How to Develop a Treatment Plan

Now that you have analyzed Dr. Chang's revised differential and diagnosis to be treated, it is time for you to critique Dr. Chang's work in developing a treatment plan. The physician's role at this stage is to recommend therapies that will ease or eliminate the patient's symptoms and that will help the injury to heal and prevent further damage. Another important goal is to help the patient return to normal functioning as soon as possible, minimizing the time lost from sports, school, and home activities, while also keeping the patient from further aggravating their injury.

Use the step-by-step instructions that follow to critique Dr. Chang's treatment plan for Jenny
Anderson. You will evaluate whether Dr. Chang addressed all of the necessary components of treatment for this patient and whether she made the appropriate recommendations in terms of the different treatment options.

Getting Started

1. Get prepared to do your work in this task.
   
   
   • Go to the email sent to you by Dr. Mendoza, and download the attachments. You will need the following throughout the task:
     
     
   • Treatment Plan and Rationale- This form shows Dr. Chang's plan for managing Jenny's injury. Dr. Chang lists the different treatment options she considered, the treatments she ultimately prescribed, and her reasons for choosing these treatment options over others.
     
     
   • Critique Template of the Treatment Plan- This is the form that physicians at Lakeshore Hospital use to critique a fellow physician's treatment plan and prognosis.
     
     
   • Carefully review the email from Dr. Mendoza to become familiar with the goals of this task.
     
     
2. Briefly review the attachments to the email-- the Treatment Plan and Rationale and the Critique Template of the Treatment Plan-- to familiarize yourself with the contents of each.
   
   • Read the general instructions in the beginning of the Critique Template so you'll understand how to use it and be aware of the questions you'll need to answer.
     
     
   • Read through the Treatment Plan and Rationale document to see the kind of information that Dr. Chang provided. Feel free to note any initial reactions you may have to Dr. Chang's recommendations, for example, if something stands out or surprises you.
     
     
   • When reading through both documents, familiarize yourself with the list of the various treatment components that may be present in a sports injury treatment plan.
     
     
3. Explore the available resources to get an introduction to developing a treatment plan.
   
   
   • First, work with your teammates to create a quick list of the questions that you have about how physicians in sports medicine create a treatment plan for a patient. These questions, as before, might help you to focus your thought process during this task.
     
     
   • As you read, take notes on any material you find that answers the questions you raised with your team or that may help you to critique Dr. Chang's choices.
     
     
   • Read section 5 of the Diagnosis and Treatment Process document: Develop a treatment plan (and/or prevention plan). This section describes some of the considerations a physician must make when developing an appropriate treatment plan for a patient.
     
     
   • Explore the resources on Developing a Treatment Plan in the Resources (above).
     
     
   • For additional guidelines that physicians in sports medicine follow during this step of the diagnosis and treatment process, see the Tips and Traps (above).
     
     
4. Organize your team to do the critique.
   
   
   • If you need a refresher on getting organized, refer back to the step-by-step in Task 1.

Completing the Critique Template: Sections A and B

Note: You will follow the same set of steps (given below) to fill out both Section A and Section B of the critique template. The difference between the two tables is the time frame for which the physician is planning—1-3 days following the injury in Section A and 4-14 days following the injury in Section B.

1. First, identify the most pressing issues that Jenny Anderson's treatment must address during the next few days (Section A) and in the next few weeks (Section B).
   
   
   1. Use the following questions to prompt your thinking about Jenny's needs. As you answer the questions, take notes to record a list of these needs and any important details you and your teammates generate.
      
      
      • What has happened to Jenny Anderson? That is, what specific parts of Jenny's foot and ankle anatomy need to be healed or repaired?
        
        
      • What symptoms and signs does Jenny have that need to be eased or eliminated? (These can range from generalized symptoms to specific limitations in motions or functions of the joint.)
        
        
      • What progress, both general and specific, does Jenny need to make before she can return to her normal activities? What might be done to speed up her recovery?
        
        
      • What do you think needs to be done, if anything, to prevent Jenny from increasing the damage to her ankle?
        
        
        • For example, if there is a fracture, what might cause the fracture to get worse? What could prevent that from occurring?
          
          
        • In addition, you should consider whether Jenny's ankle is stable or unstable. If there is significant damage to certain ligaments, it can lead to the movement of one bone away from another bone. What could be done to prevent that?
          
          
      • What kinds of things do you think Jenny must do in order to prevent future injuries? How might she prepare her body for injury-free participation in sports?
        
        
   2. To the extent that you are able, differentiate between the patient's needs in the acute stage (1-3 days after the injury) and the patient's needs in the following week or two, after the acute symptoms have subsided. (It's fine if you are not sure now, as you will research this information later.)
      
      
   3. With your teammates, come to a consensus about Jenny Anderson's most important health needs at this point. Develop a team list of these needs.
      
      
2. Decide whether each component of treatment was a) necessary, b) irrelevant, or c) wrong (and potentially harmful) to include for Jenny Anderson, in order to address the needs you identified. For each component, record your answer in the second column of the critique template. In order to decide whether each component of treatment was necessary, ask yourself the following questions:
   
   
   1. Am I familiar with each component of treatment?
      
      
      • If you are unfamiliar with any of the terms, research to find out what they mean.
        
        
      • Find out why each component is generally important in treating patients with sports injuries, and when it is usually used.
        
        
      • To help you, consult the following resources: Resources TBD
        
        
   2. Was each component necessary for Jenny Anderson?
      
      
      • To help you, consult the resources available.
        
