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PT and the Greater Good

"Nobody Can Give Me a Goal!"

Published April 24, 2012 12:40 PM by Dean Metz

I'm in the throes of my fieldwork project for my MPH degree now. I'm conducting a health needs assessment for a neighboring town. It is a great learning experience! I'm looking at overall population trends, current health status, emerging populations, access to care and services, disparities in care and outcomes, services already in existence, and trying to find the gaps where services need to be focused.

Is this an area that needs a physio's attention? Absolutely! The ability to function, gain community access, additional care needs and health status are all areas we understand clearly and where we can have a huge impact (well, should have a huge impact) on policy and service provision. I've worked for more than two decades delivering care to individuals. Now I get to help a whole population. That is exciting to me.

Part of my work is interviewing providers to determine who does what, how they get referrals and what barriers they face in ensuring the best outcome for their clients. I was chatting with one provider last week who mentioned another physio service. I knew which practice he was talking about and questioned why that service was a barrier when it should have been an ally?

The physio in charge of the service in question doesn't accept referrals with regard to people with a certain presentation. "Nobody can give me a goal to work toward with them!" is the rationale behind the refusal. Huh? Silly me, I always thought the goals came as a result of a good evaluation. All of the published evidence on this particular presentation also states that the single most important intervention is physiotherapy!

There are still many practitioners who work in a very compartmentalized way. This is obviously one of them. This approach is simply not going to work with the changes the NHS is undergoing. More importantly, it is not an approach with the patients' best interest in mind.


Roger, Thanks for your response! I have many of the same issues with patient goals. In many cases it is a paper exercise of asking, writing it down and forgetting about it. However there is a huge push for patient involvement in goal setting here in the UK. I shall post about "no decision about me, without me" next week. I think you hit the nail on the head with "aligned with the person's expectation of care" in terms of involvement with goal setting.

Your comment made me wonder if I was clear that the physio expected the referral source (Nurse, GP, A&E) to provide them with goals for the patient. I wasn't referring to patient stated goals. This physio, in plain terms, doesn't like working in a particular domain and is using this rather poor excuse to decline referrals.

Cheers, Dean

Dean Metz April 27, 2012 12:37 PM

I agree each skilled assessment should identify areas for goals.  I do challenge the need to have goals be meaningful to patients.  I expect to include functional and aligned with the person's expectations of care.  In a world of person centered goals, we need to understand the person....The term patient centered goals, has our clinical lenses and can limit us to our discipline or sickness model vs looking at the person resuming a healthy life.  I find it a subtle but interesting perspective.

Finally patient/person goals are something many may agree with, but I have yet to find a data set that collects the identity (just yes or no) of patient goals known to the clinician.....let alone what are the goals and were they achieved.

Lastly the term goals is a clinical term....Something I have seen in surveys to past patients.  Using other terms that are more lifestyle and functional focused may be a better term for our clients than goals.

Roger Herr April 27, 2012 3:26 AM
San Francisco CA

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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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