Step II PE Question

[MedicineMike]

Taking the PE in a few days and have a question about the "osteopathic exam." I don't even know what that is, for starters. Do I need to list it under objective portion?

Thx

 

[HarryPlopper]

That means OMM and it should be under plan that you discussed with patient about OMM and you performed it.

 

[MedicineMike]

That means OMM and it should be under plan that you discussed with patient about OMM and you performed it.

Ok great. I planned on putting it in the plan but just wanted to make sure I didn't have to do one of those diagnoses or something

 

[PB n J]

There is also a focused osteopathic structural exam. This includes checking the extremities for motion in all planes; checking the cervical, thoracic, or lumbar spine; checking the sacrum; checking the innominates; or anything else you can think of. This is generally catered toward the chief complain. Not all areas need to be checked. You would put this under the objective portion of your note and any diagnoses you list in the form of "________ somatic dysfunction" must be supported by the information you gained from your focused osteopathic exam and listen in the objective portion of your note.

 

[MedicineMike]

There is also a focused osteopathic structural exam. This includes checking the extremities for motion in all planes; checking the cervical, thoracic, or lumbar spine; checking the sacrum; checking the innominates; or anything else you can think of. This is generally catered toward the chief complain. Not all areas need to be checked. You would put this under the objective portion of your note and any diagnoses you list in the form of "________ somatic dysfunction" must be supported by the information you gained from your focused osteopathic exam and listen in the objective portion of your note.

So can I put somatic dysfunction in my assessment without listing an osteopathic exam in the objective part?

 

[PB n J]

How do you know there is a somatic dysfunction, and similarly, how do you wish to treat said somatic dysfunction if you didn't examine the patient in order to diagnose the exact somatic dysfunction?

*Edit: I guess you could, although I don't know specifically. I just know that I always put a supporting finding in the objective portion of my note (and I recently received a passing score).

 

[MedicineMike]

How do you know there is a somatic dysfunction, and similarly, how do you wish to treat said somatic dysfunction if you didn't examine the patient in order to diagnose the exact somatic dysfunction?

*Edit: I guess you could, although I don't know specifically. I just know that I always put a supporting finding in the objective portion of my note (and I recently received a passing score).

So let's use an example: pt comes in with shoulder pain

I check their ROM and realize that it is decreased, but don't find any other TART findings bc the pt is just acting

So under objective I write: "omm - decreased abduction in left shoulder"

Is that good enough, or do I need to write more?

 

[BigSib]

This thread worries me.

As an example, someone presents with low back pain. You will perform a structural examination and mark the appropriate somatic dysfunction in the objective section of the note. Maybe the cause is really a herniated disc, muscle strain, whatever - somatic dysfunction is now on your differential in the assessment portion of the note. During the encounter the patient asked, "My friend had this thing called, OMM - do you think that would be beneficial for me today?" You performed lumbar soft tissue and subsequently indicate that you performed this technique in the plan section of the note.

 

[MedicineMike]

This thread worries me.

As an example, someone presents with low back pain. You will perform a structural examination and mark the appropriate somatic dysfunction in the objective section of the note. Maybe the cause is really a herniated disc, muscle strain, whatever - somatic dysfunction is now on your differential in the assessment portion of the note. During the encounter the patient asked, "My friend had this thing called, OMM - do you think that would be beneficial for me today?" You performed lumbar soft tissue and subsequently indicate that you performed this technique in the plan section of the note.

So if I test them and only notice that try are decreased in lumbar flexion for example, is that sufficient enough to be able to put somatic dysfunction in my assessment?

Also, what if they have shoulder problem and tenderness with motion is the only finding... Is that also sufficient enough to claim somatic dysfunction?

Thx

 

[BigSib]

... if I only notice that try are decreased in lumbar flexion for example, is that sufficient enough to be able to put somatic dysfunction in my assessment?

Probably not, but it depends on the severity of the problem and the orientation of the work-up. If the patient is there for mild low back pain then you really should be as specific as possible with your osteopathic diagnosis (e.g., L2 flexed, sidebent right, rotated right) if you plan to treat the patient with OMT. If the patient is there for acute low back pain in the ER with a fever and such then the osteopathic correlation is not as important to your note.

... what if they have shoulder problem and tenderness with motion is the only finding...

Students are not well versed in documenting osteopathic structural findings outside of the spine, so in light of this just do your best. Most of what you will want to describe should be listed under the musculoskeletal exam in the objective section. Note fascial restrictions, restrictive barriers in various ranges of motion, and muscle hypertonicity for the osteopathic exam of the knee, shoulder, etc. It depends upon if you plan to treat the dysfunction in the room - if the patient asks you for OMT then you should have some form of an osteopathic exam in your objective section for that patient.