Early in my career as a Physical Therapist I was very eager to “fix” every diagnosis that came my way. I actually stated I would never be interested in working with Geriatric patients because they have so many medical issues that you can’t fix it all. My attitude was both naïve and sad, but it also reflects a tragic truth about modern healthcare. We treat or manage literally every problem, but we don’t prioritize preventing or avoiding anything. Providers are forced to play diagnosis “catch-up.”
It took me a few years to learn that I wasn’t actually “the fix”. That knowledge shifted how I practiced, leading me to acknowledge maladies that we might prevent before they became (cue dramatic music) a diagnosis.
From my view, prevention seemed to be the way to improve my patients’ overall and long-term health. We were not only addressing today’s concerns, we were enabling them to do more of what they loved, for years and decades to come. You know, the illusive “quality of Life” topic.
Because knowledge is power, I wanted to read and learn more so that I could give my patients the best advice possible. As I educated myself, I began to see what medicine often misses. I learned the vast majority of those “Complex Geriatric Syndromes” I had held such distain for were entirely preventable with appropriate and early intervention. When comparing the existing research with how my colleagues practiced, I noticed that rarely, if ever, were predictive components assessed by any medical provider.
To combat what I perceived as “missing” I began including more functional and predictive data in my notes and educational components during my patient visits. While I wanted to be thorough, I also wanted to give my patients the empowerment of knowing that they could make a positive difference in their own lives. I mean, we’re physical therapists, how could I not want my patients to understand how physical movement affected all aspects of their life?
During the mid-2000s my annual performance reviews started becoming arduous. Notations like, “You’ll improve your efficiency if you assess less” or “I want you to stop assessing walking and balance components on your neck or shoulder patients”. I explained my premise and cited my overwhelming positive patient outcomes thinking that would be enough.
After a decade of push-back, I finally received my justification in 2015 when Avin published in a Physical Therapy Journal that we should consider assessing factors of mobility prior to muscular concerns. If that wasn’t powerful enough, in 2016 Goldman et al. published a multi-national study on risks for mortality. Many of the risk factors for premature death were components I had been checking on my patients. Screening tests like mobility, walking speed, and balance concerns – roughly half of the list of mortality identifiers, were tests that I was being told were “extraneous crap”. None of these screenings were part of our “standard care package.”
Including testing and education that was not “standard” was my downfall; but ethically, I didn’t see much point in “fixing” my patient’s shoulder pain only to have him fall down and break his hip or get a traumatic brain injury. (There are more than 38,000 fatalities per year due to falling – that’s over 100 deaths per day). Why wouldn’t my supervisors allow me to do BOTH? What about patient CARE?
Our western medical system is reactionary. We wait for a problem to show up and then we get referred to the person best able to address that problem – it all happens AFTER. (Martyushev, 2022 PMID: 35651862 and Langevin, 2022 PMID: 35273832) Despite guidelines and recommendations, even from two decades ago encouraging more mobility assessments, these are rarely performed in the clinical settings; one author said assessments were “dramatically lacking from Physiotherapy practice.” (Algudairi, 2024 PMID: 39807376) Another author notes that screening and follow-up are typically poorly supported in clinical practice despite clear evidence of effectiveness. “Rehab Professionals have been slow to adopt this practice”. (Clemson, 2017 PMID: 28173827)
Okay, great. Ron gets marked down and then some papers get published and Ron is justified. So, what’s the problem? Nothing has changed. The more I read, the more I assessed, the more I saw, and the numbers were staggering; I couldn’t unsee what was walking through my clinic every single day. While a former boss suggested that I assess fewer things, a new boss suggested that I stop treating potentially preventative issues that are ten or twenty years away from needing treatment. Ethically, I couldn’t identify a person at risk and do nothing for a decade until something catastrophic happens. I took a Hippocratic Oath and was committed to providing the best care possible to every single patient; and not addressing a concern was unacceptable.
So here we are in 2026. The theme of this year’s National Physical Therapy Month is “PT for Future Me”. It’s catchy and cute, but it feels disingenuous. The world of modern medicine pushes providers to see more patients – to take a more limited or specialized look at one or two factors without seeing the whole person in front of us. It is time that we, as consumers of the US Healthcare System, demand our providers understand all of what we bring to our appointments. We need to actively seek out providers who are driven to gain a deeper understanding beyond simply “what’s wrong with you?” I encourage each reader to seek out providers who can take the time to learn about your life, who will take the time to explain options that fit your life, and encourage you to live your best life.
No AI was used in this blog – it’s all us
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