Do Patients Really Need A Diagnosis?

Posted By: Andy Barker

Giving a patient a diagnosis is a BIG part of what we do as therapists.

It’s often seen as the primary goal of your initial assessment with your patient and the first step in helping your patient out of pain and back to full fitness.

But does your patient really need a diagnosis?

In some cases, giving a diagnosis to your patient can be detrimental to your patients care and treatment plan.

It can affect patient understanding and stop your patients buying into your treatment plan.

It can confuse patient and make them focus on the wrong things, causing a lack of clarity as to why they should go away and complete the rehab exercises you have set as part of their home exercise programme.

All this makes the management of your patient much more difficult.

So, do you need to give your patients a diagnosis?

In this blog you will discover exactly why a diagnosis can be detrimental to your treatment plan and what you need to focus your attention on instead to ensure greater patient adherence to your treatment plan, resulting in better and faster patient results.

Why A Diagnosis Can Actually Be Detrimental To Your Treatment Plan

I’ve worked in professional sport the entirety of my therapy career and many of the experiences (and challenges) have helped improve the way I explain a ‘diagnosis’ to a patient.

Sport is unique in many ways.

The very acute nature of injury management is one such difference between this area of therapy and others.

Whilst in the NHS or private practice it might be several weeks, months or even years after an injury has started that a patient comes to see you, in sport it can be just a few seconds.

You might be at a training session or at a game and you might be assessing an injury as soon as it has happened.

You’ve probably even witnessed the injury happen.

If not, it might only be a matter of minutes before you have been sent a video of the injury from the team analyst.

Assessing very acute injuries is tough but is bread and butter for therapists working in sport.

Managing acute injuries like this is one of the big challenges for therapists in sport.

In sport you live and die by your decision making and ability to diagnose.

Miss a big injury on the field and allow a player to play on, making his injury significantly worse and maybe even affecting his ability to perform and his effect on the teams result, could be the curtains of your career at that team!!!

The ability to accurately make a quick clinical decision on the field can be tough.

It’s a high-pressure environment and you need to decide quickly as to the best management plan for that player at that time.

Having made a clinical decision then that clinical message needs to be relayed to both the player and other staff, namely the head coach, so he/she can make plans for a substitution and any tactical changes if that player was to leave the field.

Mentoring therapists that work in sport they all tell me how they find it difficult not to give a diagnosis and sometimes a prognosis of injury straight away.

Maybe their assessing a player after a game in the changing rooms.

Everyman and his dog want information.

They want to know what’s going on.

Your only half-way through your assessment and the head coach is asking you when he is going to be back playing?

The player and his teammates are asking you the same question.

Do I need a scan?

Is it my ACL?

Is it as bad as (player X’s) injury?

The big error I see with New Grad therapists is trying to please and trying to give a diagnosis too early.

They feel under pressure, feel like they must come up with the answers and often jump the gun and give a diagnosis and sometimes even a prognosis.

For some injuries in an acute setting like this, it can be possible and with some accuracy.

But for many injuries it’s can be very difficult.

The danger is that you make an inaccurate diagnosis and prognosis.

The injury might turn out to be not as bad but could also be much worse than you initially said.

Either way this makes you look incompetent in your assessment skills and some might question your clinical ability.

You might not work in sport and maybe are wondering how this applies to the NHS or private practice.

But these same principles can be applied to any environment.

Whether you are working in the NHS. private practice or sport, giving your patient or athlete a diagnosis might not be the best course of action.

Whilst in the NHS and private practice you may not be assessing acute injuries as regularly as a sports setting, the same pressures to give patients a quick diagnosis during your initial assessment are the same.

Keep reading to find out why patients don’t need (or want) a diagnosis and what they actually want instead…

Patients Don’t Want A Diagnosis

A diagnosis is just a label.

It could be ‘shoulder impingement,’ ‘sciatica’ or ‘anterior knee pain.’

The diagnosis itself doesn’t matter.

The main problem with giving a diagnosis is that is focuses the patient’s attention to that area.

Do you need to educate patients on the structures that are painful and are giving them their current symptoms?

But you don’t need to give them a diagnosis.

So, what do you do instead?

A better way is to focus on the patient problems.

A patient may have ‘shoulder impingement’ but why have they got that problem in the first place?

Your treatment plan is NOT going to fix ‘shoulder impingement.’

Your treatment plan is going to fix the problems that are causing patient symptoms.

Their problem might be a lack of range of movement or poor muscle recruitment or strength or any other problem you have identified in your assessment.

These problems will be specific to each individual patient and will be directly related to your assessment findings.

These are the problems you need to focus your patient’s attention on.

As these are the problems you can FIX.

These are the problems you will address directly with your treatment plan, through your hands-on treatment techniques and your rehab exercises.

Your patients don’t need a diagnosis.

They need to understand their problems, the reasons their shoulder, knee or lower back is painful and then be clear as to how your treatment plan is going to fix these very problems.

But Surely You Still Need To Give A Diagnosis?

Patients will push for a diagnosis.

They quite often want a label to help them understand what is causing their knee, ankle or back pain.

I’m not saying that you should not address this and explain what is causing the patients symptoms to your patient.

But what I am saying is that after you have addressed and explained this, your attention MUST quickly turn to highlighting the patient PROBLEMS you both, you and the patient, need to address.

This concept is quite possibly very different to how your current clinical approach is now.

It’s very different to how we were taught to assess our patients at University for sure.

But it makes simple and logical sense.

Not only for you, but also for your patient.

You and your patient both want the same thing; to get out of pain and back to full fitness and quickly as possible.

A diagnosis doesn’t help you do that.

A list of problems does.

It gives you direction as to what to do next.

Problems make you think about solutions.

These solutions are your hands-on treatment techniques and rehab exercises.

It also makes explaining your treatment plan much easier to your patient.

I want you to go away and do ‘Exercise A…B…C’ because it is going to help fix ‘Problem A…B…or C’

This is much better than… ‘You have shoulder impingement, that’s why your shoulder is painful, here’s some exercises to do.’

Being specific about WHAT you are asking your patients to do is key.

Once patients can understand how you are going to fix them, they understand how their home exercise programme addresses the problems they have, they will go away and do every rep of every set of the exercises you give them.

If you are struggling to keep your patients on track and find they are not adhering to their treatment plan, maybe they just don’t understand HOW the rehab exercises you have sent them are going to fix their problems.

And if they lack understanding as to why they are doing your rehab exercises and how these exercises are going to get them back to the sports, hobbies and activities they want to, why would they do their home exercise programme?

You might think it a patient problem.

Your patient being lazy or something like that…

But maybe it’s a therapist problem.

Maybe you have focused too much on the diagnosis, labelling the injury and not enough attention on the problems the patient needs to fix, so they understand and buy into your treatment plan.

Key Take-Aways

  • Giving a patient a diagnosis can be detrimental as it focuses the patient’s attention on the injury and not on what they need to do to fix this problem
  • Focus your attention on identifying patient problems, then link your solutions (your treatment plan) to help your patient understand WHY they are doing a particular rehab exercise
  • Understanding these problems will result in greater patient adherence to your treatment plan, meaning better and quicker positive patient results

I would love to hear your own struggles in relation to your objective assessments and your thoughts about giving (or not giving) a patient a diagnosis.

Send me an email to to let me know your thoughts and I’ll get back to you straight away.

If you enjoyed reading this blog, you need to grab a copy of my ‘New Grad Physio Survival Guide.’

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