#DPTSTUDENT TOPIC FOR WEDNESDAY, MARCH 13, 2013: THE PT/ PTA RELATIONSHIP

The first PT clinic I ever experienced as a patient utilized PTAs to the max. In fact, I think I only saw the PT for 10 minutes at most each visit. The next PT clinic where I was a patient did not have PTAs at all because the clinic owner wanted the physical therapists to spend the maximum amount of time with each patient. I received great care at both clinics.

What are your thoughts on the relationship between PTAs and PTs? How much time should a PT spend with their patient versus the PTA? Do you think patients understand the difference between the PT and PTA? What are the big differences in what we do?

And lastly, let’s about the article that appeared in the December 2012/ January 2013 edition of Pt in Motion titled “The Joint Manipulation Debate” that discusses the APTA policy that only PTs can perform join manipulations.

Talk to you tomorrow evening at 9pm EST!

CHAT UPDATE

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#DPTSTUDENT CHAT TOPIC FOR WEDNESDAY, MARCH 6, 2013: PHYSICIAN OWNED PHYSICAL THERAPY SERVICES (POPTS)

Physician owned physical therapy services and referral for profit can be added to the laundry list of items that physical therapists are standing against. What is a POPTS? The name pretty much sums it up- it is a clinic which offers PT services that is owned by a physician. This means the physician gets a kick back of the profit for patients referred to the physical therapist.

I read about the bill and the legislation behind it, I read the cons that the APTA stated about POPTS, but it was not until I read Joe Black’s post on POPTS that I truly realized what it was, the impacts it had on PTs and patients. It was then that I also realized that in 2009 I was one of those patients getting mediocre care at a POPTS clinic. I took a pretty nasty fall why skiing, tearing my ACL, MCL, and medial and lateral meniscus. I went to the best Orthopedic surgeon that the DC area had to offer. After surgery he referred me to “his” PT clinic saying that I would get the best care there because “his” physical therapists know the ins and outs of the surgery I just had. I did not argue because I did not know any better. After 2 weeks of seeing a PT that asked me every time I saw her what my injury was, I decided to find attorney for birth injuries claims to help me financially for what I am about to do next. I went to small independently owned clinic and worked with the PT who pushed me beyond my limits, had me running in a few weeks, and came to cheer me on at the finish line of my first 10k. She is the reason why I became a triathlete, quit my job in accounting and am pursuing a career in PT but that is a different story for a different day.

Now looking back on it I also realize that the POPTS clinic charged me $25 each visit where as the independently owned clinic did not charge me anything because she told me my insurance covered it in full. Darn, I wish I would have not been so uninformed back then!

To play devil’s advocate- do you ever think a POPTS clinic model could be a wise investment for both the physician, the physical therapist AND the patient? Let’s talk about it!

For your reading pleasure here are several great reads on the topic:

Stop POPTS
Term and Title Protection for Physical Therapist and Physical Therapy
AB783 and the California Campaign to Stop POPTS
POPTS in California. The Anti POPTS Movement Goes Web 2.0
POPTS and Referral for Profit
APTA and POPTS-II

Talk to you Wednesday, March 6 at 9pm EST!

CHAT UPDATE

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#DPTSTUDENT CHAT TOPIC FOR WEDNESDAY, FEBRUARY 27, 2013: IS TAKING A HISTORY AND PERFORMING A PHYSICAL EXAM NECESSARY?

The other day this article was making its way around Twitter. It discusses the importance (or lack thereof) of performing a history and full physical exam on a patient.

While this article is not about PT specifically, it got me thinking. I am spending a great deal of time learning how to perform a PT exam- I even have a class this semester titled “Physical Therapy Examination”. Yet, I know that some PTs do not perform a comprehensive exam and even fewer take vital signs during a visit. There is a ton of valuable information that can be learned through vital signs and a full evaluation. What do you think about this? How do we balance efficiency while still being thorough and treating the whole person? Is a full evaluation necessary or a waste of precious time?

