roles and responsibilities

Question 1

What is primary healthcare ? what are examples ?

Answer 1

to mgmt pt. needs till point of hand off to other provider 
3 C's 
Comprehensive
Coordination
Continuity
Characteristics include: 
1. Safe 
2.Effective 
3.Timely 
4.Efficient 
5.Equitable 
6.Patient-centered 

PTs, NP, PA,Family Physicians/General Practitioners Osteopathic Physician General Internists

Question 2

What is secondary healthcare ?

Answer 2

Consultative
Short Term
Disease Oriented
Assisting PCP
Historically...PT

Question 3

what is a Family/Osteopathic Physicians/GPs?

Answer 3

• Graduation from medical school
• Complete minimum of 3 years post-grad training
  -At least one month learning MSK conditions
• Shadowing orthopedist
  /sports medicine

Question 4

what is a General Internist?

Answer 4

med school with 3 years post training
no req for msk training
focus on visceral conditions; DM, HTN, Cardiac disease

Question 5

what is a PA?

Answer 5

2 years of training
1 year of clinical rotations
no IND practice, always under doc

Question 6

What is a NP?

Answer 6

clinical focus is variable but those who pursue higher EDU after grad from RN degree

Question 7

What are potential benefits of Primary Care PT?

Answer 7

A more efficient use of health care resources

Care being delivered in a more timely manner

Interdisciplinary collaboration

Question 8

What is PT access in the VA like?

Answer 8

• PTs screen patients in the ED
• Primary care clinic then triage by a nurse
• Direct: overweight patients or those who wish to improve their general health

Question 9

what are goals of the patient centered interview?

Answer 9

• Exploring the patient’s disease/diagnosis and its effect on his or her life.
• Understanding the whole person.
• finding common ground regarding intervention or management.
• Advocating prevention and health promotion.
• Enhancing the patient-provider relationship.
• Providing realistic expectations.

Question 10

what are different layers to a persons illness experince?

Answer 10

• pt profile
• goals
• fxn limits
• Patient’s perception about the disorder
• Patient’s feelings about the disorder

Question 11

what are Goals of Patient History?

Answer 11

• Establishing rapport
• Identifying any barriers to communication
• .Identifying the patient’s preferred learning style
• Establishing the patient’s goals for physical therapy
• SINSS

Question 12

what are examples of open ended questions?

Answer 12

Open-ended Questions
•Can you think of anything that makes your pain worse?
•What makes your pain better?
•What happens to your pain at night?
•How did you feel after our last visit?
•Can you describe the pain for me?
•How do you feel when you first wake up in the morning?

Question 13

what is important to remember while communicating ?

Answer 13

1 Q at a time

• restate, and summarize
• dont use jargon
• use pt line of thought
• avoid assumptions
• use a self assessment; what do they think or feel

Question 14

what are examples of questions to get more info?

Answer 14

• Would you tell me more about that?
• What has this been like for you?
• is there anything else?

Question 15

What are examples of clarifyign statements

Answer 15

I hear you saying…

• I want to make sure I understand you.
• You let me know if I’m off track, OK?

Question 16

What are responses to tough convos?

Answer 16

• That sounds tough.
• I imagine you might feel …
• I can see that you are …
• You should feel good about that.

Question 17

what are tips for Patients with Hearing Deficits?

Answer 17

1. quiet space
   2, should use hearing and visual aids when available.
   3.Clinician should position themselves to facilitate lip reading.
   4.Use of interpreter (ASL) may be needed.

Question 18

what are tips for angry patients?

Answer 18

watch out for

• pacing, body behavior, tension in hands like gripping, tone of voice
• try to deescalate and dont push them over the edge

Question 19

What are tips for depressed pts?

Answer 19

acknowlege it - “it seems like youre struggling do you want to talk about it”

• Impaired concentration.
• Poor compliance with home instructions.
• Clinician should acknowledge the situation.
• Explore potential reasons.
• Recognize potential for suicide.

Question 20

why is it important to get an important exam?

Answer 20

1. Differential diagnosis. 2.Safe delivery of physical examination.
2. Review patient’s list of medications.
3. Assess potential impact of co-morbidities.

Question 21

what are elements of the health hx ?

Answer 21

Patient demographics.

2. Social history
3. Current medical situation
4. Past personal medical history Illnesses,Allergies,Surgeries,Injuries,Medicatins
5. Social habits
6. Family medical history.

Question 22

What questions should follow the body chart?

Answer 22

area of syms and areas without symps, go through each to clarify

• qualifications of symps; quality
• chronology; what happened 1st
• p1 vs p2 relationships

Question 23

what are components of social hx and habits?

Answer 23

Social History
•Cultural customs
•Religious beliefs
•Occupation and work status 
•Living environment
 •Family and social support 

Social Habits
•Exercise:  Frequency and Intensity 
•Use of tobacco 
•Alcohol intake 
•Caffeine intake

Question 24

what are risks associated with tobacco?

Answer 24

•Leading cause of preventable death
•Smoking leads to disease and disability
•Harms virtually every organ system in thebody
•Primary risk factor/causes:
Cancer
Heart disease
Strokes
Lung diseases
Diabetes
COPD

Question 25

what does CAGE stand for?

Answer 25

-Have you ever felt you should Cut down on your drinking?
•Have people Annoyed you by criticizing your drinking? •Have you ever felt bad or Guilty about your drinking? •Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)?

Question 26

what is caffeine intoxication?

Answer 26

-recent consumption of caffeine (≥ 2-3 cups)
•Distress or impairment in social, occupational, rehabilitation, school, etc

Caffeine Withdrawal Presents with: Headache Lethargy
Fatigue
Dysphoric mood
Muscle pain/stiffness

Question 27

what is a good flow to review collected info ?

Answer 27

1. Review patient health history beforehand.
2. Begin with patient’s chief complaint.
3. Discuss therapy and patient’s own goals. 4.Review patient health history for accuracy, thoroughness

Question 28

Will a pt volenteer all information freely?

Answer 28

not always, explain to them that theres overlap btwn MSK and visceral pain

Question 29

what are descriptors for Vascular disorders

Answer 29

–throbbing
–pounding
–pulsating

Question 30

what are descriptors for Neurologic disorders

Answer 30

–sharp –lancinating
–shocking,
–Burning

Question 31

what are descriptors for Visceral disorders

Answer 31

–aching, 
–squeezing 
–gnawing 
–burning,
 –cramping

Question 32

What elements and behaviors descriptors should be investigated?

Answer 32

•pn at Rest
•Activities
•Time of day (morning, midday, evening, or night) Positions and postures •Constancy
•Frequency
•Duration of symptoms •Fluctuations in intensity; ass ociated with non physical activities such as eating?
- changes in location?
•24-hour behavior

Question 33

what are considerations for Night Pain ?

Answer 33

• How many nights per week?
• Is there a consistent time when you wake up?
• How does the intensity of the night pain compare with the pain experienced at other times of the day •What do you have to do to fall back asleep?