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Toni Talks about PT Today

Clinical Judgment

Published June 29, 2010 9:43 AM by Toni Patt

I had an interesting conversation with a nurse today. We were talking about a patient I was planning to see. She told me to check with the doctors because she wasn't sure about his medical status since he'd had a neuro status change. She seemed shocked when I said it wasn't necessary. I would defer treatment for today. She actually asked me if I could do that. Of course I can decide not to see a patient. That's one of the reasons I have letters after my name. I do more than assess goals and develop treatment plans. Before I see a patient I have to decide if the patient is appropriate for therapy. Checking for orders and talking to nurses is just one piece of making that decision. PTs do a lot more than other disciplines realize.

The ability to make those decisions is part of the rationale behind the drive for direct access. The lack of recognition of our ability is one of the barriers. In this case I determined the patient's medical status wasn't appropriate for PT based on the available information. The reason for looking at lab values, vital signs and checking with nursing is to determine the patient's status. I don't know why that nurse was surprised I deferred treatment based on that information.

 Clinical judgment is what tells me how far to push a patient. It enables me to determine if I can safely ambulate a patient by myself. It enables me to decide if I should take a patient to the BR or use the BSC. It is one of the hardest things to teach. Knowledge alone doesn't ensure sound clinical judgment. I've worked with many therapists who were book smart. Some of them could answer any question correctly. Their problem was inability to use that knowledge in the clinic.

I once worked with a PT who used lab values as a method to avoid treatments. Any time a value was a little off, he deferred therapy. He also used pending radiology studies as a reason, stating he wanted to be sure the patient was stable before mobilization. He took a good idea and turned it into bad practice. Another part of clinical judgment is the understanding of why tests are ordered. Many such studies are done routinely or at specific intervals. Doing so is a display of lack of clinical judgment or lack of understanding of the purpose for the study.

No one is correct all of the time. Most of us will err on the side of caution and safety. That can mean deferring therapy, monitoring vitals or having someone assist. Knowing your limits is just as important as knowing your talents. I'm happy to say I can't think of anyone who absolutely scared me with poor judgment. I have known a few PTs who were braver than I might have been in the same situation but they weren't dangerous. Deep down, all PTs want the best for our patients. It is the framework from which we make decisions.


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