Lec3 Ethics PDF

ETHICS OF DIAGNOSIS, TREATMENT AND PROGNOSIS and PT ROLE Diagnosis can be defined in two ways. Firstly, "the term which denotes the disease from which the person suffers (such as osteoarthrosis)", and secondly, the art of applying scientific methods to the elucidation of the problems presented by...

ETHICS OF DIAGNOSIS, TREATMENT AND PROGNOSIS and PT ROLE Diagnosis can be defined in two ways. Firstly, "the term which denotes the disease from which the person suffers (such as osteoarthrosis)", and secondly, the art of applying scientific methods to the elucidation of the problems presented by a sick patient". There are three types of diagnosis; (1) Primary diagnosis or the presumptive diagnosis (the most likely based on symptoms, history, physical examination), (2) Secondary diagnosis or the working diagnosis (on which management is planned), and (3) Precise diagnosis or the definitive diagnosis (an accurate description of the patient's complaint based on all the evidence, including special investigations and treatment. Due to a science-heavy education of physical therapy students, the physical therapists' eyes are considered as "consultant eyes". Physical therapists need to be able measure, calculate, reason and analyze data. They have to interpret and evaluate information to diagnose patients. Physical therapy's diagnosis of a disease is made; First, from observations; history of symptoms and signs, physical examination and any special tests; Second, by analysis of the value of the information obtained and Third, by synthesis of this information, to reach a clinical diagnosis which explains all the facts. So, at first visit physical therapist should: Provide a little information at a time.  Recognize that no everyone wants to "know the worst" even though they may have said so. Always provide hope by referring to the patient's present state compared with the past, or by giving anecdotal "past similar case" experiences of other patients. Why must the patient know the diagnosis? First; it serves as a respectable explanation to others to satisfy curiosity of what is wrong. Second; to give the patient some insight into his disease. Third; to make the illness more tolerable than a nameless fear. Fourth; To gain the true information from the health profession member not from friends. So, this prevents the patient acquiring a false diagnosis. Finally; it acts as warning because ignorance can be dangerous. Treatment (therapy or remedy) is defined as any specific procedures used for the cure of a disease or pathology, there are many types of treatment as surgical, medical, conservative, prophylactic or preventive and supportive treatments. During talking about treatment with the patients the following ethical principles should be followed: What is the name of physical therapy techniques or modality used (electrotherapy, hydrotherapy, therapeutic exercises, mobilization, manipulation, muscle testing)?  What these modalities for, their time of application and how? How important is physical therapy? What about the side effects of these modalities? How long will the patient need to continue with these modalities? When physical therapist will see the patient again? What about home program if needed? common mistakes One of common mistakes in physical therapy application is rule of "6" in sessions' numbers. Some physical therapists follow the rule of "6" to determine the number of sessions for patients. For example; this case needs 6 sessions or 12 sessions or 24 sessions or 30 sessions, etc. This is not a scientifically based rule. One explanation of this mistake is the attendance of patients will be 3 times/ week to get their treatment. In evidence based physical therapy "EBPT" some patients need daily sessions (as acute onset of paralysis and in intensive care unit), some patients need one session per week (as in shockwave therapy) and others need twice session per week. The number of session is determined according to the patient's definitive  diagnosis, patient's response and the available resources. Avoidance of this mistake needs critical judgment and experience. Prognosis is the determination of the level of optimal improvement that might be attained by the patient/client and the amount of time needed to reach the level. As well prognosis can be defined as; the forecast of the probable outcome or course of a disease; the patient's chance of recovery. The following are examples of questions commonly asked by the patients: What disability, deformity or disfigurement will I have? When will I get better and when can I return to work? If the disease is likely to be fatal, how long have I got? How will I die? Will there be pain? Predicting the prognosis is an art. Sometimes; prognosis is considered as the art of giving bad news or good news. Physical Therapy Role Roles in primary care : For acute musculoskeletal and neuromuscular conditions, initial examination are appropriate physical therapist responsibilities. The primary care team may function more efficiently when it includes physical therapists, who can recognize musculoskeletal and neuromuscular disorders, perform examinations and evaluations, establish a diagnosis and prognosis, and intervention without delay. Roles in secondary and tertiary care : Individuals with musculoskeletal, neuromuscular, cardiovascular/pulmonary, or integumentary conditions may be treated initially by other practitioners and then referred to physical therapists for secondary care. Tertiary care is provided by physical therapists in highly specialized, complex, and technology-based settings (e.g., heart and lung transplant services, burn units) or in response to the requests of other health care practitioners for consultation and specialized services (e.g., for individuals with spinal cord lesions or closed head trauma). Roles in prevention , promotion of health and wellness Their roles range from helping individuals with chronic conditions engage in physical activity programs to advising elite athletes on sports performance enhancement. These initiatives decrease costs by helping individuals: (1) achieve and restore optimal functional capacity; (2) minimize impairments, functional limitations, and disabilities related to congenital and acquired conditions; (3) maintain health (by preventing further deterioration or future illness); and (4) create appropriate environmental adaptations to enhance independent function. Examples of the prevention-screening activities in which physical therapists engage include: Identification of lifestyle factors (e.g., amount of exercise, stress, weight) that may lead to increased risk for serious health problems. Identification of children who may need an examination for idiopathic scoliosis. Identification of elderly individuals in a community center or nursing home who are at high risk for falls. Identification of risk factors for neuromusculoskeletal injuries in the workplace. Pre-performance testing of individuals who are active in sports. Examples of prevention activities and health, wellness, and fitness promotion activities in which physical therapists engage include: Workplace redesign, schools, strengthening, stretching, endurance exercise programs, and postural training to prevent and manage low back pain Ergonomic redesign; strengthening, stretching, and endurance exercise programs; postural training to prevent job-related disabilities, including trauma and repetitive stress injuries  Exercise programs, including weight bearing and weight training, to increase bone mass and bone density (especially in older adults with osteopenia and osteoporosis). Exercise programs, gait training, balance and coordination activities to reduce the risk of falls—and the risk of fractures from falls—in older adults.