningful after years of vague or contradictory advice.

Leaving the Office With a Clear Plan

There are three possible outcomes from the initial visit. 

1. Dr. Williams may determine he is not able to help with your specific condition and will tell you directly. Depending on your situation, Dr. Williams may recommend physical therapy, a pain management program, or a combination of non-surgical approaches, or provide referrals for other opinions.
2. Dr. Williams may believe he can help but needs more information—in which case he will order additional tests, imaging, or referrals before moving forward. He may recommend returning for a diagnostic nerve block if one was not completed during the visit. 
3. Dr. Williams may recommend scheduling surgery if everything points to a surgically treatable problem and if the patient is interested in pursuing that option. 

Within 24 to 36 hours after your visit, Dr. Williams will dictate a detailed clinical note summarizing the consultation, his findings, and his recommendations. This note will be shared with your medical team so that your other providers are informed and aligned. Clear communication between specialists matters, and this is one way Dr. Williams ensures it happens.