Medical Screening Examination: Not Optional for Physical Therapists

William G. Boissonnault, Charles Bass

This paper was submitted in response to the clinical commentary entitled "Diagnoses Enhances, Not Impedes, Boundaries of Physical Therapy Practice" (JOSPT 13(5):218-219).

We have read with interest and respect the clinical commentary by Behr et al (1) regarding boundaries of physical therapy practice. Their review of "Pathological Origins of Trunk and Neck Pain-Parts I (2), II (3), III (4)" reflects some philosophical similarities and differences regarding the physical therapist's role in the differential diagnosis process.

We believe that physical therapists should include a medical screening component in their examinations. This screening is a necessary adjunct to history and physical examination components, which are designed to identify mechanical dysfunction(s) related to patients' symptoms and/or functional limitations. The Review of Systems Checklists (Tables 5-10, Part I) (2) present items designed to screen a body system (i.e. gastrointestinal system) for general pathology. The checklists are NOT designed for screening specific diseases-such as peptic ulcer, cholecystitis, pancreatic cancer, or hepatitis. "Yes" responses should prompt therapists to refer their patient to a physician. This is clearly stated in the forward (5) and the subsequent articles (2-4).

J Orthop Sports Phys Ther 1991;14(6):241-242.

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