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The AMA: an information-leasing racket!

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Daniel Carlat, MD has written a piece in the New York Times that is perhaps the most transparent look into the world of pharmaceutical marketing tactics that I have ever read, "Dr. Drug Rep."

I learned a great amount from this piece about one of my least favorite parts of health care.  Dr. Carlat discusses his year long experience as a "drug rep with an MD" and provides quite the insider perspective. 

I was most surprised when Dr. Carlat discussed data mining for physician prescription trends and pointed a finger at the AMA as a major player.  Information that the AMA leases to marketing companies is critical in providing pharmaceutical companies specific information to target individual doctors. 

"The A.M.A. licenses its file of U.S. physicians, allowing the data-mining companies to match up D.E.A. numbers to specific physicians. The A.M.A. makes millions in information-leasing money."

This relationship may be acceptable in other industries, but seems out of place for a professional medical organization purportedly concerned with unethical practices in the pharmaceutical industry.  A profession truly interested in health care reform could be expected to make better decisions.   

ERIC

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NPA Think Tank Poll

I’m trying out a polling/survey program, so check this out:

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The Many Faces of the Electronic Medical Record

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The electronic medical record can mean different things to different people.  To Microsoft and Google among other Health 2.0 companies, it is a future of their business.  To patients, it is concern over privacy and hope for improved care continuity.  For medical providers it is an enormous added expense and a headache of technical details to do a job they are already performing. 

But, the electronic medical record could also be a way to do business differently, to become more efficient.  To do the job better.  A couple things are certain: as health reform progresses the electronic record will prevail, and that it might not be so smooth.  Just yesterday I read a news piece where electronic claims filing made it easier for Wal-Mart to recoup money paid in an injury settlement, effectively taking one woman’s health-trust and leaving her dependent upon the government for her care.  Is this what we had intended when we first thought of the electronic records?

Radiology as a Benefit to Physical Therapist Practice

My personal experience with electronic medical records is with the military health system.  It was sometimes slow and tedious, but it was incredibly useful all of the time.  In fact, I have a hard time imaging practicing without an integrated medical record in front of me at this point. 

Perhaps the most useful aspect of the military’s electronic system, which contrasts most significantly from usual physical therapist practice, concerns radiology reports.  Forget for a moment the benefit that military physical therapists have in ordering radiographs (yes, they can order all types of radiographic imaging and may do so as effectively as orthopaedic surgeons) , and just consider the benefit of reading reports and viewing the radiographs themselves.  I think this calls for a list:

1.  Reduced guess work when patient history is unclear

2.  A greater understanding of each patients pathology

3.  Patient education opportunities are enhanced in front of their radiographs

4.  Observation of what studies have been performed provide insight into thinking and problem solving of other providers

5.  Improved prognosis decisions

The radiographic benefit is but one example.  The overall message is that despite the many different particulars of the electronic medical record, it is somewhere we are heading.  Careful consideration of the pitfalls and benefits of the process will ensure the efficient, timely transition. 

ERIC

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Giving Thanks & A Holiday Wish List

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It’s the holiday season and the time is ripe for a holiday-related post!  Thanksgiving is a time to give thanks, so what do physical therapists have to give thanks for this year?  How about:

1.  Bountiful clinical research productivity

2.  The DPT transition in educational programs and rapid adoption of the tDPT degree

3.  The APTA’s new CEO

4.  Growing numbers of Residency and Fellowship programs

5.  Podcasts, videos, and re-designs offered by our journals; and blog readership and writing, as more PT’s exchange information via the collaborative web.

Whatever your celebratory affiliation is, gifts such as these corporate hampers aare somehow involved in December; and the season is upon us. One great tool for organizing gift ideas is Shoppok’s wishlist feature, which can be particularly handy for professionals. What are some things that might fall on physical therapists’ wish lists? Here is mine:

1.  Not just autonomous practice, but true ownership of our profession through phasing out of referral-for-profit arrangements.

2.  License to utilize radiological imaging in clinical practice.

3.  A profession-wide, rapid shift to a clinical education model that more closely resembles the medical model.

4.  Abolition of the CAP.

5.  Freedom from legislative assault

Leave some comments about what you might be thankful for…or are hoping for as the new year approaches!

Happy Holidays!

ERIC

image by Robert Lynn

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Physical Therapists or Stealth Medicine?

For those of you who are not power blog readers, I may first need to introduce you to the Respectful Insolence blog, written by Orac.  It’s one of the best, so subscribe.

