Maria Calla ENG 3840j Writing Reading and Rhetoric in the Professions Mr.

Vetter September 25, 2013 Physical Therapy: Influence of the Professions Genres

In my past experiences with writing and reading different pieces of literature I've always found genre to be a term referring to the dry format and basic content classifying different groups of writing together. I did not realize room for interpretation has been developed over the years to turn genre into a more dynamic and fluid structure as authors such as Berkenkotter and Huckin have pointed out with their theory of dynamism. They emphasize this by depicting how different genres have grown and developed over time to successfully serve the purpose they're meant to (1993). Genre is also seen by many students as a simple framework meant as a means to set up a boundary for writers to simply place their words in. However, it has proven most effective in professional settings to view dynamic forms of genre as rhetorical actions meant to make a statement or prove a point about what the writer of the piece is trying to enunciate or accomplish. Implementing rhetorical actions through genre is especially expressed in the article Navigating Genres by Kerry Dirk through her main point that as professionals and writers we care most about the response we are trying to elicit with our writing and not simply expose the formalities of the content (p. 30-31). Throughout this essay I plan to analyze the initial evaluation form which pertains to new patients stepping into a Physical Therapy office. I will also be going through an analysis of how the genre of SOAP notes are used by the physical therapist throughout the remainder of the

patients time at the office to enhance the quality of their care by documenting important variables which can consistently be referred to. In analyzing these pieces of writing I will be referring to articles written to help define the essence of genre and how different communities present differing values with respect towards their workplaces writing. Authors Berkenkotter and Huckin present in their article Rethinking Genre From a Sociocognitive Perspective the idea of situatedness which demonstrates how we best learn social conventions of genre by immersing ourselves in the culture. In Transferring Writing Knowledge to the Workplace, Are We on Track?, author Anne Beaufort discusses her ideals on discourse communities and how it is important for the professional to understand the one theyre a part of to be able to engage in the appropriate conventions of genres incorporated into it. Kerry Dirk expresses in Navigating Genres the idea genres are more than just passive written documents but seek to carry out a particular message. I will be looking at initial evaluation forms and SOAP notes with respect to the "situatedness" of the genres (Berkenkotter & Huckin) while molding in the importance of their discourse communities values (Beaufort) and the social actions they seek to accomplish (Dirk). From my experience with physical therapy I have come to find SOAP notes will differ with respect to different types of physical therapy settings, specifically outpatient versus in-patient care. While SOAP notes are written to fine detail in both settings it is important to consider content will differ regarding the varying states of patients between the two types of offices. Both forms of genre will have slight variations between different outpatient offices as well due to the fact of varying work ethic between different physical therapists and the differing of their values and ideas in the profession. Understanding the variations of the same genre between different

settings can help the physical therapist to realize there is diversity within the field and every patient case is unique. Berkenkotter and Huckin bring up the term "cognitive apprenticeship" which encompasses the idea that students who are thrown into practices of their professional communities will implicitly learn the correct manner to speak and act within the culture. This leads to them being able to carry out professional pieces of work (p. 485-486). I have my own personal experiences of performing internships in physical therapy offices and I can say first hand Ive witnessed cognitive apprenticeship. Ive observed and picked up on how physical therapists must subtly change their mannerisms when dealing with patients and coworkers to performing their writing of initial evaluations and SOAP notes. Initial evaluations are written with the patient as the therapist engages in the appointment. That being said the therapist is given some background history of the patient beforehand but the most useful information comes from directly speaking with the patient and explicitly taking measurements. For example, the physical therapist will most likely be given ahead of time previous surgeries the patient has had but they will have no clue as to how the patient felt after the surgery took place. This is a prime example of content they want to delve into regarding initial evaluation forms. The therapist must be focused on writing down patient issues, concerns and abilities while moving on to objective and measureable variables. However they also must ensure they are personable and approachable so the patient will feel comfortable in the office and release appropriate and effective information pertaining to their condition. It takes enculturation into the field to understand the missing pieces of the puzzle the physical therapist must find to get a full picture of the new patient case.

