"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Sunday, February 17, 2008

Three Obstacles to Physical Therapy Diagnosis

It occurred to me that there are many reasons why physical therapists might not want to or can't routinely diagnose their patients. Here are three reasons that seem to be the most obvious.

1. Physical Therapy Diagnosis is too hard.

Physical therapists already provide implicit diagnoses.

It’s high time physical therapists develop some backbone and put a ‘Physical Therapy Diagnosis’ in the written Plan of Care to the physician, for example the following diagnosis is routine in my clinic.

“Functional limitation in overhead lifting due to loss of shoulder external rotator muscle strength” (measurement in the body of the plan)

The diagnosis implies the treatment (strengthening) which is also written in the Plan of Care.

2. Physicians don’t want a Physical Therapy Diagnosis.

A popular physical therapy management consultant advises his clients (PTs) to not diagnose patients because physicians will be upset and referrals will decrease.


If you want referrals ‘out the wazoo’ then you should act like the highly trained, educated professional that you are.

Physical therapists who take pride in their work, who diagnose functional deficits and who treat impairments in ROM and strength will become recognized as high-quality musculo-skeletal care providers.

Physicians ultimately want what is best for their patients and will tend to refer to those physical therapists who get good results.

3. Physical therapists aren’t trained in diagnosis

Diagnosis is a logical process that many trained professionals use to simplify complex sets of information and to standardize the workflow.

Physical therapists are trained in physical therapy.

Diagnosis is the result of systematically applying your training, education, experience and observational skills to your patients on a daily basis.

Each patient is unique but their conditions are rather routine.

· abdominal muscle weakness
· spinal instability
· hip joint stiffness
· postural syndrome
· shoulder joint stiffness
· rotator cuff weakness
· scapular dyskinesia
· knee extensor weakness

These are some of the conditions that every orthopedic physical therapist sees on a daily basis.

Each of these conditions is linked to a finite set of functional limitations (as described in the OPTIMAL scale).

Each patient deserves their own diagnosis.

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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

"Make Decisions like Doctors"

Copyright 2007-2010 by Tim Richardson, PT.
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American Physical Therapy Association
Consistent with the American Physical Therapy Association Vision Statement for Physical Therapy 2020, the American Physical Therapy Association supports exclusive physical therapist ownership and operation of physical therapy services.