Let’s talk about it!

Current PTs are welcomed and encouraged to join in on this chat! All of us students would love your input!

 Chat Summary

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This chat also included a great list of recommended readings.

Maitland’s Vertebral Manipulation, 7th ed: http://t.co/tPQHxzanTm

  • Eric Robertson (@EricRobertson): “Also the Maitland texts have an excellent chapter on communication.”
  • Jerry Durham (@Jerry_DurhamPT): “Directed towards Maitland book which was very helpful”
  • Kyle Ridgeway (@Dr_Ridge_DPT)- “Read the Maitland Subjective Exam Chap about 1x every 4 months w/ experience it will make more sense”

 

Checklist Manifesto by @Atul_Gawande

  • Kyle Ridgeway (@Dr_Ridge_DPT) – “all #DPTStudent should read Checklist Manifesto by @Atul_Gawande #PTScience”

 

Reading list by @mikereinoldblog

  • Mark Kev SPT(@markymarkkev) – “@mikereinoldblog has a good reading list”

 

Illness Narratives by Arthur Kleinman

  • Kyle Ridgeway (@Dr_Ridge_DPT)– “All PTs should read the book Illness Narratives by Arthur Kleinman For us the subjective is VITAL”

 

 

#DPTSTUDENT CHAT TOPIC FOR WEDNESDAY, FEBRUARY 20, 2013: SHOULD PTS HAVE RADIOLOGY PRIVILEGES?

Physical Therapy as a profession continues to push towards direct access, which allows patients to come to us first in hopes that we can diagnose and either treat them or refer them to the correct medical professional. However, are we able to fully understand the injury and the best path of treatment without seeing an x-ray or MRI? Should we as PTs have privileges to write scripts for MRIs and x-rays?

If PTs are given radiology privileges, are we educated enough to correctly interpret the results? Would DPT programs have to add more classes on radiology?

I can see the pros and cons of both sides so let’s talk about on Wednesday at 9pm EST!

CHAT UPDATE

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Barb Melzer, I Will Miss Your Brain

Barb MelzerIt is with a heavy heart that I write this post, one I sincerely wish I didn’t have to. My esteemed colleague and friend, Dr. Barbara Melzer, PT, PhD, DPT, FAPTA, has passed away. The world has lost a kind and intelligent soul and the physical therapy profession has lost a legend. Her captivating smile, is no more.

 

If I may summarize her bio:

Dr. Barbara Melzer, PT, DPT, PhD, FAPTA has been an active participant in physical therapy clinical practice and education for 38 years. She has served as the Texas Physical Association President and Chief Delegate. She has served on the American Physical Therapy Association (APTA) Board of Director and as APTA Secretary, as well as the Chair of the APTA Nominating Committee. She served as an officer of the APTA Education Section for 6 years and Commissioner on the Commission on Accreditation for Physical Therapy Education (CAPTE) as a Team Leader. She was a co-editor of the Normative Model of Physical Therapist Professional Education, Version 2000, and has presented almost too many times to count on matters related to clinical education in physical therapy. She has impacted countless physical therapy education programs through the activities above as well as through her widespread consultation. She has served on dozens of doctoral dissertation committees. At Texas State she served as Professor, and Director of Clinical Education, and has represented the School of Health Professions on the Faculty Senate and was a multiple winner of the Texas State University Presidential Award for Service. Dr. Melzer was awarded the status of Catherine Worthingham Fellow in 2003, the highest honor for members of the APTA. Through the incredible span of her service and lengthy list of accomplishments, she has impacted the profession in ways no words can accurately capture.

But more than these accomplishments, she was strong. She was generous, and entertaining. She may have been the only faculty on her phone more than I during faculty meetings, which I appreciated.  She could distill most of the world’s problems to a primary color. She was a balanced, thoughtful and wise voice of council that I will personally miss, and Texas State University will not be the same without her.

