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PT and the City

Is the Treatment or Diagnosis More Important?

Published January 9, 2014 4:06 PM by Lisa Mueller

A friend of mine asked me to meet for a cup of coffee while I was home for Christmas so she could show me some paperwork she received during her recent experience with physical therapy. I assumed she wanted to show me her home program and we could converse on my line of work compared to her experience. I was looking forward to seeing her and catching up after almost a year since our last visit.

After we talked about our holidays, husbands and jobs, my friend started to show me her home program and some simple sketches of her scapulothoracic joint (she had been going to physical therapy for shoulder pain), explaining her therapist's explanation of the serratus anterior muscle. She demonstrated a few of her exercises (as best she could in a public coffee house) and repeated phrases from her therapist such as "shoulder blade stabilization." I was impressed with how much information she retained and was able to repeat to me.

I asked my friend how much better she was feeling since going to physical therapy, and she responded with, "A little better." I repeated, "A little?" And she confirmed, "It's not much better than it was before." I asked what kind of treatments had been done and she described common physical therapy interventions, which got me thinking. Do our diagnosis and handmade home programs matter if our treatment isn't effective?

I remember as a student struggling with determining a physical therapy diagnosis. My professors and clinical instructors were helpful, but internally I would debate the difference between capsulitis and bursitis and find myself disappointed if my diagnosis was incorrect. Even recently, I've had discussions with physicians about patient symptoms and special testing in order to determine a correct diagnosis. When writing an assessment, my documentation focuses on "Signs and symptoms consistent with this diagnosis." Physical therapists, and medicine in general, seem to focus on the diagnosis for a patient.

If I try to imagine this from a patient's perspective, there may be some relief in a diagnosis or label for my impairments, but that relief is likely only temporary if improvements in my pain and function aren't made. I could tell my family and friends, "Yes, I have a problem with a nerve in my low back," but that statement doesn't help when I still struggle to get out of the car.

What do you think? Is an effective treatment more important than a diagnosis, or are both equally as important in the care of a patient in physical therapy?

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2 comments

It is all about function. I think everything we assess should be gearing us towards which intervention we are going to employ. While a diagnosis can give patients some understanding of what is hurting and why, the future of our profession and the value we provide is in what we do with them to restore their function in goals.

For the aforementioned reason I really question the value of MMT, ROM testing, and special testing as a means for re-evaluation. I think we need to shift towards function based. PT schools may need to shift more towards focus on treatment and a little less on learning a gazillion tests. Yes, we need to know some of those, but if they aren't proven valid, then leave them out and teach more interventions.

Craig Swisher, Physical Therapist - PT January 14, 2014 4:03 PM
Huntington WV

If we can't provide relief or effective treatment, why should patients come to us or why should insurers reimburse us? Why would I choose physical therapy if I wasn't going to feel/function any better?

Odds are, If I can't tell what's wrong though, I won't be able to properly treat it.

Dean Metz January 10, 2014 11:22 AM

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