Feb 22, 2013

Friday 5: 5 Evaluation Goals



Here is a checklist of things to strive for during that ever important first visit.

You know what they say about first impressions? Here are 5 things I try to do during the first visit.

1) Set the tone

  • front office always greets a patient
  • introduce myself to the patient as they're filling out the paperwork and tell them I'll be right with them
  • ask them, how they are, other than the reason why they are here

2) Reduce the threat

  • warning! CNS on lockdown, warning!
  • do not look at scans, EMGs, etc... that often leads to verification of some doom and gloom traditional medicine has told them
  • quote research that states most asymptomatic individuals have false positives on their scans
  • find the directional preference or position of ease immediately after the history
  • use cause and effect for symptoms with the above, showing them they can manage it, and cause it
  • how many visits you think it will take to accomplish their goals - I set this in 4-6, 8-10 etc
    • internal studies and external by trained MDT clinicians classify up to 87% of patients as derangement syndrome, meaning they should respond rapidly 
    • this means most of the people walking in your door should respond within 6 visits with big changes
  • tell them it's a good prognosis to make changes on the first and second visit, normally leading to good outcomes

3) education

  • the most valuable thing you can give a patient
  • let them know the temporary effects of treatments
  • they are responsible for themselves
  • if they want to get better, it's time for some changes
  • posture, movement, pain behaviors are habits that can be broken, but like any habit, take work

4) movement assessment

  • use a system to classify them to guide your treatment
  • my preferences - MDT and the SFMA
    • MDT gives the DP which can be expanded upon easily to immediately help the patient
    • SFMA gives you adjacent dysfunction or motor control to work on later after they can manage their pain on their own

5) education

  • Should be occurring the entire visit, not just in the beginning or the end
  • I cap each visit by saying, if you feel better when you leave, but the changes made today do not last more than a day, you are not performing your homework enough


I hope everyone has a great weekend! The voting for Best PT Blogs has been extended, please vote here for Best Overall PT blog if you have not done so already! Thanks again for all your support!



6 comments:

Eric Lehman said...

Dr. E,



Another great post, emphasizing pt education!



In regards to directional preference, Dr. E, can you tell me what you typically observe in the cervical spine? The other day in our manual course we reviewed Traction, Retraction Extension, for a common direction preference in patients with radicular/referred sx (possibly root? discorgenic)... Do you see this pattern ? What are other patterns of directional preference you see here? Thanks so much!

Dr. Erson Religioso III, DPT said...

Eric,

The pattern is for central or bilateral complains in the c spine, most respond to retraction and derivations of like traction with extension. For unilateral mid/lower pain or peripheralized Sx, most respond to repeated sidebending with overpressure. For upper cervical/HA they may respond to repeated rotation. I'll film this later next week and make it a Q&A for Wednesday

Barb Carusillo PT, OCS, COMT said...

In those studies by trained MDT clinicians that say 87% of patients show derangement syndrome, do the studies look at mainly acute patients? I could see that being true, since when I worked in occupational medicine and saw patients right after injury, almost all could be treated with repeated motion and directional preference techniques quickly and successfully. But now I see mainly chronic pain patients, folks that have had problems for often decades, and with that group, I can seldom use MDT type techniques.

Barb Carusillo PT, OCS, COMT said...

Actually, I should say, I seldom use repeated motion strategies with the chronic patients, since most have dysfunctions rather than derangements. I still use all the good posture, back protection info.

Dr. Erson Religioso III, DPT said...

Barb, yes, it was with patients of all types, not just acute. The difference between DIPs and CertMDTs is that DIPs have more training and tend to make derangements out of what most would call dysfunction.

Dr. Erson Religioso III, DPT said...

I would say regardless of how long the patient has their complaints, most of my patients also tend to respond rapidly. Unless they have true central sensitization.

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