The Opioid Crisis: What Former NFL Lineman Jeff Hatch is Doing to Help

Addiction is a disease that disregards an individual’s race, socioeconomic status, and prior achievements. Since 1999, deaths from prescription opioids have more than quadrupled. From 1999-2010, the number of prescription opioids sold to pharmacies, hospitals and doctors’ offices has nearly quadrupled as well. Yet the amount of pain Americans report has not changed during this time.1 In 2012, health care providers wrote 259 million prescriptions for painkillers. That is enough for every American adult to have their own bottle of pills.2

I was lucky to get the opportunity to speak with former NFL offensive lineman Jeff Hatch. Throughout his life, Jeff did everything the “right” way. He won the Presidential Award for his work with the homeless, graduated from the University of Pennsylvania, where he became unanimous first team All-Ivy selection and Division I-AA All-American, dated Miss Maryland, and signed a multi-year $1 million contract with the New York Giants – all by the age of 22. However, Jeff was not happy. According to him, checking off all of his accomplishments was a way to disguise his contempt for himself:

I was determined to be successful as I could be… On one hand, doing everything well enough could make me happy and on the other hand doing   things well… would keep people from looking too deeply into what was going on with me… It was a way I could mascaraed and keep people at bay

This contempt, in addition to a family history of substance misuse disorder, fostered Jeff’s relationship with substances.  The first time Jeff was exposed to opioids was following his career-ending spinal fusion surgery. He recalls the opioids working great to relieve his physical pain, but it wasn’t long before he was utilizing the pills to resolve the emotional pain he was dealing with.

People say [substance abuse] is a slippery slope that you go down. For me it wasn’t a slope, it was a cliff and I jumped off

Opioids and alcohol gave Jeff something that all his past achievements did not fulfill. It allowed him to be comfortable in his own skin. He shares how drug and/or alcohol consumption is different for someone affected by substance misuse disorder: “I think there’s a difference between somebody who suffers from the disease of addiction and somebody who can participate in using drugs or alcohol recreationally and not have a problem. For those of us who suffer from the disease, the use of drugs or alcohol is a tool by which we escape our reality, not a means by which we seek a good time.”

Jeff was fortunate to receive treatment in 2006 and has now been sober for over a decade. Though he continues to experience pain from a physically taxing football career, he believes exercise and NSAIDs are powerful analgesics that are often overlooked in the management of chronic pain.

Not only has Jeff successfully battled this disease, but he also uses his personal story and experiences to inspire others to seek and remain committed to recovery. Jeff works for Granite Recovery Centers, a New Hampshire based substance misuse disorder treatment provider. This comprehensive program treats individuals throughout all phases of recovery. The program focuses on the 12 steps then offers a bridge program, The Granite House, that continues to work on life skills necessary for community re-integration. Although getting quality treatment is a staple for those in recovery, Jeff states there are additional factors that need to be addressed to successfully combat the epidemic.

We need to continue to break the stigma down, we need to continue to fight against the insurance industry and them trying to close the portals by which people use to get treatment and we need to continue lobbying the government to treat this disease the way it needs to be and to really follow through with that Parity Act that got signed in 2008

Though it is easy to get caught up in the statistics surrounding the current state of the opioid crisis, Jeff explains how we should look at the glass as half full: “We look at the 23 million people suffering from substance misuse disorder in America and we go ‘Oh my God what a terrible problem’ but on the other hand there are 24 million people who are in long term recovery from it and we don’t ever really talk about that.”

For more on Jeff Hatch and his work with those in recovery, visit Granite Recovery Centers. To learn more about the APTA’s initiative to choose Physical Therapy for safe pain management, check out Move Forward and #ChoosePT. Jeff’s interview with Talus Media News can be heard in its entirety here.

 

 

 

 

 

 

 

  1. Centers for Disease Control and Prevention. Understanding the Epidemic. https://www.cdc.gov/drugoverdose/epidemic/index.html. Updated August 30, 2017. Accessed September 2, 2017.
  2. Centers for Disease Control and Prevention. Opioid Painkiller Prescribing. https://www.cdc.gov/vitalsigns/opioid-prescribing/. Updated July 1, 2014. Accessed September 2, 2017

A Year Later

I had been assisting another therapist with a treatment session on the other side of the medical ICU when one of our unit clerks peaked her head into the room. “Kyle, I know you’re busy, but we need you out here.” Naturally, my mind begins listing every possible worst case scenario as if I’m about to walk into a corridor of unimaginable horror. “There’s someone here to see you.”

