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Physical Exam 101: The Hands
I am sure you are familiar with the old adage: "When the only tool in your toolbox is a hammer, everything starts to look like a nail."
The Science of Stretching
In 1986, Rob DeCastella set a course record by running the Boston Marathon in 2:07:51, just 39 seconds off the world record.
A Guide for Talking to Doctors about Acupuncture and Brain Chemistry
Before I begin any discussion of how to talk about the effects of acupuncture on brain chemistry, nervous and endocrine function, it is essential to understand just what physicians most need help with.
Immunizations by Colorado DCs: Really?
You probably didn't hear about it, but back on Nov. 21, 2013, the Board of Directors of the Colorado Chiropractic Association (CCA) adopted "immunization authority" for Colorado DCs as its No. 2 legislative goal.
Finders Keepers: The Secret to Relationship-Based Marketing
Becoming a successful practitioner has less to do with what you learned in school, and more to do with your ability to find new patients and keep them!
Vaccines and Chiropractic: Evidence-Based Medicine or Medical Dogma?
Right or wrong, the chiropractic profession has historically been against vaccinations. However, a growing trend within the profession is seeking to reverse this position.
Peer Points: Always Seeking To Grow
Ellen "Kiki" Geary has spent the last decade honing her craft. As a specialist in integrative holistic care, she went straight from completing her master's degree in acupuncture and chinese herbal medicine from Bastyr University to building a successful and thriving practice in the small community of Anacortes, Washington.
Are You a Bad Chiropractic Patient?
My father was a great DC. In fact, as you might expect, he was the doctor of chiropractic I measured all other doctors against. Sadly, he died at age 61 when I was in my early 30s.
Fibromyalgia: Put the Pain in Its Place
While some fibromyalgia patients respond favorably to regular chiropractic care, others experience minimal relief. Unfortunately, many of these patients must rely on pharmacological management to relieve their constant pain.
Building From the Bottom Up
I caught up with my dear friend Honora Wolfe, in her Colorado painting studio where, if she is not praying in Bhutan or doing charitable work in a Nepali free clinic, she spends most of her time now.
Coding for the Subluxation: ICD-9 vs. ICD-10
When I attended chiropractic school, I was taught that chiropractors approach health care differently than the traditional medical establishment.
A Chinese Medicine Story: An Interview with Mazin Al-Khafaji
Mazin Al-Khafaji's work has interested me for years. In February 2014, we invited him for the second time to speak at the Southwest Symposium in Austin, Texas.
Knee Pain From the Kinetic Chain
As practitioners of manual medicine, chiropractors often treat patients suffering from knee pain.
Why You Should Include the Single-Leg Stance Test in Every Patient Assessment
The single-leg stance (SLS) test, also known as the single-limb stance test, unipedal stance test or one-legged stance / balance test, is often used in the geriatric population to assess static postural and balance control.
Medical Qigong for the Heart: Part III
Part 1 and Part II of this series focused on the physical aspect of the Heart and mental emotional aspects of the Heart respectively. Now, I would like to focus on the spiritual aspect of the Heart.
New Medical Technologies You Need to Know
We're all familiar with how fast computers become obsolete, as well as the rapid pace of development in the field of cell phone technology. The latest smart phones are far more powerful than desktop computers were only a few years ago.
Curbing Label Overwhelm
For the average consumer, reading a food package can be overwhelming: natural, organic, non-GMO, gluten free, free range ... you get the picture.
Remembering Clarence Gonstead and 50 Years of the Gonstead Clinic
Dr. Clarence Selmer Gonstead (1898-1978) took chiropractic practice from back-alley bone setting to an understandable biomechanical science. His life was dedicated to clinical competency.
By the Numbers: 3 Common Financial Mistakes With Major Consequences
Warren Buffett is on record for sharing the hidden art of becoming wealthy and making it simple enough for anyone to grasp.
March, 2004, Vol. 04, Issue 03
Clinical Reasoning Skills
By Whitney Lowe, LMT
In the health care arena, assessment is commonly defined as the systematic process of gathering information in order to make informed decisions about treatment. We all do this any time we make a decision about how much pressure to use, which technique to employ, or how to address a particular problem presented by a client.What is different is the degree to which we use these assessment skills. As massage therapists become more involved in treating people, the process of assessment becomes increasingly important. You must be able to distinguish between conditions with similar symptoms and make vital decisions about how to approach a client's condition, or determine whether to treat the condition at all.
There are numerous systems of assessment for pain and injury conditions that share common elements, including the use of specialized orthopedic tests. These tests are used by different types of health care professionals to identify various pathological problems. Since different health professionals utilize the same tests, communication between multiple practitioners regarding the condition of a client/patient is easier. However, while these tests are a valuable part of the assessment process, a common trap can occur when using them. The trap occurs when too much emphasis is placed on using tests over other methods of assessment and evaluation. For example, if a client complains of shoulder pain, and you know about special orthopedic tests for shoulder disorders, it is a common fallacy to run through these tests to see if you can find the nature of the client's problem. This is still a shotgun approach. What is missing is an essential element of the assessment process: clinical reasoning.
When first learning about a subject, the information is often divided into separate facts or concepts. It is only after achieving a greater degree of mastery in the subject that people organize this information into usable patterns. Studies that have investigated the difference between the way experts and novices present information have found that experts put together more patterns of information, while novices tend to gather more separate details, many of which may be irrelevant to accomplishing the final task or skill they are learning. This aspect of learning and processing information is essential in assessment and clinical reasoning processes, and can be well-illustrated in the following example.
When a client complains of shoulder pain and describes the common symptoms, the practitioner must determine what information is relevant and how to proceed in the evaluation process. If the statements are considered separately, they may not lead to essential clues about the nature of the condition. This is often where the practitioner jumps to the use of several tests to see if he or she can hit on the "right condition"; however, the more skillful practitioner will pick up on statements during the initial intake and begin to form patterns. This practitioner will see connections between various signs and symptoms, and the further line of inquiry will almost lead itself in many cases. The art of reasoning is the ability to see these patterns of connection; therefore, the challenge is learning how to perfect those skills and see the patterns.
Consider the job of a detective. When investigating a crime, the detective must pick up on clues and determine which ones are important (and which ones are not). The ability to discriminate between the two can be difficult. The best way to make this choice is through a combination of subject-matter knowledge and experience.
For clinical practitioners, the more we know about various pathological problems, the wider the base of information we can draw from when searching for relevant clues. At the beginning, it will be difficult to know which clues are relevant - this is where experience comes into play. After seeing similar conditions a number of times, we develop an experiential background against which we can see similar patterns and recognize which cases are similar to others we have worked with before. As we combine our knowledge and experience, we are able to more accurately and quickly find the nature of a client's complaint.
The more skilled you become in clinical reasoning, the easier and faster the assessment process will be. Therefore, as you learn about assessment and range of motion evaluations, muscle tests, or specialized orthopedic tests, always think about why you are using a particular procedure, instead of just going through the motions. The more you understand why you are doing what you are doing, the more you will contribute to your ability to see these patterns within the clinical evaluation process, and significantly improve your skills.
Click here for more information about Whitney Lowe, LMT.
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