Orac has made mention again of over-zealous chiropractors, characterizing them as "physical therapists with delusions of grandeur who don’t know their limitations."  He, along with Panda Bear, MD, is quick to point out the gaping holes in the science behind the whole subluxation concept.  Yes, that’s the concept which forms the core of chiropractic medical care.  In this case, Panda Bear, MD is concerned about the new pediatric focus in chiropractic care:

"Would you take your child to a Physical Therapist for routine health maintenance, well child checks, or even something as serious as asthma? Of course not. And no Physical Therapist would touch your child in this capacity for the same reason I don’t perform abdominal surgery, namely that it is well outside of my training and my legitimate scope of practice."

Limitation, problems with subluxation science…seems like something I’ve heard before.  Indeed I have.  Please reference Peter Huijbregts’ Journal of Manual and Manipulative Therapy editorial manifesto:

"Chiropractic Legal Challenges to Physical Therapy Scope of Practice: Anybody Else Taking the Ethical High Ground?"

Also check out the continuation of this conversation in the subsequent responses to the editorial (one of which was penned by yours truly).

Agreed, Orac and Panda Bear, MD.  Stealth medicine at its best here.  But perhaps the world does not realize how truly vulnerable the physical therapy profession is to these attacks.  It’s a simple case of "my lobby is bigger than yours."

For those non-physical therapists reading this, it may be timely to point out that what IS in our scope of practice is all sorts of manipulative therapy.  That’s right, the specialization area of Orthopaedic Manual Physical Therapy is one where the physical therapist is equipped with both the tools to manipulate the spine or peripheral joints AND develop a comprehensive, integrated program of neuromuscular modalities for orthopaedic conditions.  Check out the AAOMPT for more info on this area of physical therapist practice.

ERIC

 

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Yoga as exercise is a stretch

Yoga_stretchFirst, a note on access to the Wall Street Journal.  WSJ has now placed Digg buttons at the bottom of each story.  When some subscriber diggs the story, it becomes listed on the digg site…enabling free access to everyone who gets there through the digg page.  You can subscribe to this as an RSS feed, and get some good WSJ content without the subscription fee!

This story from the WSJ about Yoga came to my eyes in the above fashion.  Worth a note on the blog, as I’ve met some pretty hard-core Yoga folk in my time.  Bottom line on the article is that Yoga is good at stretching and relaxation (to a debatable degree), but it surely does not qualify as cardiovascular exercise.  In fact, it may cause less energy expenditure than
walking!

ERIC

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Physical Therapists: The new medical translators?

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I posted a while back on Stephania Bell’s ESPN Fantasy Blogging gig.  Well, she’s going strong and recently wrote up a winner in her breakdown of the LCL injury to Viking’s running back Adrian Peterson.  If you’re into fantasy sports or if you want to learn some "fun with biology" regarding your lateral collateral ligament, this column should be a regular read.

The broad and ever-growing appeal that Stephania is creating, not to mention Physical Therapy branding, is simply priceless for the profession.  Often, it only takes one door to open before the masses push through.  What does that mean?  Well, I could imagine several well-written physical therapists leveraging Stephania’s role at ESPN to quickly become the medical translators of choice in popular media outlets.

ERIC

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I'm back!

Hey NPA Think Tank readers:  I’m back from my blogging hiatus and ready to roll.  My apologies for the unexpected lapse in my postings…

Here’s some video entertainment fresh from Texas State University.  As you enjoy it, consider Evidence in Motion’s hint of a "Best of" video contest.  Could be scary!

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AAOMPT Conference Wrap

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I got the chance to spend this past weekend at the annual conference of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT).  The event was excellent and my hat is off the the planners from AAOMPT who put together a seamless conference packed with incredibly useful programming, leaders in the field, pleasant receptions, and some awesome research platforms.

One of the more interesting moments occurred during the business meeting when a motion pass a position statement against referral-for-profit arrangements was passed without so much as a quip of debate.  This, from a group who then proceeded to debate the appropriate use of the word "Evidence" vs. "Research" for more than 20 minutes!  To me, this speaks to the ethical and rigorous standards the AAOMPT and its members are known to hold itself to.

Aaompt_2007_photo_2This year’s conference marked the addition of a Student Association into the AAOMPT family (AAOMPT-SA).  The
students who attended were well received and played a very significant role in the conference.  Congratulations to them and to those students interested…join up!  The networking and career growth that can occur from a conference like this is great.

Next year, we’re off to Seattle, Oct 29 – Nov 2.  Convention center and all, it will be big time!

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Images from Liz Sonnenberg