Critical observations of health, science, and the physical therapy profession.
I found this tucked away in the schedule for the Medical College of Georgia Tech Fair planned for tomorrow (3/12):
12:15 p.m.
· Windows on my Mac?
· Getting the Word Out – Internal Communications at MCG
1:00 p.m.
· Adobe Dreamweaver
· Rehabilitation and the Nintendo Wii
1:45 p.m.
· Collaboration Within an Online Course
I guess Wiihab is everywhere! At least I get to go see a presentation on it. I’ll be sure to have some pertinent questions ready for the presenters! Anyone wish to join me?
ERIC
Do you consider the environment when deciding whether or not to recycle? Of course you do. But do you consider the environment when you have back pain that needs treating? Perhaps you should!
The current mantra among physical therapists, "You’ve got Drugs, you’ve got Surgery, or you’ve got Physical Therapists," attempts to explain the choices patients have in managing their musculoskeletal dysfunction. It’s no secret that of those choices, the pharmaceutical option is the big winner from an economic standpoint, if not from an actual effectiveness standpoint.
Now, with reports of drug residue in our water supply, scientists are becoming concerned with the effects of all these drugs patients have been taking. As physicians prescribe more and more drugs each year, this pollution can only be expected to get worse.
It is also no secret that drugs are often no better than a temporary fix when managing musculoskeletal pain. Back pain and osteoarthritis respond much better to exercise than they do to any pharmaceutical. In that sense, physical therapists can provide the natural, holistic approach to healing. Exercise is a free, renewable resource, and physical therapists stand little chance of polluting the water supply when using spinal manipulation.
Taking drugs unnecessarily is bad for the environment. Going to see a physical therapist is your environmentally friendly health care choice. I guess riding your bike to the local physical therapist is even better…
Here is a post I wrote last year that’s worth checking out:
[Top 5 Physical Therapist Recommended Body Hacks]
ERIC
Image courtesy of Jack Brauer.
Physical Therapists don’t treat back pain! Of course that’s not true. Physical therapists are among the best providers for patients with back pain. But, perceptions are everything. Let me explain:
Earlier in February, an article was published in the Journal of the American Medical Association which described increased spending for patients with back pain along side decreased outcomes. This strongly hints that the health care system is treating back pain poorly and a situation of medical waste is occurring. Check out some related blog posts.
Well, I sent a press release from AAOMPT to my local news and a couple weeks later a camera crew showed up at my office for an interview. I proudly explained how physical therapists could help solve this problem and even demonstrated some manipulations and exercises. However, when the interview aired I was none too pleased.
As you can see, the interview was pretty decent until they cut back to the anchors for a wrap who began babbling about chiropractic care and finished with, "So if you are experiencing back pain, make sure you contact your doctor or your chiropractor.."
Link to Video [NBC Augusta]
[Update 3/8/08: NBC Augusta has temporarily removed the story in response to viewer comments…click the comments to this post below for details and a nice letter.]
AHHH!
Is Physical Therapy’s image problem is so bad that, despite just running an interview that was with a physical therapist, that demonstrated physical therapist interventions, and that included statements that physical therapists can do more for less, the anchor’s sub-conscious defaulted to "back pain treatment = physician or chiropractor"? I guess so.
This really demonstrates the huge challenge that our profession faces. And, the poignant need for marketing and branding help on all levels. Back pain is big business, but until people relate their back pain to a physical therapist all the time, we’re not a big enough part of it.
By the way, I was bummed they didn’t use my carefully dropped tag line of, "You’ve got drugs, you’ve got surgery, or you’ve got physical therapists." Maybe the media just doesn’t get that line.
ERIC
The spirit of health care reform!
Massachusetts, famous in health care reform for diving head first into universal health coverage, is now making news as the state senate proposes to ban ALL gift to docs from pharmaceutical companies. That’s right, not even a cool pen would be available to drug reps as they try convincing doctors to use their drug. The WSJ Heath Blog covers it well.
