The Problem-Oriented Approach to PT
I had a conversation today with a nurse of the same supervisory level as myself. We are overseeing the clinical education of a junior nurse. I think it is remarkable that both nursing and physio will oversee the clinical education of either discipline.
We both agreed that this particular individual had a great deal of difficulty with problem-solving. This person tends to follow the recipe approach to patients. In other words, find the diagnosis and then follow the NICE (National Institute for Clinical Excellence) guidelines. The NICE guidelines are all based on evidence and work well for following clear-cut presentations. When was the last time you had a clear-cut presentation?
She had a client who had fallen, had a history of arthritis and an old surgery to her right ankle. She followed the guidelines for all the above, but failed to notice the DVT that developed in her right calf despite very clear symptoms indicating one.
I have had similar issues with physical therapists, nurses and managed care providers back in the states. There is no such thing as a comprehensive assessment to them, only body parts in need of a fix. There is no curiosity to look beyond the diagnosis written by a doctor or by another therapist. There is no such thing as, "What is going on with this person today?" when approaching the patient.
As physical therapists/physiotherapists, we are taught to take a problem-oriented approach to things. This is how we develop our goals for the patient. When I mention goals to most nurses, they have no clue what I'm talking about, despite having care plans (largely ignored) loaded with them.
The group I worked with in New York finally got their minds around the concept, demonstrating excellent results. How do I replicate that in a whole country here?
By the way, I got an "A" on my epidemiology final. Thanks to those who wished me well and gave words of encouragement.