3 Key Objectives of an Initial Evaluation
Sweaty palms and nervous jitters cloud my brain as the proctor firmly asks for my diagnoses. “Likely glenohumeral impingement” I sigh out. The proctor nods and the butterfly’s in my stomach scurry away to the pester next victim waiting to enter the exam room.
The initial evaluation is not all its sold to be.
Clinical practice is messy. Black and white answers are hard to come by. We come from a medical system that tells us labeling the issue is the first step to treating it. However, how accurate is our labeling system in physical therapy? How much does the name we ascribe to the issue really drive best practice? Can we even expect to collect enough data to build a comprehensive plan of care in the first interaction? Would trying to do this even be the best use of this time?
I believe that patient encounters are often hindered by the “search and destroy” method of an initial evaluation. The quest to assign a label gets in the way of the 3 main opportunities of an initial evaluation.
Make sure you are the right guide: based off your experience, your scope of practice, and the story the patient is telling you, are you fit to guide them through this process? Get to know the patients expectations as well. Will you be able to meet these or amend them if needed?
Paint a picture of the process– the initial visit is a starting point. Establish a vision for the patient of where they currently are and how they behaviors you will ask them to establish can be a potential solution. We are looking for buy in. We cannot accomplish much without change and the patient must walk out of the meeting with trust in you order to take the first step. Remember to be of best service, they probably need to come back.
Figure out where to start– creating a treatment plan in permanent marker after one encounter is a waste of time. We do not need to know every bit of data, just enough to know where to begin. Our job is to simply establish a safe starting point. From here, we apply a stimulus that is very unlikely to have adverse effects and we see how the system responds. The first in a series of “evaluations” that will guide us through this fluid process.
Just like myself, the students I mentor routinely put an undue pressure around the initial examination. The bad memories of PT school practicals or a CI breathing down your neck has created a sacred cow.
Take a breathe. You would never judge your knowledge of a book after reading the first chapter. Simply build rapport and establish a safe starting point.
Author: Dr. Anthony Iannarino, DPT, CSCS; Site Director, Rehab 2 Perform – Bethesda
- Key Takeaways: Overdiagnosis and over-medicalization are rampant problems in our modern healthcare system. The patient has shifted the control of their health from themselves to the medical industry. This leads to misaligned incentives, overdiagnosis, overmedicalization, and a sicker society.
Article: “Lower Extremity Stiffness: Implications for Performance and Injury” (Butler et. al 2003)
- Key Takeaways: Stiffness is a super power. But like any super power can easily turn into a vulnerability if not well managed.
Book: Mastery- Robert Greene
- Key Takeaways: Success leaves clues. Many who have achieved mastery have left a blueprint. Greene does a phenomenal job of outlining the key similarities and the path that this has unveiled. We must acknowledge the point we are at on the path and maximize opportunities within it and then take action when it is time to move to the next step.
Social Media Follow: Dr. Mike Young (@drmikeyoungphd)
- Key Takeaways: Mike gives a behind the scenes look into his training process with the Athletic Lab Track Club. Mike provides transparent reasoning for decisions, testing processes, and real “skin in the game” successes and failures.