The diagnostic process: examples in orthopedic physical therapy

Diagnosis by the physical therapist has received increased attention in the physical therapy literature. The contributions thus far are in agreement that although physical therapists do not identify disease in the sense of pathology, they certainly can identify clusters of signs, symptoms, symptom-related behavior, and other data from patient history and other testing. These clusters can be labeled as classifications or diagnoses by physical therapists and can guide management of the patient. The purpose of this article is to discuss what has yet to be included in articles about diagnosis: the diagnostic process. We first acknowledge the complexity of the diagnostic process, reviewing the study of clinical diagnosis mostly from the field of medicine, including statistical as well as process-tracing approaches. We next discuss steps we believe are important to consider in order to interface the diagnostic process into entry-level training curricula, urging teachers and mentors of future physical therapists to rethink our emphasis on the problem-oriented medical record's "SOAP" type of approach as a clinical decision-making format. We next discuss error and clinical judgment and strategies to constructively deal with error in the clinical environment. We urge physical therapists to strive to reach a point at which we can (1) identify and classify patients in such a manner that allows for more efficient treatment management and (2) demonstrate such abilities in peer-reviewed publication form.