Last week in our OPTIM online mentoring session, the question was asked about how to provide great care while managing 2-4 patients at a time. If you see a high volume of patients per day, is it possible to practice evidenced based medicine? If so, what are some implementable strategies to managing multiple patients?
The quick answer is 'Yes.' It is possible to be busy and effective at the same time.' With that said, succeeding in this environment is difficult and often leads to professional burnout. In order to succeed in a busy clinic, you must be efficient in your history and examination. Efficiency is recognizing patient movement and behavior patterns and minimizing your objective testing according to these patterns. There is no time for irrelevant tests and measure. The clinician should only perform pertinent positive and negative tests. For example, if you treat an individual with a history of non-specific mechanical back pain for the past 10 years, the physical examination will not point to one specific structure. From a musculoskeletal standpoint, all structures have healed. The patient now has chronic pain with central sensitization. A more general strengthening and conditioning program may be more appropriate early in the plan of care. Additionally, choosing how to classify patients should come from the intake paperwork and subjective history. You should gather ~80% of the information during this portion of the evaluation.
A second strategy for success in a busy clinic is SIMPLIFYING your treatment plan. Dana Tew, OPTIM president, often relates various PT diagnosis' to treating the common cold. When you go to your PCP for the common cold, do you want a new, innovative treatment OR do you want the gold standard for treating a common cold? The answer is simple, the gold standard. For example If a patient presents with low back pain with mobility deficits, they likely need a lumbar manipulation followed by mobility exercises and hip strengthening. There are high levels of evidence to support manipulation for acute low back pain, but many PT's are still not performing these techniques. In addition to simplifying the manual treatment, simplify your exercise routine as well. It may be tempting to choose a fancy, new Youtube exercise, but you should choose consistent progressions that are evidenced based.
In conclusion, continually reflect on strategies to be more efficient during your examination and work on methods to simplify your treatment progressions. OPTIM discusses these components in our COMT and Fellowship courses because these components determine if you are practice at a novice or expert level.
Let me know if you have other strategies for being effective in a busy clinic!
James Heafner PT, DPT, OCS:
Owner and lead physical therapist at Heafner Health, cash-based physical therapy in Boulder, CO. Areas of expertise include orthopedic and manual therapy, functional movement, pain science, and movement science.
In May 2013, I earned my Doctorate in Physical Therapy from Saint Louis University. After graduating from the Harris Health Systems Orthopedic Residency in October 2014, I moved to Boulder, CO. Since living in Boulder, I have started my own cash-based PT practice, earned my OCS certification, and teach for the OPTIM Fellowship and COMT program in Houston TX and Scottsdale, AZ.
Chris Fox PT, DPT, OCS: Physical therapist at Foothills Sports Medicine & Physical Therapy in Scottsdale, AZ and regularly lectures at the Phoenix Campus for NAU's DPT program and for Optim Manual Therapy's COMT program. Completed multiple advanced manual therapy courses implementing aspects of biomechanical analysis. He received his DPT from Saint Louis University in 2013. Completed Scottsdale Healthcare's Orthopaedic Residency (now Honor Health) in July 2014. He became a Board Certified Orthopaedic Specialist in 2015. Level I Expert in FMS and SFMA , Kinetacore FDN Level 1 certification, and IASTM Technique course completion. He would like to pursue further education in McKenzie Technique, Dry Needling, Strength & Conditioning, Orthopaedic and Manual Therapy.
Brian Schwabe PT, DPT, SCS, CSCS:
- Board Certified Sports Physical Therapist (SCS) at Elite OrthoSport in Santa Monica, CA which specializes in treating collegiate/professional athletes and clientele from the Beverly Hills, Hollywood, and Santa Monica areas.
- USC Sports Residency Trained Physical Therapist (<1% of all PT's residency trained)
- DPT from Saint Louis University
- Future plans/interest include:
1. USAW, SFMA & Catapult Systems technology for NBA teams
2. Pursuing a position as a sports physical therapist &/or Strength coach for a Division 1 athletic medicine department or professional sport team.
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