Please join me in extending thoughts and prayers for Barb and her family, and raising a toast in her honor. Let’s celebrate a life of excellence and service, lest we invoke her ire for stopping to be sad for too long. Barb Melzer, I will miss your brain. I will miss our conversations. I will miss your smile.

Her memory and contributions to the profession will live on forever.

Update:

The College of Health Professions and the Department of Physical Therapy will establish a scholarship to honor Dr. Melzer’s contributions to the College, Department of Physical Therapy, and Texas State. Donations will be accepted in memory of Dr. Barbara Melzer. Please make checks payable to the Development Foundation and mailed to:

Texas State University-San Marcos Development Foundation
Attn: Donor Services, JCK-480
601 University Drive
San Marcos, TX 78666
 

Update #2:

Barb had worked with a charity she helped found, Texas WINGS, that provides health care to uninsured women with breast cancer. She served on the board as secretary and treasurer of this charity. With this in mind, this is another avenue by which those who wish to donate in Barb’s memory can take action.

Transformation Scrutinization: Vison versus Reality

I wonder if academics in medieval universities had their own versions of Twitter debates about the use of the word “doctor.” I wonder if the opponents to its use decried it a foul and unfair title, which should be reserved only for the Apostles and those learned elite of the Catholic church (who had, of course, taken a test and paid the appropriate fee to earn such a prefix). That argument seems ridiculous now, but it’s a worthy perspective for us to consider, especially after a #DPTstudent tweetchat which debated just such a question: should we be called “Doctor” as physical therapists who have earned the Doctor of Physical Therapy degree.

My very intelligent and witty friend, Courtney Kelsch, who happens to be a student of the English language and an academic herself, later joined in the debate. She’s not a PT, nor a healthcare practitioner, but her post on Twitter reminded me of this perspective. She wrote, “…the title Dr comes from the Latin word for “to teach.” Origins in academia, was never tied solely to physicians. Which is to say, arguing that PTs should not be called doctors makes no sense. Doctoral degree = doctor.” Well stated, and for us, quite embarrassingly so. I wonder just what drives someone who is currently paying for, and working hard to obtain a DPT degree, to feel the title is unfitting for them? What is this? Professional insecurity? Something else?

Yet even as individuals entering this profession are reluctant to permit others to refer to them as a doctor of the field, the American Physical Therapy Association’s Board of Directors is proposing a new vision statement to guide us forward, “Transform Society.” Bold! But, it is appropriate?

Points of consideration:

-Things that I’ve considered transformative to society include antibiotics, air travel, mobile communications, the semi-conductor, the cotton gin, and fire. Public health as a collective overall field can perhaps make this list as well. When physicians in Texas embarked on a campaign to stop spitting on the sidewalks, everyone lived an extra year or two. Not quite as profound as the first flight, but yes, the applications of the germ theory of disease was transformative to society. I just don’t see the same effect happening from widespread deployment of movement impairment analysis.

-This past week a physical therapist related to me the following statement: “Since we are PT’s, we can’t eat until 12:45 once all the physicians have eaten.” The worst part is: this was spoken without indignant offense, but rather in passing as part of a separate story.

-In a video spot a few weeks ago, a physical therapist got on a national TV show and purported cutting edge techniques, which were in reality, non-evidence-based banter that most skilled PT’s would never touch. That damage will take a long time to be undone given the scope of the audience.

-In a thoughtful post written by Jay Deragon entitled, “5 Stages of Societal Transformation,” he states, “Those that reach the transformation stages are the groups who create meaningful and significant change that positively impacts the entire human network. These groups are philosophically connected and grounded in a common set of principles that guide everything they think and do.”

And that’s the catch for me.

I know the APTA Board of Directors is a cohesive group tied together by a common vision. In fact most of the physical therapists I interact with on a regular basis whether at work or through conferences would probably fit the definition of a cohesive group philosophically I just worry that this vision doesn’t extend to the reality of the multi-faceted body of physical therapists that ultimately define the profession. There are tens of thousands of physical therapists that don’t go to conferences, don’t engage in professional dialouge, and who use outdated practice patterns. One former student of mine went down the road to work at a clinic in Texas where the clinic’s owner was adamantly against the concept of direct access to physical therapists.