This article from Wired Science News reminds us of just how sneaky those big pharmaceutical companies can be.
You can also check out the blog, Drug Rep Toys to see some of the threatened gifts. I guess those MA drug reps might have to rely on evidence and research to push their products. Crazy!
A month or so back, I wrote a post urging Physical Therapists to become more active in the blogosphere. I highlighted a few blogs that were new to the scene, but was very pleased when my comments became a buzz of activity with PT’s reaching out to let me know of their existence in the world of blogs.
Here is a list of the sites I’ve had time to check out. You will notice that this list has some active blogs, and some less frequently updated sites. You will also notice that the content of these blogs is very diverse, with a large portion of them related to pain science. Finally, yes, there are women PT bloggers!! I’m sure there are some more blogs out there, but I got a little dizzy trying to determine which blogs were active, which were proposed blogs, and which were abandoned. If I left you off the list, do not be offended, just send a note and I’ll update it.
Check em Out! (in no particular order)
Orthopaedic Physical Therapy Blog
Humanantigravitysuit (which includes a very interesting tag line: From the Vantage Point of a Professional Human Primate Social Groomer, or "Neuroplastician")
TherExtras The "truth about healthcare and therapy for children with disabilities"
Apparently, I’m not the only one who wonders about PT’s uptake of Internet technology. One blogger wrote regarding PT’s web use:
"The resistance to any use of the web is beyond your imagining" Barrett Dorko
As a side note, several of the comments referred to John Duffy’s PT Update site as a precursor to current blogging efforts. Perhaps, although the paid subscription model keeps him firmly on the Web 1.0 side of the web universe.
ERIC
As a physical therapist on the forefront of the profession’s movement towards autonomous practice, I often find myself confronted with the fact that physicians don’t have a blue print of APTA’s Vision 2020 in their daily planner. Which means that sometimes a physician will treat a physical therapist more like a worker than a professional. On one side of the spectrum, and similar to my experience working in the Army health care system, some physicians treat physical therapists as colleagues, often asking for input on patient appropriateness, diagnosis, and dictating open-ended referrals. Alternatively, and not 20 miles down the road, I live near some very conservative, old southern physicians who would gladly have me shine their shoes and wax their car when I’m done applying the moist heat and ultrasound. I expect the norm across the United States lies somewhere in between these two extremes.
The opinions of most physicians can be observed in the type of referral they write to physical therapy. I either get an consult-ish, "evaluate and treat" open referral, or a more prescriptive, "3x/week, 4 weeks, hot pack, ultrasound, strengthening" referral. From my perspective, I only need the first kind, as I know how to do my own job. A prescriptive consult between physicians is unheard of. Imagine a family medicine doc sending a referral to an orthopaedic surgeon that read, "Shoulder pain, instability, please perform capsular shift and progress with conservative strengthening protocol over 8 weeks!" The open consult is more consistent with autonomous physical therapist practice.
How can we reconcile these two types of physician referrals? I am strongly biased towards the open referral type, but can research tell us anything about which of these two attitudes result in the best patient care? Gary Brooks and colleagues hypothesized that a prescriptive referral would result in a higher utilization of resources by reasoning "that prescriptive referrals oblige therapists to negotiate patient management issues with physicians, creating a greater administrative burden that may be reflected by a higher number of patient visits."
In their research, which was limited by a very low inclusion of patient records (6.8% of eligible subjects) this hypothesis was not supported. What they did find, was that the type of referral was not associated with number of visits, but was attached to a greater level of discharge disability. This study can then add to the argument that a prescriptive referral is of no extra help in the provision of physical therapy services, and might be associated with poorer patient outcomes.
