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Physical Therapy Walk-In Evaluations

by | Sep 7, 2022 | Cash Based Practice

The following is a Facebook post from 09/07/2022

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We all know how much we LOVE to people-watch.
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Airports, coffee shops, malls. We see every idiosyncrasy.
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Why then do we think every initial evaluation… even the easy ones, requires 60 minutes and multiple layers of tests and measures?
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I just shared a video talking about a new patient who walked into my clinic today to schedule an initial evaluation. He was on his way to a lunch meeting but thought he would just stop in and schedule.
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This used to happen more often when a group of physicians worked in the office across the hall.
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It became second nature for me to immediately drop what I was doing and start my initial evaluation.
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This patient was referred to therapy for insidious onset shoulder pain. He was scheduled for an MRI in two weeks and surgery after that if required. He wanted to start therapy before the MRI.
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I watched him open my clinic door. I watched him sign my admission paperwork. I wanted him to get his insurance card and license out of his wallet. He showed me his range of motion. He gave me his list of medications. He told me he was still able to drive, but it was painful. He mentioned he was unable to sleep on his involved shoulder but before onset, he preferred sleeping on that side. I watched him carry his stuff and grimace when he had to reach behind his body with his involved shoulder.
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I effectively completed my initial evaluation while he was standing at the front counter. We discussed goals related to sleeping, dressing, grooming, and bathing. We discussed the prior level of function and expected goal level of function.
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I was even able to watch him leave my clinic 10-minutes after entering and I watched through the window as he entered his car and drove away.
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Effectively in the 12-minute experience, I did everything I needed to do to assess his condition and develop a basic plan of care.
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Now if you are still reading it may be because you are thinking, what about this and what about that? What about ROM and MMT?
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What about dermatomes and distributions? What about the neck and the upper quarter screen?
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I promise I know all of those things exist. But before I go on a witch hunt trying to track down the most obscure condition, what if he just has an inflamed cuff and a couple of simple exercises will allow it to heal in 3 visits?
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I would rather start with the most obvious problem and solution. Then if things don’t improve, I can dive deeper.
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Once again, we (the profession) get upset because we work so hard and do so much, but maybe a lot of what we do is done because we want to do it and not because we are being paid to do it.
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BTW, this patient’s evaluation and POC were completed this morning and he is returning later today for treatment. He will likely work with my PTA, but I have verbally relayed my plan of care to the PTA along with any additional information that might help the case.
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The face-to-face time from this morning and the treatment minutes from this afternoon will all be documented in the treatment note along with procedure codes and interventions.
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My point in sharing this isn’t to have therapists skimp on complex cases, but rather to appreciate the easy cases with easy solutions.
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Don’t overcomplicate things until those things prove themselves to be complex.