The examples in this post, from reluctance to use an earned degree title, to persistance in old practice patterns, to flat denial of the role of physical therapists as a primary access provider support my notion that perhaps physical therapy as a profession isn’t ready to transform society. Despite how ready my colleagues and I might be to fight and redefine the role physical therapists play in the health of our society, I worry that just as I wage the battle, others in my profession are undermining it.

So I’m left with the question: how do we transform them?

Work hard to improve health and find ways to engage society in new and different ways? I get it. I want it. But I’m afraid the interpretation of the “transform society” vision will be muted by the volume of those scoffing at it. Not all of those people scoffing will be strangers.

 

 

Comments On: Building Community & Discourse Through Conversation

Often, intense dialogue emerges in the comments section of blog posts. In my opinion, the discussion enriches the original post. Comments add depth to the post, and benefit the reader. Further, it allows a post to remain dynamic over time as knowledge improves or reasoning changes. A guest post on @MikeReinoldBlog entitled Trigger Point Dry Needling for Lateral Epicondylitis resulted in over 220 comments. At one point, Mike even closed comments. Later, in a decision I respect and agree with, he re-opened the comments section. That post is rich in various content, lines of reasoning, and debates on various aspects of science, physical therapy research, pain, and mechanisms of manual therapy. A true resource. On PT Think Tank, our most commented on post  OsteopractorTM Not now, Not ever currently has 201 total comments. In  Comments Off on PT Podcast @ErikMeira states:

Do I not want the feedback? Do I not want to foster discussion? Not at all. The answer is simple: I don’t have the time to manage it. When I have allowed comments in the past I was bombarded with spam posts. This required constant attention to weed out the crap… The other problem is trolls. Most comments are either blind emphatic agreement or blind emphatic disagreement. Then you get into name calling and weird irrelevant attacks. No thanks. I’m not the only one who feels this way. Look herehere, and here for some much more thought out reasons for not allowing comments on blogs.

I agree that moderation can be difficult. Spammers and trolls are a constant, annoying problem. Spam widgets and spam reducing practices exist. See 7 Ways to Reduce Blog Spam for ideas. For those not familiar, @ErikMeira hosts two fantastic podcasts, PT Podcast (@PTPodcast)and PT Inquest. On his site, he published a fantastic 5 part Science Series.

Once a site decides to have comments open the author of a post has a couple of options:

1. Allow the commenting community to discuss
2. Address critiques or questions directly
3. A combination



For moderation, a policy statement can guide decisions to un-approve a comment(s) utilizing set standards as a reference. I uphold that heated discussion and debate eventually lead to progress, are extremely helpful to readers, act as real time peer review, and illustrate when people are being ridiculous. The more people comment, the more obvious their intellect, intent, and true value (or lack of) is displayed. Comments allow for multiple participants and viewpoints to present and discuss issues. Often, connections are made to other concepts not explicitly explored in the initial blog post. For a reader, following the discussion can engage analytical processes, allow them to follow arguments, and challenge ideas. There is value for the author in the for of feedback, questions, and a forum for further clarification. There is value for the commenting to engage with the author and each other in an archived discussion. There is also value to the reader. Personally, I have extracted tremendous intellectual challenge and benefit from reading through a blog post with a engaged comments section.

Although a fear of negative comments is present, allowing individuals to post dissenting views illustrates enriches the post. Even without any moderation the community of commentors can come to the rescue in the case of poor logic, bad reasoning, misinterpreted references, or just plain nastiness.Comments and the ensuing discussion give blogs their true power. In best case scenarios, they are an example of real time, open source peer review and academic-clinical discussion. We can discuss and collaborate around the world. SomaSimple is a prime example of an open forum. Many view SomaSimple negatively, but they have presented a moderators consensus on the Culture of SomaSimple and Information for Guests which includes the Disagreement Hierarchy. One of the resounding themes of the forum is “Here you are safe, by your ideas may not be!”

