I agree whole heartedly with my esteemed colleagues, about the value of lab values. However, my personal observation of a vast majority of PT practitioners in the application of this knowledge base, has been less than optimal.
I see multiple threads of discussion of the use, applicability, and other utility of lab values. Yet, a vast number of PTs in clinical practice, even now, barely glance, if at all, far less understand significance of the various numbers representing the clinical lab work. Even less, understand the notations associated with documentation of lab work. Why is this breakdown between academia and practice? For those astute individuals who are routinely using this information, how are they different from the others?
Now don't get me wrong. I like the notion of evidence in practice. And towards this end I find a lot of PTs looking to integrate knowledge of lab work into clinical reasoning. However, there are also those, who are still trying to find justification or evidence, for rationalizing the utilization of labs in PT practice. It does not make sense why an integral part of the evaluation of physiological homeostasis is being debated for clinical relevance, as if it is a separate entity.
Let me digress for a moment. Much as we focus on the unique body of knowledge in PT, one undeniable fact in the realm of evidence-based practice of physical therapy remains the allopathic philosophy, which we commonly share with the general medicine body as well. The science of PT practice is based on the same cause-effect relationships that govern modern medicine. Obviously, here is our trump card over some of our so-called "competitors" whose philosophy may be rooted "elsewhere" (read: spinal misalignment OR, bone misalignment).
Using the philosophy of allopathy, we need to able to ascertain how the pathology (cause) is affecting (effect) homeostasis and vice versa. Obviously, labs are adjunct investigations. But these help in setting the baseline understanding of the development, progression, and prognosis of disease. With specific reference to Acute PT practice, but may equally be broadened to include any setting, we need to understand how pathology and lab values are integrally tied. And to try to treat a condition without an integral understanding of the pathologic homeostatic mechanism is truly not wise.
Which brings me to a question. Why do we need to have to find evidence, just to support the use of lab values in our practice? It may be poor analogy to some, but to me, it is like trying to find evidence of the need to do a history review, or, a chart review, for purpose of evaluating a patient. I have never, ever, seen anyone asking the relevance, or evidence, of history taking, for instance! Then why do we need to do that for integrating knowledge of lab values ?
Well, I think I can partially guess why. And I will try to hazard a complex thought with the hope that I write it right. We are rapidly approaching a new era in PT practice. Something we refer to as autonomous practice, or simply, Vision 2o2o. As we progress towards our goal, we have awakened to the higher calling of practice. We are expanding our practice turf and hopefully advancing our level of responsibilities to the point where we may possibly serve as healthcare gatekeepers of our own specialty. At this time, progressive professionals are trying to catch up with the missing pieces of the puzzle of complex medical syndromes and how they impact what we as PTs can offer; and academics, on their part, are trying to integrate that knowledge base into coursework of future professionals.
However, from my own vantage of teaching scores of students in clinical rotations, I find them poorly prepared to integrate classroom knowledge with practice philosopy for one MAJOR reason. And that is the flaw in the method this lab work teaching is engineered. Many of the current students, as well as well meaning PTs in practice, are attending weekend courses and seminars, as a continuing education in lab values. And I admit, there is value to this as no knowledge ever goes waste in my philosophy. However, using this method, it will be years before a clinician can become adept, far less astute in assessing significance and application in practice. Indeed, if my thinking is right, there needs to be a paradigm shift in how this piece of knowledge should be integrated into education.
And that would require three components:
- Revamping and retooling the packaging of the knowledge;
- Residencies - in appropriate settings, with worthy mentors;
- Teachers that can get out of the handout mode and REALLY teach the integration of this knowledge base without asking guest doctors to superficially skimp through the information.
Having stated this, I will write a brief on my take on Lab values and how they should be packaged as a larger piece of the puzzle. So, read on...
Lab work is part of a larger Science: Lab Medicine. Lab medicine may be defined as the study of the molecular and cellular constituents of blood and other body fluids for the diagnosis and management of illness and for the investigation of the mechanisms and pathogenesis of disease. Each subtle variation of lab values are integral to the pathologies that they are associated with. We may know the relationship, which is when we can make good judgments. And we may not know the relationship, where we may miss making optimal judgments.The best way to assimilate this is by understanding the basic pathology and its physiopathologic basis by which a disease is known to alter normal homeostasis. Thus, the best method of interpreting lab work, is to integrally package the knowledge of the pathologic basis of disease, and how it affects processes, altering normal homeostatic mechanisms as a composite study.
I appreciate your patience in reading this long post.
Have a great time folks. Good to have you as a valued reader.
Until next time....
Cheers,
AcutePT
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