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PT and the Greater Good

How Comprehensive is Your Assessment?

Published June 8, 2010 10:14 AM by Dean Metz

In the Greek language, "brisko" is a word meaning "to detect." Lenny Briscoe, Jerry Orbach's character on "Law and Order," would have made an excellent clinician.

I was called out to evaluate a gentleman who has a history of COPD. His GP (general practitioner) had referred him to our team. He has had recurrent chest infections over the past six months, which resolve with antibiotic therapy but return within a few weeks. I was called in to provide chest physiotherapy and perform the initial evaluation for the team. Note, here in the UK, physiotherapists can open any case, not just orthopedics.

I went to the home and found a pleasant man who lived with his spouse in a two-story, terraced home. I did a complete physical examination, history, recorded his current medications, and provided percussion and vibration as well as deep-breathing exercises, which had the desired result of expectoration and improvement in his lung sounds. So what's the big deal, you might rightly ask? I noted that the ceiling had recently been repaired in the bathroom where I washed my hands. I inquired how much dust that had created? He responded that there had been a leak in the roof, detected nearly nine months ago, and the repairs were now finally complete.

I inquired if they had any mold as a result of the leak? He and his spouse looked at me blankly, but the adult daughter who had been listening from another room blurted out, "Oh my God!" She informed me that whenever she walked into her parents' home she could smell the dampness, even now after the repair. They are now undergoing an investigation for mold in the home. This could be the explanation why this man was exacerbating so regularly. Without disclosing any identifying information, suffice it to say there is no other reason for him to exacerbate so regularly. He is relatively young, stopped smoking years ago, stays as fit as possible and has no other triggers in the home.

There is a reason that a comprehensive assessment is now fairly standard for new patients, not just in the UK, but also in my native New York as well. There are so many things that create, contribute or exacerbate the conditions we work with. I could have simply treated this man and thought nothing more of it. By investigating all aspects of his situation, including his environment, I may have prevented further episodes of illness. How comprehensive is your assessment?


Turns out an overlooked concurrent dx could have led to an entirely different treatment course for my scaphoid fracture.  Needless to say, a comprehensive assessment was nonexistent.

Even when a patient is referred for a specific diagnosis, a thorough history is vital.  The clinician must ask the questions.  Don't depend on your client to offer the relevant information...even if your client is a clinician!  Pain and illness can turn off a clinician's "medical mode".  Treat them like any other patient.  Except you may be able to use bigger words!

Thanks for this reminder, Dean.

Janey Goude June 9, 2010 10:09 PM

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About this Blog

    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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