A prime case example of “comments on” is the contraversial post OsteopractorTM Not now, Not ever. To date, the post has garnered more than 200 comments. The dialogue was not terse and rather intense at times. Overall, I think the comments section benefits those who read and engage PT Think Tank. I attempted to respond to most comments  and critiques. The commenting community dialogued further. Eric Robertson moderated comments that were blatantly attacking individuals or grossly off topic. In total, less than 10 comments total were moderated (deleted or discarded). One comment by a single individual and all the rest by another. So, overall 2 users and less than 5% of all comments required moderation.

Comments? Comments, anyone? Anyone?

#DPTSTUDENT TOPIC FOR WEDNESDAY, FEBRUARY 13, 2013: INTERPROFESSIONAL EDUCATION AND COLLABORATION

Last week, when we discussed the new proposed APTA vision we discussed several of the vision elements included within it. We briefly touched on interprofessional education and collaboration. The element of collaboration is written as follows in the new vision statement:

Collaboration: The physical therapy profession will demonstrate the value of collaboration with other health care providers, consumers, community organizations, and other disciplines to solve the health‐related challenges that society faces. Education models will value and foster interprofessional approaches to best meet consumer and population needs and instill team values in physical therapists and physical therapist assistants. In clinical practice, physical therapists, who collaborate across the continuum of care, will ensure that services are coordinated, of value, and consumer centered by referring, co‐managing, engaging consultants, and directing and supervising care. Interprofessional research approaches will ensure that evidence translates to practice and is consumer‐centered.

Are we as students given enough of an opportunity to learn about other health professions in order to foster great interprofessional collaboration once we are out in the working world? Do you think it is important that we learn the basics of what other practitioners do as well as educate them on our role as physical therapists? Let’s talk about it!

 CHAT UPDATE

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#DPTStudent Topic for Wednesday, February 6, 2013: Beyond Vision 2020- Can We Transform Society?

Since 2000 the APTA has been making strides towards Vision 2020, a vision which outlined goals for the profession of physical therapy to reach by the year 2020. These goals included care that was provided by doctors of physical therapy, direct access to physical therapy by consumers and more.

In 2012 the APTA has created a vision that goes beyond Vision 2020. You can read more about it here. While this new vision includes aspects of advocacy, access and equality, innovation, value, collaberation and other strong points, the controversy lies in the first line of the proposed vision which states that “The physical therapy profession will transform society by optimizing movement for all people of all
ages to improve the human experience.”

Some argue that the words “transform society” is too strong. Others argue that those words are exactly what we need as a profession to get our point across. What do you think? Let’s talk about it!

Here is a great video of Bill McGehee, chair of the APTA Vision Task Force, discussing the updated APTA vision.

CHAT UPDATE

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#DPTSTUDENT CHAT TOPIC FOR WEDNESDAY, JANUARY 30, 2013: SHOULD WE BE CALLED DOCTORS?

By the time we have the letters DPT after our name we will all have gone through four years of undergraduate education plus three years of graduate level education that is PT specific. That is 7 years of higher education but is that enough to be able to call ourselves Doctor? Especially when our undergraduate degree did not have to be in pre physical therapy, biomechanics or exersice science (Mine is in accounting and statistics!).

I want to discuss this as it was a side topic from last weeks chat in which people felt very strongly one way or the other.

Should only PhDs or MDs be able to be called Doctor? Will you introduce yourself as “Hi, I’m Dr. (insert name here), I’ll be your physical therapist” or will you leave out the word doctor all together? With many professions now offering entry level doctorate degrees, does the word doctor have less meaning?

Think about it and then let’s talk about it on January 30th at 9pm EST!

Remember, there are going to be many opinions on this so let’s agree to disagree respectfully!

CHAT UPDATE

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