Treatment Recommendations for New Clinicians

Starting your career as a clinician can feel overwhelming, especially when faced with the challenge of making clinical decisions for every patient who walks through your door. You might have some ideas, but doubts creep in: “Am I recommending the right treatment? Is this the best approach for this patient?” These internal struggles are normal, and with time and experience, you’ll become more confident in your decision-making.

Here are some tips to help you hone your skills and feel more comfortable in your clinical practice:

Step 1: Gather Detailed Information

Your evaluation sets the foundation for effective treatment. A thorough intake and evaluation allow you to understand your patient’s story and symptoms, which is critical for guiding your clinical decisions. During the subjective portion of the exam, aim to answer these key questions:

• What is the injury?

• How did it occur, and what factors are contributing to it?

• What anatomical structures are likely involved?

• What makes the pain better or worse?

Too often, clinicians approach the subjective portion without a clear goal, simply going through the motions. Instead, think of it as a puzzle to solve. The more precise your questions, the clearer the picture of your patient’s condition will become.

Step 2: Refine Your Objective Examination

The objective portion should build on your findings from the subjective evaluation. Many new clinicians fall into the trap of gathering excessive information: testing every muscle and direction, running through every special test, and measuring every angle of range of motion. This can lead to information overload, which doesn’t necessarily help you pinpoint the cause of your patient’s symptoms.

Instead, use the objective exam to confirm or refute your initial hypotheses of what is causing the patient’s symptoms. Stay focused and targeted, using tests and measurements that directly relate to your patient’s story and symptoms.

Impairment-Based vs. Diagnosis-Based Treatment

In school, you were likely taught an impairment-based approach: identify deficits (like muscle weakness, range of motion, and special tests) and were taught to treat these impairments. While this can be helpful for straightforward cases, it often falls short for more complex patients.

A diagnosis-based approach, on the other hand, starts with a clear clinical diagnosis and tailors treatment to address the root cause. Here’s an example to illustrate the difference:

• Case: A female runner with anterior knee pain that occurs after running more than a mile. She points to her kneecap as the source of pain.

• Impairment-Based Approach: You identify weak glutes, poor balance, and pain-limited strength. Your treatment focuses on strengthening glutes and improving balance, expecting her symptoms to resolve.

• Diagnosis-Based Approach: You diagnose patellar tendonitis. Based on this diagnosis, you avoid strengthening exercises, as they may exacerbate her condition. Instead, you focus on stretching, foam rolling, and deep tissue massage for her quads and patellar tendon. After a single session, her pain improves dramatically.

Do you see the difference? A diagnosis-based approach ensures your treatment aligns with the underlying cause, leading to faster and more effective results.

Embrace the Challenge of Transitioning

Switching from an impairment-based mindset to a diagnosis-based approach isn’t easy. It requires practice, patience, and sometimes unlearning what you were taught in school. For me, this journey involved three years of rigorous study for my manual therapy certification. But the payoff has been immense: better outcomes for my patients and greater confidence in my practice.

Tips for Making the Transition

1. Be Patient with Yourself: This shift takes time. Allow yourself to learn and grow at your own pace.

2. Seek a Mentor: Find someone who practices diagnosis-based treatment and learn from them. Their guidance will make the transition smoother and more manageable.

3. Reflect and Adjust: After each session, take time to reflect on what worked and what didn’t. This will help you refine your approach and build confidence.

The Bottom Line

Effective treatment begins with understanding your patient’s story and using that information to guide both evaluation and treatment. By focusing on diagnosis-based care and remaining adaptable, you’ll not only achieve better results but also foster stronger relationships with your patients. Remember, this journey is a marathon, not a sprint—but with dedication and persistence, you’ll get there.