She was dressed nice and looked younger than her age. Her hair was full and well done. She was thin, but muscular. Very healthy looking actually. Walking, standing, talking, and smiling. Her face appeared eerily familiar, as if from a dream, but I immediately recognized her husband. Their names, initially escaped me, as names usually do. Her smile though, that I had seen before.

“I’m back for a one year follow up appointment.”

I couldn’t recall the details of her case, but I remembered she was in the MICU for a long time. She offered up that she herself remembered nothing from her ICU stay. Not uncommon, of course, but still a shock to hear directly. Especially as someone who spent, well resided really, in the ICU for over 6 weeks requiring prolonged mechanical ventilation. “Did I stand up while I was here?” Her husband, recalling more details than I, “Kyle held you up honey, your arms were around his neck. He basically lifted you into a chair.” At that time, she was maybe 90 pounds. She could stand for less than 2 minutes with maximum assistance and was unable to march, take steps, or ambulate.

To the casual observer her physical function was now normal, if not better. Well placed wrinkles covered a tracheostomy scar, and she moved without obvious, or discernable deviation. She reported she had been reviewing her medical record. “I was scared at first, because I had no memories of the ICU. But, also no nightmares. My doctor said that was rare.”

“I still get tired.”

“You know sometimes I go go in the morning and I just need to rest some.” Her husband chimed in “she tries to do it all you know.” She talked about the challenge of lifting her grandson “he’s a little chunk. And, he’s over a year so I need to get stronger to keep up with him.” Every limitation augmented by a goal.

In reflection, what was most unique about the case, beside her remarkable outcome in the face of a guarded prognosis, was the attitude and perspective of both the patient and her husband. Constantly positive, but realistic. Engaged, and focusing on the tasks to be done, what was improving and what could be controlled. Her husband, I recalled, was always hopeful, yes, but not blindly optimistic. Not every patient outcome turns out like this one. In fact, most do not. Exceeding the realistic range of possible prognoses involves the interplay of complex medical, physiologic, physical, environmental, psychological, and social factors. And, I’m a vocal advocate of clinicians focusing on the right process, and not validating their approach post hoc based on observed positive outcomes.

Despite this, it still feels good to encounter a success story. It’s touching of course and it’s motivating. As I shared with her, these patient stories, even the simple ones, “keep us going.” The patient and the husband exuded appreciation and satisfaction; his memory of people, names, events was remarkable. Flattered at the perceived impact, I couldn’t help but feel some guilt percolating under my pride. We should’ve done more, we could’ve started earlier, was I attentive enough to psychological issues? Did I “push” her enough physically?

But, it appears that this woman likely was to progress, to be “better” with, or honestly, without me. Her husband’s constant, but empowering support combined with her positive, focused attitude were the foundation for an outcome a few standard deviations or so from the norm. Not that I feel what I did, my role was insignificant. All I can hope is that I was a small part of nudging the momentum in the right direction. Or, at the very least, not a hindrance, an inhibition to her journey. I’m reminded of the often referenced idea that it’s not what you do, or necessarily even the outcome, but what the person experiences, their feelings that affect how they perceive events upon reflection. People don’t care what you do per se, they care about how you make them feel.

“I tried to get out of bed on my own at rehab. They got mad at me for that because, I fell.”

“She melted to the ground before 1 step.”

“I was trying to get out of bed to the bathroom.” She felt guilty and a burden ringing the call light then waiting for assistance. Especially the times when her ability to control her body were not as she would desire. “I felt so bad, I didn’t want to wet the bed.” Despite being unfortunate, my sense is the feelings she expressed are not uncommon amongst previously independent, newly debilitated patients. Her guilt and feeling of burden could break your heart. Are there means of improving our interactions to decrease this perception? Or, is this guilt, this desire to not be dependent upon others potentially a motivating factor; a goal in it’s own right?

One should never underestimate the power of a patient story. Clinicians of all professions and settings harbor them. Stories of loss, unfortunate outcomes, horrible situations, triumphs, system failure, lack of resources, personal failure, professional limitations, outcomes that defy explanation, and unimaginable bad luck. These plots impact us, because they force us to confront the longer term, the personal narrative and the very real and human enterprise of health care. And, after all we are human too. The illustration of one individual’s unique journey and the construction of a patient’s personal story, their illness narrative, is a vital part of coping, confronting, and rectifying experiences. It’s assigning meaning. These stories likely can assist other patients. And, maybe, they can assist clinicians by highlighting the potential power of our interactions. Our words, our demeanor, our interface with each unique psyche is an intervention.