With my experience in physical therapy offices, SOAP notes have been written after the patient leaves each appointment. The S stands for "subjective" and is used to document what the patient says about how they are feeling and what they have observed about their own abilities. The O stands for "objective" and represents the concrete information that can be measured and recorded such as the angle of a joint. The A stands for "assessment" which is the gathering of subjective and objective information to come up with a diagnosis for the patient from that particular visit. Finally the P stands for "plan" and is the treatment the Physical Therapist will continue with from the last visit or can be tweaked from visit to visit. I've noticed when I would observe my therapist while writing SOAP notes they were very intent and did not speak to me as much as they did other times throughout the day. A physical therapist must be fully engaged with the patient during the appointment to be able to retain all the information they receive from the patient and the information they feel is important to record. This allows them to create a sufficient assessment and treatment plan for the patient. An example of an aspect to include in SOAP notes would be if a patient expresses concern over becoming tired after walking up a flight of stairs. The physical therapist must recall this was a subjective view of the patient and record it. One cannot become proficient at the skill of creating competent SOAP notes without becoming involved directly with the patient. This takes actual immersion into the field to gain appreciation for this experience which depicts how Berkenkotter and Huckins theory of situatedness plays an important role in expression of the genres related to physical therapy. Every therapist wants to see their work enable the patient to live their lives better than they could before even if that just means being able to reach the top shelf again. It takes concentration and a professional desire to want to ensure all information depicting the patient's condition is being captured to ensure the most profound care is being provided for the patient. As

Beaufort would agree, this exemplifies the main value and goal of a physical therapists discourse community in that they should all seek to provide the most efficient and latest treatments with respect to the patient's condition. They should also ensure the patient is given the resources to reach their full potential. Derived from her article, Beaufort expresses that these goals "look beyond the immediate writing situation to the broader backdrop of institutional and social norms (p. 185). Initial evaluation forms seek to create a basis for the physical therapist to be able to begin the most effective treatment regimen. SOAP notes seek to organize patient information in such a way it can also be used to help mold the therapists mind to use treatments that are most specific to the patients struggles. They allow the therapist to keep small but essential details in their mind about a patient and act as the primary source of reference. The information proposed in these genres get at the core of patient pathology. From this the therapist is able to use the values and goals of their discourse community to execute a plan of action for correcting what is causing the patient harm. As Dirk states in her article Navigating Genres, genres can be defined simply as "tools to help people get things done" (p. 252). Not only are SOAP notes and initial evaluation forms necessary for the physical therapist to be able to refer to, but insurance companies also utilize them to ensure the therapist is fulfilling their duties to their highest potential. For example, if SOAP notes are not created in the proper manner such as defining the details of the how the patient feels about their condition, what important variables of the condition are being taken into consideration and what plans are being made to treat the condition, insurance companies have the right to not provide payment to the employees at the office for their services. It is also pertinent initial evaluation forms are kept on file throughout the remainder of the patients treatment for insurance companies to access if they please. This is why the action of initial

evaluation forms and SOAP notes must be clearly understood by all employees so as to not disrupt the discourse communitys goals which could potentially lead to social disruptions between employees in the office. If a physical therapist were to forfeit the writing down of their treatment plan for a patient with a broken leg, for example, insurance companies may feel the patient is not benefitting from care leading to reduced funding to the physical therapy office employees. The phenomenon of initial evaluation forms and SOAP notes making an active testament to the work happening in a physical therapy institution shows how genres are active and dynamic groups of writing that serve a purpose in the workplace. Understanding the difference between the rhetorical situations underlying inpatient and outpatient settings is the driving force for therapists to be able to be successful in the beginning of their careers when they are still in the process of being transferred to different settings and offices. Our knowledge of genres is derived from and embedded in our participation in the communicative activities of daily and professional life states Berkenkotter & Huckin when describing their theory of situatedness (p. 478). With respect to in-patient versus out patient care, the rhetorical "situatedness" between the two has considerable variations which therapists need to come to terms with to fulfill the duties of their profession. Therapists working in inpatient care must recognize the reality that these patients have a much less of a chance of improving their conditions drastically and the population will most likely consist of elderly people. They are still in a hospital for a reason and throughout my conversations with therapists I have learned it is not uncommon to see patients not make it out. Because of the more critical conditions of these patients SOAP notes will seek to consider different factors for each patient in terms of simplicity. Elderly and disabled patients are less likely to give solid subjective information so descriptions of how they feel will be less involved. Treatments will be much

