How to Communicate the Treatment Plan

As the next step in assisting Dr. Shah with Jenny Anderson’s case, you will communicate with the patient and family regarding Jenny's treatment and possibilities for returning to activity.

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. Shah’s choice for managing Jenny’s injury.
       
       
2. Organize your team to do the work.
   
   • If you need a refresher on getting organized, refer back to the step-by-step in Task 1.
   
   
3. Briefly read Dr. Shah’s treatment plan for Jenny Anderson and review Dr. Mendoza's e-mail for comments about the treatment plan.
   
   
4. Prepare to give the patient and family a realistic prognosis. Take notes on the following to help you prepare:
   
   
   • What is the musculoskeletal problem that the patient has? Describe how you will explain the problem to the patient and the family so that they can fully understand it.
   • What is typically involved in the healing process and recovery from this injury? How long does the process usually take?
   • For data to support your answers, consult Resources (above) in this or in prior tasks, as well as DATA, for information on the patient’s injury.
     
     
5. Decide which areas of the plan, if any, can be considered as alternatives for the patient. Take notes recording your ideas.
   
   
   • Remember, while you certainly want to help the patient return to the competition she enjoys and is committed to, the short and long-term health effects of what you recommend must be your utmost concern. Use the following questions to prompt your thinking about components of treatment you might be willing to change.
     • Is this component of treatment critical to address in some way at this time?
     • If so, are there any alternative methods or therapies that could be used to address this component of treatment? Might any of those methods give more flexibility to the athlete?
       
       
   • If there are options that would satisfy the same or similar health needs but give the patient more freedom, you may want to suggest them as a substitute. (For example, there are a number of different medical devices to choose from that can provide stability to a sprained ankle.) To find out about such options, explore the materials on treating ankle injuries in DATA (in the Resources above).
     
     
   • If there are options that could be used but would be inferior in fulfilling the patient’s health needs, note them. Note why choosing each option could entail health risks or less-than-optimal treatment for the patient. Include any long-term effects.
     
     
   • Are there any additional components that could be put into the patient’s plan that would help her to return to sports more quickly?
     • For example, are there any devices that could be used or strategies the athlete could employ that could serve as additional protection against reinjury? How safe and effective are these?
       
       
   • Can any parts of the treatment plan be adjusted in terms of the timing of treatment? For example:
     • Can any of the components of treatment be (safely) left out or delayed for a period of time? Why or why not?
     • Can any of the therapies suggested be carried out for a shorter period of time?
       • If your answer is “yes” or “maybe,” what signs of progress would you need to see from the patient in order to agree to abbreviated treatment? Note these so you can explain them to the patient.
       • If you think shortening each component of treatment would be detrimental to the patient, say so and explain why.
         
   • Consult the materials in DATA, including the Science links for background and the discussions of treatment for this diagnosis, to find information that supports your answers. Also review the Tips and Traps (above) to remind you of the ethical and legal considerations you must make in speeding up an athlete’s return to play.
     
     
6. Decide which components of treatment, if any, are critical to the patient's recovery. Prepare to advise the patient and family taking notes on each component you would not want to alter.
   
   
   • Why is this component of treatment so critical for the patient’s long-term recovery? Take notes to explain.
   • Why would replacing this component with a different option, delaying this part of treatment, or eliminating it be an inferior solution and inadvisable from a medical perspective? What are the risks the patient would face by changing this component of the treatment plan?
   • Again, consult the materials on Treating an Ankle Injury and the materials on Return-to-Play Issues in the Resources (above) to find information in the medical literature that supports your answers. For some of the ethical, legal, and medical principles involved in making these kinds of decisions, see the Tips and Traps (above).
     
     
7. Prepare to give the patient and family realistic expectations regarding the patient’s schedule for returning to play. Take notes on the following topics to help you prepare:
   
   
   • What are the major stages of rehabilitation for a patient with this diagnosis? What are the signs that the patient has reached each stage?
   • What is Jenny’s current status in the healing process? How far along is her recovery? What progress does she still need to make?
   • What are some of the physical demands of the patient’s sport (tennis)?
   • What benchmarks would you like Jenny to meet before you will clear her for play?
   • What are the risks and dangers involved in returning to play before these benchmarks are met?
   • What can the patient do, if anything, to meet these benchmarks more quickly? What work can she do to help the rehabilitation process?
   • For information on these topics, refer to links within DATA and to any other materials you research.
     
     
8. Based on your notes addressing all of the above (Steps 1-7), write a sample script that plans what you will say to the patient and family. Be sure that your script includes:
   
   
   • a clear explanation of the injury and a realistic prognosis
   • a discussion of the treatment plan, including elements that can be adapted or modified, elements that cannot be changed, and why
   • an overview of the rehabilitation process and the typical sequence followed by most patients with the diagnosis
   • a clear explanation of the progress Jenny needs to make and what signs or benchmarks you need to see to prove her progress
   • a plan for what you will say to address the patient and family’s psychological needs and distress

Meeting to Exchange Feedback

1. Meet with your cohort to discuss your findings and ideas. You will be assigned one or more portions of your proposed communication at the beginning of the meeting; your team will present your key ideas and lead the discussion of those portions with the cohort.
   
   
2. After incorporating any feedback you may have received during the cohort 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 conduct conscientious follow-up examinations of athletes with injuries, especially athletes who are minors (under 18), before clearing patients to return to competitive sports. Especially in the case of young patients, only those without health risk should be readmitted. Physicians do remain aware that they are vulnerable to lawsuits if a patient returns to play too early and suffers further injury.
  
  
• Conflicts may arise between an athlete’s desire to return to play and the physician’s responsibility to make appropriate medical decisions. Physicians do not allow themselves to be pressured into making particular decisions by patients, parents, coaches, etc. The physician’s commitment to serve the athlete’s health and welfare must always take precedence over the requirements of athletic competition. This is true even in the cases of professional athletes, when owners, teammates, fans, and monetary concerns may add additional pressure.
  
  
• Physicians do counsel young athletes not to push themselves beyond their limits; overuse, overtraining, and repetitive stress can cause damage to the growing body. While participation in sports can be healthy, if it takes the form of "training for maximum performance" at any price, the participation cannot be considered ethically and medically appropriate.
  
  
• When there is more than one appropriate treatment option for a sports injury, physicians do fully inform their patients and family members about the different options, including the short or long-term risks and benefits of each. Physicians do make sure that the patient and parent(s) fully understand and agree to the treatment ultimately chosen. This is known as the principle of informed consent.
  
  
• Physicians do consult other experts and refer patients to specialists appropriately; they use particular caution in rendering an opinion outside their own specialty and experience.
  
  
• Physicians do keep consistent and accurate records in case any medical or legal questions arise in the future. It is a good idea to record all decisions regarding treatment options, treatments given, prescriptions, etc. as well as a log of correspondence related to referrals and any follow-up concerns.
  
  
• Physicians do not record misleading or incomplete information on examination forms or clearance forms in order to help patients do something they’d like to do or to get excused from something they don’t want to do.
  
  
• Physicians do prescribe pain medications to the level that patient’s truly need it; however, physicians do not prescribe medications to help amateur athletes play sports through pain or because they help the patient “feel good.” They are alert to the possibility of abusing medications while not prohibiting them for those who need them.

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?