It’s easy to forget the impact of clinicians on a patient, or even a family member. Fleeting and brief, even the unforgotten moments, the words we can’t recall, may be etched in stone within our patient’s nervous system. A memory, good or bad, helpful or harmful, that persists long afterwards. But, let us not be so naive to think the impact is unidirectional. At times we may forget names, or details, but the themes stay with us. Unscripted and subconscious lessons forged through the cognitively unseen process of emotion. Our personal experiences within this professional realm can simultaneously, and paradoxically, taint our future perspectives and motivate thoughtful change.

The Filling

Some people utterly despise going to the dentist. I get it. The face and mouth are a locus of sensory innervation, and a dentist’s tools don’t exactly exude comfort. The grinding, the drilling, the scraping. Someone else’s hands in your mouth. Bleeding gums. Mouth held open, saliva building up, and plaque flying like saw dust in a wood working shop. Me? I actually enjoy it. At least the cleanings. The feeling of having my teeth scraped clean and polished is somehow satisfying. Afterwards, my mouth feels great. I’d go to the dentist every week, if I could. Recently, my dentist told me I needed a filling replaced. The current one was worn out, discolored, and not as smooth as the dentist desired. I’ll spare you the details. She informed me it would likely take less than 30 minutes. Not a problem I thought. So, I made the appointment.

Two days later, I sat into the customary recliner chair. A partner of my usual dentist would be performing the procedure. “Simple” he said. “I just need to numb that tooth and surrounding area and then we’ll get this done and get you out of here.” I panned to my right to see the syringe and needle.

And, that’s when things got interesting…

As a child, most (see almost all) of my baby teeth required extraction. Those experiences were not pleasant. In fact, quite the opposite. With merely a local anesthetic, I would pin my eyelids shut so as not to view the medieval metallic torture tools required to unroot the stubborn (and might I add inappropriately named) “baby” teeth. Not that I needed to see. The sensory experience of pressure, pulling, and vibration combined with the sounds of the tools upheaving teeth from my gums provided more than enough information for my young nervous system to make a judgement of the situation. This sucked. Plus, as I took my position into the torture victim’s dentist’s chair I didn’t miss eying the tools purposefully arranged in an evenly spaced row of exponentially increasing painful possibilities. At least so they seemed. The imagination may be the most frightening tool. I shuddered just looking at them.

My memories of those extractions are fractured, cloudy, and likely a bit inaccurate.

The build up was always horrible. I dreaded the waiting, the anticipation. Subsequently, I continually reassured myself as I received shots of numbing medicine. Shots in the cheek, the gums, and worst of all, the roof of my mouth. Those ones always hurt, that I did remember. I feared the procedure itself. It’s hard to express what in particular was so frightening.. Likely a combination of the unknown, the possibility of pain during (and after), and just the unsettling experience itself. It’s hard to recall the exact content of my self talk and inner experiences. Although, it felt like some type of duel or argument within me. It’s as if I had multiple inner agents all vying for control of reality. A teeter totter between feelings, assessments, and projections of the possibilities. I attempted to balance “being tough” with the acceptance of the reality regarding the horrible nature of the experience. Imagine someone grabbing you by the tooth with a pair of plyers and shaking your jaw about as if to scramble the contents of your skull.

In regards to both quality and intensity, I honestly can’t remember any pain. I do recall pain with pre-procedure shots in the gums and the roof of the mouth. But, no real details, no illustrative adjectives. I also remember a soreness and difficulty eating after the procedures. My most vivid memories are the experience and associated feelings of sitting in the chair prior to and during extraction. By far, the build up was worse than the actual event. I’m unsure how much explanation I received prior, whether distraction was helpful, or how my dentist even acted. But, I  vividly remember how odd the feeling of a numb mouth and cheeks. I couldn’t spit accurately into a sink for hours afterwards. But, boy could I ever drool down my chin and onto my shirt. The sensation of no sensation always amazed me. My cheeks felt as big as balloons.

Oddly, I’m not afraid of needles. When I have blood drawn or receive a TB test I actually watch the needle being inserted. It’s interesting to me, sensorily, visually, and cognitively. Although, on this day, settling in for a routine filling repair, the dentist informed me I needed to receive a shot of local anesthetic…I felt a rush of not just memories, but palpable states, from my childhood. My body tensed, my respiratory rate elevated. I’m sure my heart raced, and my mind immediately went into a manic panic. I was actually frightened. I tried self-talk, deep breathing, and cognitive re-assurance. These were mildly helpful initially.

