Differential Diagnosis for Physical Therapists: Screening for Referral. 4th ed. Goodman CC, Snyder TE. St Louis, Saunders Elsevier, 2007, softcover, 911 pp, $69.95.
Differential Diagnosis for Physical Therapists: Screening for Referral is a medical screening textbook with significant improvements and expansion in the recent 2007 edition. The new “Screening for Referral” part of the title clearly reflects the goal of this edition. As more and more physical therapists practice in direct access environments, the need to recognize conditions that are outside the scope of practice and to know when referral is necessary for patient safety and wellbeing becomes paramount. The goal of the textbook is to enable readers to recognize red flag histories, risk factors, and symptoms and signs that indicate referral is necessary. In each section the text does an excellent job at discussing medical diagnoses that may clinically be similar to neuromuscular or musculoskeletal conditions that are addressed by the therapist. In the preface, Goodman and Snyder clearly state, “It is not our intent to teach physical therapists how to diagnose pathology or medical conditions, which we consider outside the scope of the physical therapist's practice.” This textbook is a valuable resource and will serve as a reference that will likely be used well into the graduate's professional career.
The 4th edition is greatly expanded with more than 300 additional pages of information and is significantly reorganized. Section One, with 4 chapters, provides an introduction to screening and the interviewing process. Chapter 3, “Pain Types and Viscerogenic Pain Patterns,” is a new chapter that has been added and includes discussions of sources of pain, types of pain, systemic versus musculoskeletal pain, system versus psychogenic symptoms, viscerogenic pain and emotional and psychologic overlay. Chapter 4, “Physical Assessment as a Screening Tool,” is also a new chapter providing a survey of physical screening that includes auscultation, integumentary, nail bed, lymph node, musculoskeletal, neurologic, and body region screening and is well illustrated.
Section Two, “Viscerogenic Causes of Neuromusculoskeletal Pain and Dysfunction,” is a collection of chapters organized by body system. Chapters cover hematologic, cardiovascular, pulmonary, gastrointestinal, hepatobiliary, urogenital, endocrine/metabolic, and immunologic diseases and disorders, as well as cancer. In the previous edition, there was a single chapter on systemic origins of musculoskeletal pain. In this 4th edition, Section Three represents the most reorganized section of the text and now includes 5 separate chapters discussing systemic origins of neuromuscular or musculoskeletal pain and dysfunction, organized by body region: head/neck/back, sacrum/sacroiliac/pelvis, lower quadrant, chest/breasts/ribs, and shoulder/upper extremity.
The inside front and back cover each include an easily accessible listing of reference values for common clinical laboratory tests. Each chapter includes key points on physician referral, “key points to remember” for the chapter content, and case studies to illustrate application of appropriate clinical reasoning. Finally, each chapter concludes with a set of practice multiple-choice and true-false questions to support and reinforce learning.
The appendices include a screening summary with a quick screen checklist, list of red flags, systemic causes of join pain, and the referral process. This edition includes a new companion CD-ROM with printable screening tools and forms, checklists, questions to ask, and symptom-based animations. The superbly organized and thorough tables and lists liberally included throughout the text to summarize information greatly enhance the potential for regular use as a resource by physical therapists. I highly recommend this text for entry-level PT students, for transitional and graduate DPT students, and for PTs in clinical practice who want to increase their medical screening skill and reasoning and also desire a useful resource.
Dennis W Fell PT, MD
Associate Professor and Chair Department of Physical Therapy College of Allied Health Professions University of South Alabama Mobile, AL