Meet Juanita - she's my patient.
Juanita fell two weeks ago and fractured her left proximal humerus.
Juanita has also been diagnosed with early Alzheimer's disease and neck pain subsequent to the fall.
Even though she makes every effort to cooperate Juanita can't can't change this fact: she is a complex patient.
For those who use Electronic Medical Records (EMR) this next question is familiar territory: which template do I use?
I have a choice of at least four templates in Juanita's case:
We could choose templates that divide the patient up by anatomical part, functional segment or risk reduction strategy:
- Shoulder pain template
- Cervical pain template
- Falls prevention template
- Dementia screening template
I took the position that one (1) template would better fit the current 'best practice' model.
We discussed the 'best' template and agreed that while one might be too few, twelve might be too many. How many templates should physical therapists use for typical, high-volume conditions?
My rationale for one template is Wainner's Regional Interdependence model - where dysfunctional motion at some body segment, like the hip, is liable to show up as symptoms in another body segment, like the knee.
One argument against multiple templates based on anatomical body part is that these templates trap PTs into thinking along the lines of the pathophysiological 'Medical Model' that has failed so many chronic pain and movement dysfunction patients we see in physical therapy.
If you are told by your clinical manager that you, as the PT, need to fill out the 'elbow' template then could miss important findings in the cervical and thoracic spine, the shoulder and maybe even the wrist.
You may be disinclined to screen for dementia, depression or Fear Avoidance Beliefs.
What should a PT manager do?
One, two, four, or twelve templates?
Which is the best number?