Chad Cook has provided us with a significant amount of literature and has been the language for manual physical therapy as of late (especially in my ‘young’ career). I have cited many of his articles & books in the past and want to piggyback on his editorial in recent JMMT.
“The lost art of the clinical examination: an overemphasis on clinical special tests” really hits a personal side of treating that I feel is a fault in our current medical model. Chad hits the nail on the head with this commentary.
The clinical exam is a dying breed. Physicians don’t have the time to do it now, chiropractors using imaging more and massage therapists denoted solely on the soft tissue aspect; is this a huge break for physical therapists? Are we the last ones standing?
Unfortunately, we are an over-diagnosed society. Bottom line, patients want to have a “condition”. For musculoskeletal conditions in physical therapy particularly; diagnosing is not the end-all-means and doesn’t do what the patient came to your office for…treating to get pain relief.
I know many may say you can’t treat without a diagnosis. Well, I agree to this to an extent. My biggest argument is that most of our clinical diagnostic tests are poor to fair. Check out the evidence here.
A large aspect of my diagnoses that aren’t “clear-cut” result in a simply a mechanical dysfunction of the affected joint or region.
I get to this conclusion through a clinical exam but most importantly, a hands-on approach to aid in altering the arthrokinematics of the joint. Not only does the patient get a reason for the pain, pain-relief is a positive consequence that is not given through a verbal diagnosis or imaging. The latter do not treat.
I actually may like the way the trend is going. The loss of the clinical exam in other professions equals a better future for physical therapists.
What are your thoughts? Do you think academia is going down the right track in implementing radiograph and other imaging education in the doctorate programs? Would it be better to go down another track and let other professions do this?