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PT and the Greater Good

Safe Bet or Bad Practice?

Published January 2, 2014 3:58 PM by Dean Metz

Over the holidays, we were sitting and whinging (English for complaining) over drinks about the demise of clinical and critical thinking in practice. In both the US and the UK, algorithms have been employed to standardize care in an attempt to assure everyone gets the same quality of treatment. As a public health advocate, I almost always advocate for something that reduces variations in care. Why should a patient have better treatment from practitioner A than practitioner B? Algorithms are an essential component to telemedicine and tele-physio. NICE (National Institute of Clinical Excellence) in the UK and the Milliman guidelines in the US provide those frameworks we need to work within in order to get paid.

That would work perfectly if every person with back pain presented in the same way, or with chest pain, or a hip fracture. When did you last see two of any presentations that were identical? For an algorithm to capture every possible presentation, it would most likely be unmanageable and of little practical use. Many professions are now being trained according to an algorithmic approach. At my last post in the US, we actually taught new employees about critical thinking because it was a skill lacking in so many newly hired people. Are we dumbing down the health professions in an effort to standardize care?

When I took a practical exam in PT school, many years ago, there would be wildcards in the patient's presentations. Our skills of thinking on the spot were harshly tested. I'm grateful for that now that I'm older and minutely wiser. I wrote about taking an OSCE (Objective Structured Clinical Examination) here in the UK when I first arrived. There was no thinking involved, simply a checklist to run through in 7 minutes. It wasn't easy, but it didn't prepare me for a real situation.

Are we risking our patients and our careers by trying to stay safe?

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1 comments

I totally agree Dean. The last class of PTA students I taught fought me youth and nail against critical thinking. Every lab I included patient case tidies and they hated it. They were not interested in deductive reasoning but in just giving them answers on what to do in any given situation. You and I were taught the same way and it has proved invaluable to the way we treat patients! Thank you for an insightful piece.

Maureen Thornby, Physical Therapy - Dr., SNF January 2, 2014 5:50 PM
Bradenton FL

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