Since starting Heafner Health (my cash based PT practice), I have started to shift my thought process on discharge planning. In my previous jobs, I would essentially discharge a patient once they could meet their pain and function related goals. In other words, I would discharge a patient when they reached their prior level of function. As an private practitioner, I have seen firsthand the downsides of this insurance based plan of care.
My Soap Box:
In general, people function at 60% of their full musculoskeletal capacity. Using an imaginary chart, they function slightly above the 'injury line.' Most people are never exploring their full movement potential, but instead are barely escaping pain. The reason most people operate at 60% is because they do not spend adequate time focusing on their musculoskeletal health. Our society promotes aesthetics over movement efficiency and function. The average workout is time dependent and judged by amount of weight lifted or distance travelled. Yes, injury is more common as people get older, but simply because the freedom of movement is forgotten.
Redefine Your Discharge Planning
In my previous jobs, I was forced to discharge my patients back to their 60% baseline. I would eliminate their pain and restore a baseline level of function. The major joint and muscle dysfunctions were fixed, but underlying movement impairments still existed. Additionally, I would provide education and resources to hopefully prevent the injury from reoccurring. Fortunately in my current position, I can now focus on the bringing people to a higher level of movement. For me discharge planning is now about maximizing function and movement efficiency. When a patient no longer has pain, I begin treating secondary and tertiary impairments that are causing movement breakdown. During this phase, patients come to the clinic much less frequently. They are given higher level tasks that incorporate greater neural programming. The focus is now on the human movement system.
Physical therapists are the movement experts. Just because someone can function in society without pain does not mean they are no longer appropriate for our services.
Many people reading this are likely thinking that this will never work in their clinic. The insurance only covers 'x' amount of visits or my clinic has a policy that tries to discharge all people within 'x' amount of days. My advice: find a local strength and conditioning expert that you can trust. Once the patient has reached their discharge point, refer them to a personal trainer who understands movement and exercise progression. The physical therapy field needs to develop stronger ties with our strength and conditioning friends. We need continuity in our patient care so that we have the opportunity to bring all patients far beyond their baseline of function.
Discharge planning, manipulation, advanced clinical reasoning...OPTIM continually strives to give students the 'Monday morning applicable' experience.
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