simpler with respect to exercises prescribed and manipulations performed because these patients cannot usually handle anything rigorous. The main goal with patients in these situations is to ensure they are being made as comfortable as possible and are able to complete basic functions such as walking. In an outpatient setting the physical therapist has more freedom to use more creative treatment techniques. Patients in these situations are normally seeking to greatly improve function such as going back to work for a middle class adult or even performing a sport again for a child or athlete. With this in mind therapists are required to be a little more aggressive with plans of treatment and are more likely to get more usable objective information from higher cognitive functioning of the individual. Implicit learning of the varying conditions of these settings comes through exposure to them and allows physical therapists to become adaptive to the needs of different patients requiring different levels of treatment. Along with becoming adaptive the therapist begins to take more regard towards understanding the genuine will to want to see improvement in the patient's condition. A desire for forming relationships with the patients also becomes embedded within the therapists professional mindset. Secondary to forming solid foundations of the understanding of the discourse communities values and goals they will improve the effectiveness of their documentation and relevance of the information they choose to record. For example an experienced physical therapist will take down notes as to changes they may later make in their treatment plan while a novice will simply write the treatment plan at present. While the rhetorical situations between different outpatient offices won't differ much on a disciplinary level different evaluation forms are used between different physical therapists mostly on a formatting level. No matter who owns the office it is important to reach a conclusion to the basic questions such as family history, past surgeries and required

measurements to test patients current functioning level. SOAP notes are also approached with the same goals of desiring accurate and usable information pertaining to the patient's condition no matter the office but a different format may be used between offices as well. It is, however, important to be aware all different types of personalities are in charge of different offices so it is not uncommon to run into some offices who take more of a genuine concern towards patients needs while others merely mean to get the job done. This can be reflected in initial evaluation forms and SOAP notes by observing a lack of detail in concern for the patients subjective views and time taken to record all objective views. The assessment and plan also may appear lack luster on paper compared to offices where employees take more value in their documentation. Differing conditions of initial evaluation forms and SOAP notes can reflect the discourse communitys values of a particular office and allow one to view comparisons with respect to goals and values between offices. This will help determine which facility doctors will recommend their patients to. Considering the situatedness of physical therapy genres while taking into account the values and goals of the social situation with regards to rhetorical actions documentation is supposed to be making can give insight to a freshly graduated professional on how to be successful in the field of Physical Therapy. I believe the most important quality of a Physical Therapist is to take appreciation for the profession because all of the skill required follows the drive to succeed and enjoy ones work. There is no better way to appreciate the field than to become familiar with its discourse community to be able to absorb how to effectively communicate with others involved. Caring for patients and enjoying the company of patients and coworkers allows for professionals in health care professions to use their skills to their fullest potential.

References Beaufort, Anne. Transferring Writing Knowledge to the Workplace, Are We on Track? Expanding Literacies: English Teaching and the New Workplace. Ed. Mary Sue Garay and Stephen A. Bernhardt. State University of New York Press, 1998. Print.

Berkenkotter, C. and Huckin, T. (1993). Rethinking genre from a sociocognitive perspective. WrittenCommunication, 10(4), 475-509.

Dirk, K. (2010). Navigating genres. In Writing Spaces: Readings on Writing, Volume 1. Retrieved from http://www.writingspaces.org/essays