My first concern when negative change in function happens isn't about me or my ranking in FOTO's database. You see, the reason I use FOTO isn't for my own self-serving purpose. My motive is two fold: to serve each patient as best as I can and to grow, learn and improve. A negative change in functional score leads me to have a conversation with the patient to gain an understanding of their perspective.
As mentioned in a previous post, the conversation is dependent upon whether I am surprised by the score or not. As a geriatric clinical specialist, it isn't uncommon for negative change to happen. I have patients receiving dialysis... patients going through chemotherapy... patients having medication changes... patients with issues occurring in multiple body systems. My first response is not to freak when the score changes negatively. There are plenty of times I expect the score to change negatively. In fact, I view this as a test to the level of a patient's honesty with me.
For the patients who I predicted should have had a negative change, my conversation focuses on appreciating that negative change and my pleasure with FOTO's capability to capture the change. I spend time plotting out a game plan of when their individual situation should change so the person is back up where he/she started or better.
What about those patients who have been less than stellar in embracing their role in improving their situation? During this conversation, I focus the discussion on leading the patient through a problem solving process of how or what needs to change to help them be more active in their rehabilitation. Improvement is up to them because they are the leading star in their rehabilitation journey while my role is that of an assistant.
My conversation is much different when a negative change occurs unexpectedly. In this case, my primary concern is differential diagnosis. Did I miss something during my evaluation and examination? Is something else occurring that is inhibiting their ability to improve? Has their situation truly worsened or is this negative change shifted to reality? (By this last question, I mean the person misperceived their ability and learned via working with me the level of their functional deficits.) I feel like I'm in the middle of a good mystery unraveling it to bring light to the situation.
As you can see, FOTO helps drive my clinical thinking and my conversations with patients.
Until next time,