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Differential Diagnosis for Physical Therapy: Introduction: Summary
LEARN Model • Listen with empathy and understanding the patient's perception of problem • Explain your perceptions of problem • Acknowledge and discuss the differences and similarities • Recommend treatment • Negotiate agreement Culture Competences in Screening/Interview Process • Learn culturally specific information • Attempt to learn some words in the patient’s native language • Used trained interpreters who can interpret language as well as culture cues • Limit number of forms and paperwork ○ Millions of immigrants age 25 years and older may have less than 5th grade education Client History • What happened? Mechanism of Injury? • When did it happen? • Location of pain? • Associated symptoms: this is particularly important as this well help with DD of systemic pain vs musculoskeletal Medical History • Arthritis • Diabetes • Recent immoblizations; increasing risk of blood clot • Medications: polypharmacy (patient takes more than 5 drugs) can increase the likelihood of a patient having an adverse drug event ○ Importance of asking about over the counter drugs (OTC) that might not be recorded in medical chart ■ 75% of all older clients take OTC medications that may cause confusion,
communication, documentation, patient/client related instruction, and direct interventions) • (P) Plan portion of a S.O.A.P Note Outcomes • Measurable able component to assess progress of intervention
LEARNING TIP! Example: an activity level outcome measure of the ICF model would be a time up and go test.
Decision Making Process Client History/Diagnostic Interview • Tips for interview: ○ Eye contact ○ Avoiding “yes”/”no” questions
○ Importance of open-ended questions using the Explanatory Model ■ What do you think caused your problem? ■ What have you done to treat this? ■ Do you have fears about your sickness? ■ Have you asked anyone else to help you? ■ Are there anything that you know of that will help you? ○ Diagnostic interview includes: ■ Nonverbal communication ■ Eye contact ■ Body position ■ All of the above can be influenced by age, gender, culture, race and ethnicity ○ When primary language is not English: ■ Medical interpreter is preferred and usually times required if it is a large health institution ■ Avoid use of family ■ Keep a list of available interpreters and schedule patients accordingly ■ Physical proximity ■ Facial expressions
cause or contribute to additional symptoms, and interact with other medications
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