I would have liked to see a greater sample size, but this was limited as most eligible records were incomplete due to patients not completing their physical therapy sessions and so discharge data was often missing. That is a shame, because research like this can really help to reconcile some differences with physical therapist-physician relationships. I wonder if the subjects in the study had deemed themselves ready for discharge prior to the physical therapist considering them as such. If so, did this study churn up a practice pattern of generalized over-utilization by physical therapists as they string out patient visits? It’s possible, and much more likely when the physician dictates an arbitrary number of visits irrespective of patient progress.
My conclusions: I continue to consider open referrals more appropriate, with some small exceptions for post-surgical protocols of complicated surgeries. I now have this bit of research in my pocket that tells me the prescriptive referral is at least no better. I look forward to more research of this type that also delineates the differences when physical therapist expertise is factored into the mix.
As an aside, when I posed the question that is this post’s title to one of my first year PT students, she reflexively responded, "NO!" I look forward to the day when a medical student might answer the same question in the same manner. Then, we would be getting somewhere.
ERIC
Brooks, G. (2008). Is a Prescriptive or an Open Referral Related to Physical Therapy Outcomes in Patients With Lumbar Spine-Related Problems?. Journal of Orthopaedic and Sports Physical Therapy, 38(3), 109-115. DOI: 10.2519/jospt.2008.2591
If you have some extra time, take a stroll through Flickr’s Nasty X-ray pool. There are some beauties in there. I especially liked the decomposition and miter saw radiographs.
This fellow would like to give it 2-thumbs up, but is having some difficulty!
US Sen Robert C Byrd fell down in his home and is scheduled for some physical therapy. Sen Byrd will receive his rehab to improve his balance at Walter Reed Army Medical Center. I expect he will have a great experience, and will be in good hands as his physical therapist works to reduce his fall risk.
You can read about the Walter Reed Physical Therapy Staff here. Excellent credentials, but sadly no faces or names!
Columbia Physical Therapy in Washington State has filed a lawsuit against Benton Franklin Orthopedic, a group of orthopaedic surgeons, in what figures to be the next big referral-for-profit / physician-owned battle in the physical therapy profession. The physical therapists have an interesting set of laws on their side, the physicians have the normal repertoire of “doctor’s know best” arguments on their side.
However, the attorney for the orthopaedic group might have underscored the position of desperation his clients may be in with this quote:
“If physicians can’t employ physical therapists, nobody can, and they are used in all sorts of medical settings.”
That has to be the craziest argument in favor of physician self-referral yet. No one can get physical therapist interventions if they are not employed by a doctor? This assumption of employment visible in the quote underscores the widely held belief that many physicians hold about physical therapists, that they are an auxiliary service rather than an independent medical professional of similar value and capability in the care of musculoskeletal conditions. Perhaps physical therapists’ fondness for video games assists in perpetuating this belief.
In a stone-cold logical retort, Columbia Physical Therapy’s attorney states his client’s problem with physician self-referral as he describes the practice as having the ability to “create a captive referral market where the referring physician controls both the supply and the demand for patient services.”
Captive markets are dangerous for consumers. Does that mean that all individuals take advantage? Not at all. There are some high-quality physician-owned groups out there. In fact, I met one last night! However, the danger lies in the possibility of abuse which is something our health care system should have very little tolerance for.
ERIC
My fear of having non-fitness personnel take up the profession of Wiihab is coming closer to fruition as Nintendo has announced a Fitness package which will include a balance board. Nintendo itself is spearheading the effort into the fitness industry.
The APTA is very typically all excited about this gimmick and announced their new love affair in this week’s news:
"Look
for an upcoming article in the May issue of PT Magazine about PTs who have used the Wii as part of
patient care."
How many people in the world can do Wiihab without having to spend time getting a doctoral degree? Exactly! So should this be something physical therapists do? This is very similar to going to see a physical therapist and getting put on an exercise bike for a half hour. Yes, within our scope of practice, but not good practice. If I was a patient and hurt my shoulder only to be put on a Wii-regimen…well, I’m not coming back.
I’ve got a bad feeling about this.
ERIC