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In the previous chapter, a process for symptom-based diagnosis was described. The outcome of that process is the diagnostic label, which is the pathology or the pathological process that is the root cause of the patient's or client's chief concern.1,2,3 Once a diagnosis has been established, the clinician's evaluation must continue until the etiology of the pathology is uncovered. The focus of this investigation is specific to the discipline of the searcher. Once a diagnosis of myocardial infarction is reached, for example, the cardiac surgeon looks for the offending coronary artery, the internist measures cholesterol and blood pressure, the dietician looks at eating habits, and the physical therapist examines exercise patterns. Each health care provider goes beyond the diagnosis in search of the underlying etiology, in order to provide the optimal management plan.
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The process of searching for an underlying etiology by a physician may be more familiar to some than the search for an underlying etiology by a physical therapist. This chapter provides an overview of the ways physical therapists use diagnostic labels in making treatment and prognosis decisions, as well as how physical therapists search for the underlying etiology of a pathology.
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Many health care providers wish to identify the tissue or pathology responsible for a patient's symptoms, and they strive to understand the root cause of the chief concern. Physical therapists use and elaborate on the diagnostic label for purposes of treatment. Perhaps the most intuitive manner in which the physical therapist can elaborate on the diagnostic label is to revise it with their diagnostic label, impression, or decision as described in the previous chapter. For example, a patient referred to a physical therapist with a diagnosis of Back Pain may be referred back to the physician after a physical therapy evaluation with the diagnostic impression of Kidney Stone vs. Urinary Tract Infection. In this example, the physical therapist is elaborating on the initial diagnostic label by advocating additional testing that may result in the label's revision. Physical therapists, like other health care providers, also use and elaborate on the diagnostic label to create a plan for intervention and prognosis. This involves a search for the underlying etiology of the pathology denoted by the diagnostic label. Diagnostic reasoning at the level of pathology is a similar process for both physicians and physical therapists and also for other health care providers in allopathic settings. The search for the underlying etiology, however, is specific to the discipline, and therefore physical therapists' unique professional focus and expertise characterize their search.
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Physical Therapists Use the Diagnostic Label
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Given a particular patient problem, the first goal of the physical therapist's evaluation is to ...