The Stock Standard Assessment Approach

While on the general medicine cardio placement the majority of patients I had to treat were very sick, usually elderly patients with COPD or severe pneumonia, but there were some younger patients with cystic fibrosis who had come in with an acute exacerbation. These younger and often quite active patients require a different assessment, requiring you to think about the individuals previous exercise tolerance. Assessment thus needs to modified and although standard assessments such as the six minute walk test can be used they are often unsuitable and not adequate in determining appropriate treatment. I approached my supervisor about this and they recommended a modified incremental shuttle walk test developed especially for cystic fibrosis patients, which is kind of like a normal beep test with varying levels of difficulty. This is the gold standard but is sometimes impractical and not very functional to use as an outcome measure and thus the individuals desired or previous exercise tolerance becomes a quick and easy outcome measure (eg. How many flight of stairs a patient can walk up, or how long they can ride on a exercise bike for). These can also form the basis for treatment as well.

Reflecting back on this experience it is very important to consider the previous and desired exercise tolerance of a patient in both assessment and treatment of patients. This experience has taught me that you cannot have a standard and set assessment for every patient, you need to consider each patient’s desired goals for treatment and modify assessment and treatment according to the individual. This experience has not only influenced how I treated patients on my cardio placement but will continue to influence how I will treat patients in the future.