        
        • See the web articles in the section on Treatment for Ankle Sprains as well as the FAQ on Treating Foot and Ankle Injuries in the Resources (above).
          
          
        • See the link on Ankle Sprain in the DATA (Diagnosis and Treatment Archive), also in the Resources (above).
          
          
      • Does this component of treatment appear to be recommended for the management of ankle sprains? Check to see if the component is recommended in reliable resources on treating patients with moderate to severe ankle sprains.
        
        
      • For which phase(s) of treatment is this component recommended?

      Note where you found any relevant information, as you will be exploring the same information in more detail in step 3.

   3. Using the information gathered above, was each component necessary to include for Jenny Anderson at that time?
      
      
      • As you fill in each table, make sure that the component was appropriate for Jenny during the specified time frame (approximately 1-3 days following the injury, or 4-14 days following the injury).
        
        
3. For each component of treatment, answer the question in the third column of the template: Did the physician make the correct recommendations with regard to this component of treatment? Explain why or why not. In order to decide whether Dr. Chang made the right choice in each case, ask yourself the following questions:
   
   
   1. Am I familiar with all the different treatment options available to address each component in cases of ankle sprain?
      
      
      • For example, there are a number of devices and methods used to immobilize a joint, such as braces, CAM walkers/ walking boots, and air casts. Use the materials in the Resources (above), including DATA and web articles, to gather information about the different options for addressing each component.
        
        
      • What are the pros and cons of using each option for treatment?
        
        
      • Based on this research, what are my own opinions regarding the best treatment options to meet Jenny Anderson's needs for the given time period?
        
        
   2. For each component, how did the treatment options Dr. Chang considered and the ones she chose compare to the choices I would have made? You may want to jot down notes and organize your ideas before filling in the template.
      
      
      • Check to see if Dr. Chang omitted a component that you thought was needed (or included something you thought was unnecessary or potentially harmful). If she did, note your disagreement in the template. Explain what you think she should have done and why.
        
        
      • For each component that Dr. Chang did address, decide whether she addressed it with the best treatment option. While the ultimate question is “Did the physician make the correct recommendations with regard to this component of treatment?”, use the following questions to guide the development of your response:
        
        
        • Did Dr. Chang address the component (or patient need) comprehensively? For example, if she prescribed strengthening exercises, do you think she included all of the exercises the patient needed and also educated the patient well enough on how to do them?
          
          
        • Did Dr. Chang implement the treatment option at the right time to best aid the patient's recovery? A treatment option that may be appropriate in the acute stages of the injury may be harmful if used in the later stages and vice versa.
          
          
        • Were Dr. Chang's choices consistent with the recommendations suggested by your research?
          
          
        • Based on your answers to the questions above, do you think Dr. Chang chose the best treatment option out of those available? Explain why or why not. If your answer is no, write what you think she should have chosen.
          
          
4. Check your work to be sure that you completed everything in the template that was required. Edit your work with the help of your teammates so that your ideas are clear and organized.
   

Meeting to Exchange Feedback

1. Meet with your cohort (made up of all teams participating in the rotation) to discuss your findings and ideas. Your mentor will assign your team one or more sections of the critique form at the beginning of the meeting. Your team will present your key ideas and lead the discussion of that section.
   
   
2. After incorporating any feedback you may have received during the discussion, submit your work to your mentor. Be sure to save all of your work, regardless of whether you submit it to the mentor.

• Physicians do determine what treatment options and techniques are appropriate based on the type of injury, its severity, and the goals of the patient for recovery.
  
  
• Physicians do consider the patient's symptoms, especially the degree of pain, when choosing among treatment options.
  

Communicating with the Patient and Family about Treatment

• Physicians do inform the athlete and the family about treatment options and their possible consequences in an understandable way. Physicians do invite the patient and family to participate in making treatment decisions.
  
  
• Physicians do make sure that the patient is on board with the plan. The physician checks to make sure that the patient and family understand the rationale behind the approach and understand and accept their role in the treatment process.

Making Decisions about Returning to Play

• In determining whether the injured athlete can return to playing the sport, physicians do make the health and safety of the athlete, including prevention of further injury, their highest priority. Physicians don't allow the outcome of the competition, parents and coaches to influence the decision; rather, the possible risks and consequences to the health of the athlete must always take precedence over other concerns.
  
  
• Physicians do caution patients to avoid painful activities during the rehabilitation process. The patient should not return to play until s/he is sure that s/he can stress the injured tissues without any reaction of pain, swelling, or limitation of movement. When resuming play, the patient should start slowly and gradually build up to full participation.
  
  
• Physicians do give advice to help minimize risk factors for the patient returning to play, such as checking for a safe play environment, wearing the appropriate athletic footwear, joint supports and safety gear, etc. They also incorporate strategies, such as building strength, into the treatment plan to prevent future injuries.

Diagnosis and Treatment Archive - Sports Medicine

Diagnosis and Treatment Process
This document describes the process that health care professionals typically use to diagnose and treat their patients.

Orthopaedic Glossary
This glossary defines many of the terms used in this rotation.

These two links are supplements to the glossary:

Anatomical Terms of Location FAQ

Joint Motions FAQ

Ask the Expert

What is the general professional opinion on prescribing pain medication that has a risk of addiction?

What are the risks of returning to activity for a patient with an ankle injury?

How do you decide is a patient can return to activity?

In what kinds of situations might a patient be allowed to return to activity sooner?