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Are you a PT in a Busy Clinic?

1/17/2016

3 Comments

 
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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?

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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! 
​Jim

3 Comments
Glenn
1/18/2016 11:35:22 am

This is a very insightful post, thanks Jim!

Currently in school we are becoming more efficient with a lumbar scans for low back pain. Our instructors emphasize that the scan is always the same and shouldn't take more than 10 minutes, but it is quite comprehensive (myotomes, dermatomes, reflexes, plantar response test, faciliated segments, sign of buttock etc.)

Are there any shortcuts that you use clinically, or should our scans be comprehensive to always rule out any red flags that may not be evident?

Thanks,
Glenn

Reply
Jim
1/19/2016 05:08:55 pm

Thank you Glenn!

You bring up a few great points. Your MsK scan or screening system needs to be systematic, efficient, and reproducible. I think it is important that your school is emphasizing a pre-set scan. However, I think it may be inefficient to complete that entire scan on EVERY patient. For example, if the individual has an acute onset of mechanical low back pain without symptoms into the lower extremities, I would not perform a full neuro exam (this is me personally, others may disagree). With that said, I would have the patient walk on their heels and toes to grossly demonstrate L4 and S1 strength. I would have them walk, squat, and perform SL balance to demonstrate gross LE strength and coordination. Additionally I always check individuals SLR which shows neural tension, LE strength, and potential disc involvement. These are a few examples of shortcuts I take.

Thank you again for the comment. Thank you for following!
-Jim

Reply
Glenn
1/19/2016 06:09:01 pm

Thank you for your detailed response!

Perhaps further discussing some of your efficient and systematic scans that you use clinically could be another post, if it does not already exist.

Reply



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  • Home
  • About Us
  • Insider Access
    • About Insider Access
  • Online Courses
    • Hooper's Knee
    • Physical Therapist Entrepreneur Course
    • Physical Therapist Consultant Course
    • Orthopedic Management of the Cervical Spine
    • Return to Sport Essentials Course
  • Resources
    • Newsletter
    • Business Minded Sports Physio Podcast
    • Day in the Life of a Sports PT
    • Residency Corner
    • Special Tests >
      • Cervical Spine >
        • Alar Ligament Test
        • Bakody's Sign
        • Cervical Distraction Test
        • Cervical Rotation Lateral Flexion Test
        • Craniocervical Flexion Test (CCFT)
        • Deep Neck Flexor Endurance Test
        • Posterior-Anterior Segmental Mobility
        • Segmental Mobility
        • Sharp-Purser Test
        • Spurling's Maneuver
        • Transverse Ligament Test
        • ULNT - Median
        • ULNT - Radial
        • ULNT - Ulnar
        • Vertebral Artery Test
      • Thoracic Spine >
        • Adam's Forward Bend Test
        • Passive Neck Flexion Test
        • Thoracic Compression Test
        • Thoracic Distraction Test
        • Thoracic Foraminal Closure Test
      • Lumbar Spine/Sacroiliac Joint >
        • Active Sit-Up Test
        • Alternate Gillet Test
        • Crossed Straight Leg Raise Test
        • Extensor Endurance Test
        • FABER Test
        • Fortin's Sign
        • Gaenslen Test
        • Gillet Test
        • Gower's Sign
        • Lumbar Quadrant Test
        • POSH Test
        • Posteroanterior Mobility
        • Prone Knee Bend Test
        • Prone Instability Test
        • Resisted Abduction Test
        • Sacral Clearing Test
        • Seated Forward Flexion Test
        • SIJ Compression/Distraction Test
        • Slump Test
        • Sphinx Test
        • Spine Rotators & Multifidus Test
        • Squish Test
        • Standing Forward Flexion Test
        • Straight Leg Raise Test
        • Supine to Long Sit Test
      • Shoulder >
        • Active Compression Test
        • Anterior Apprehension
        • Biceps Load Test II
        • Drop Arm Sign
        • External Rotation Lag Sign
        • Hawkins-Kennedy Impingement Sign
        • Horizontal Adduction Test
        • Internal Rotation Lag Sign
        • Jobe Test
        • Ludington's Test
        • Neer Test
        • Painful Arc Sign
        • Pronated Load Test
        • Resisted Supination External Rotation Test
        • Speed's Test
        • Posterior Apprehension
        • Sulcus Sign
        • Thoracic Outlet Tests >
          • Adson's Test
          • Costoclavicular Brace
          • Hyperabduction Test
          • Roos (EAST)
        • Yergason's Test
      • Elbow >
        • Biceps Squeeze Test
        • Chair Sign
        • Cozen's Test
        • Elbow Extension Test
        • Medial Epicondylalgia Test
        • Mill's Test
        • Moving Valgus Stress Test
        • Push-up Sign
        • Ulnar Nerve Compression Test
        • Valgus Stress Test
        • Varus Stress Test
      • Wrist/Hand >
        • Allen's Test
        • Carpal Compression Test
        • Finkelstein Test
        • Phalen's Test
        • Reverse Phalen's Test
      • Hip >
        • Craig's Test
        • Dial Test
        • FABER Test
        • FAIR Test
        • Fitzgerald's Test
        • Hip Quadrant Test
        • Hop Test
        • Labral Anterior Impingement Test
        • Labral Posterior Impingement Test
        • Long-Axis Femoral Distraction Test
        • Noble Compression Test
        • Percussion Test
        • Sign of the Buttock
        • Trendelenburg Test
      • Knee >
        • Anterior Drawer Test
        • Dial Test (Tibial Rotation Test)
        • Joint Line Tenderness
        • Lachman Test
        • McMurray Test
        • Noble Compression Test
        • Pivot-Shift Test
        • Posterior Drawer Test
        • Posterior Sag Sign
        • Quad Active Test
        • Thessaly Test
        • Valgus Stress Test
        • Varus Stress Test
      • Foot/Ankle >
        • Anterior Drawer
        • Calf Squeeze Test
        • External Rotation Test
        • Fracture Screening Tests
        • Impingement Sign
        • Navicular Drop Test
        • Squeeze Test
        • Talar Tilt
        • Tarsal Tunnel Syndrome Test
        • Test for Interdigital Neuroma
        • Windlass Test