Getting A Diagnosis Wrong – What To Do Next?
Posted By: Andy Barker
Starting out you may miss things in your assessments that mean you make the wrong diagnosis.
You get to session 2 or 3 and start to question if you are treating the right thing.
Maybe you made a diagnosis but then your patient or athlete gets a scan or goes to see a specialist and gets told it’s something else.
What do you do?
How can you fix up this error without making yourself look stupid and stop your patient or athlete losing faith in you as their therapist.
Here are 3 tips to help you out…
#1 Own Up
The worst thing you can do is just carry on as if your wrong diagnosis never happened.
This does not help anyone as if you are treating the wrong problem, it’s highly unlikely you are going to get your patient or athlete back to where they need to be.
Draw a line in the sand and start again.
This might mean you acknowledge and tell your patient you got it wrong.
You can be smart with your wording to save face and stop yourself looking stupid in front of your patient.
Rather than saying…
“I got it completely wrong and your actually problem is…’
You could say something like this…
‘When we first assessed your [injury] it was difficult because you had [x, y, z symptoms] which clouded the assessment…
Now we have had chance to look at things a little more it looks like your specific problem is…’
The same information just dressed up a different way.
#2 Revise Your Plan
If the diagnosis changes then your rehab plan may need changing too.
I say might, as it might not.
The thing about a diagnosis is that you do not treat a diagnosis, but you treat a patient’s problems.
These problems might be excessive joint swelling, a loss of range of movement or strength, a movement issue or something else.
You do not treat an ACL or lateral ankle injury, but the problems these injuries have caused.
So changes in your rehab plan may or may not be needed, largely a result of how different the ‘new’ diagnosis is.
Regardless of whether this rehab plan changes, you should always refer back to this plan.
This is to make sure your patient understands where they are right now and the next steps they still need to complete to get them where they want to be.
This is good practice to do in any session with every patient you see.
By referring back to the rehab plan you are not only showing the patient the next steps, but can also quickly reflect on the steps they have already successfully completed.
This helps greatly with patient understanding and adherence to your rehab plan.
Or put another way…
Patients actually go away and do their exercises because they understand why they are doing them.
#3 Don’t Get It Wrong In The First Place
Clearly you want to try avoid making the wrong diagnosis in the first place then you won’t need to backtrack.
When I first start working with any student or new grad therapist they all have issues with their patient assessments.
And this is not good, because if you do not do a great job with your assessment, not only might you give the wrong diagnosis and have all the issues we have already discussed…
You will also be focusing on the wrong things with your hands-on treatments and rehab exercises.
As I mentioned above you treat the patient or athletes problems.
You might be trying to restore shoulder flexion, or improve hamstring strength…
Reduce an acute ankle effusion or reduce a patient’s level of lower back pain when sitting.
Your ability to do this stems from being firstly able to pick out these problems and then knowing which ones to prioritise.
Your assessment is designed to do 3 things…
#1 Find the diagnosis
#2 Identify a problem list
#3 Establish the end goal and a rehab plan to get there
That is it.
But if you miss things out in your assessment, if you struggle to know what tests to do, or link what your patients has told you (subjective) to how they test in the clinic (objective) then it is going to be hard for you to be clear and confident where to start, how to progress and get the patient results you want.
The New Grad Physio Mentor
PS. Do you struggle with your patient assessments and feel rushed, unsure how to order the questions and tests you do, or even what the best questions or tests to do actually are?
If you get your assessment wrong it can be hard to turn your patient around, as they lose faith in you and this is the worst position you can be in as a therapist.
Your patient assessment is the most important thing, because everything you do after this is dependant upon what you find during the assessment (that’s why it’s at the start!).
If you want some help so you can nail your patient assessments first time, give the right diagnosis and be confident you are treating the right thing, then reach out…
Just send me an email (firstname.lastname@example.org) with the word ‘ASSESSMENT’ and I’ll get right back to you with some more advice.