Instantly, all the fears, feelings, and thoughts surrounding those previous experiences engulfed me. The intensity lasted but a few minutes. But, I definitely wasn’t comfortable. And, I definitely couldn’t escape. I wanted to ask if he was going to inject my gums or the roof of my mouth (I sure hoped not!). He grabbed my lip and cheek. “I’m gonna shake this for a bit then give you a few small injections around that tooth.” Surprisingly, they didn’t hurt at all. The dentist’s demeanor was friendly, calm, and reassuring. Not too upbeat, not too distant, not too involved in my experience, but present. He instructed me to signal to him if I was having any sensation during the procedure. Even in the moment, I was struck by simple behaviors that likely could be helpful to many patients. Explaining details. Laying out expectations and potential time frames. Gently probing for concerns. Allowing for expression. Listening. Despite his gesture of support, again, a sense of dread ballooned from stomach to throat. One of my extractions as a kid began prematurely without enough anesthetic. The sensation of cold steel gripping your teeth and gums followed swiftly by a downward tug will definitely make you appreciate the necessity of blocking afferent sensory information. But, none the less, I appreciated this dentist’s presence.

The filling removal and replacement proceeded smoothly. Sporadically, but briefly, feelings of anxiety or nervousness would creep into my chest. It wasn’t acutely distressing as much as interesting. I found it a challenge to balance experiencing those feelings, attempting to control them (futile), and analyzing them. Oddly, what affected me most profoundly were not the sensations or experience itself, but rather thoughts of my previous dental disasters and the unknown of upcoming future moments. Recently, Jason Silvernail, DPT, DSc, FAAOMPT stated:

If you’re in healthcare you should periodically be afflicted with something you provide care for. Just enough to keep you humble and patient focused. It’s done wonders for how I behave in the clinic over time.

Even though I am not a dentist, I reflect on my recent experience and am inclined to agree with Jason’s assertion. My experience, my “symptoms” were not a product of the pathology (failing filling) per se nor even specifically related to the procedure (filling replacement). This specific individual experience resulted from my personal past colliding with current events. I’m not convinced any specific intervention would have altered my experience. Although, in retrospect, I’d desire a more detailed explanation of the procedure. What locations would the anesthetic be injected? (Please don’t inject the roof of my mouth!) How many times? How much of my mouth would be numb? Straight forward and detailed (but not too detailed) information may have eased my feelings of unrest. Or, maybe they wouldn’t. I don’t know.

What can we glean from these personal events? Obviously, there are limits to what our first person experiences and observations can illustrate. Despite our intimate knowledge of health care, symptoms, physiology, and hopefully psychology, we may actually be prone to under appreciate the cloud of uncertainty and confusion swirling in a typical patient’s head when faced with common healthcare encounters, symptoms, and procedures. But, what insights do they provide about the patient in pain or distress? Those suffering with chronic pain or disability? The patient facing the unknown during a hospitalization? An individual awaiting a procedure? Those recovering from a surgery? Attempting to return to sport? Dealing with the trauma of an ICU stay?

Philosophers and scientists studying human consciousness continue to debate the role of first person experience in creating a framework and understanding of consciousness.

Each patient we see has a lifetime worth of memories that are going to color their experience on your treatment table. –Kenny Venere, PT, DPT

At the very least, our personal experiences may assist in caring. But, maybe there’s more. What would you want when facing the unknown during a hospitalization? What’s helpful when you are in acute pain? An awareness to the needs of the person, not the patient, might be honed through our own personal struggles and reflection.

Patient Questions Gifford

Maybe first person inquiry, reflection, and patient narrative are integral to our practice? It may be time to sit with our patients, and ask. It may be time to rethink rehab.

Term & Title Protection for the #PhysicalTherapist & #PhysicalTherapy

APTA Term Protection Ad

The American Physical Therapy Association recently constructed a Term and Title Resource Center regarding the use of the terms physical therapy and physiotherapy as well as the titles physical therapist, physiotherapist, PT, DPT, and MPT.

They have even constructed a 1 page advertisement, that I think is actually rather clever. The APTA announces

The full-page color advertisement will run in future editions of State Legislatures magazine, the monthly publication of the National Conference of State Legislatures which is provided to state legislators, legislative staff, and other state policy makers in all US jurisdictions.

I commend the APTA for their efforts and resources, which are no doubt, an important step. And, there have been some victories. Virginia successfully enacted term protection for physical therapy and title protection for physical therapists.

Unfortunately, physical therapists are currently losing this battle on both the legislative (lack of term protection laws), but just as importantly, the judicial level. In 2010, the Washington State Supreme Court issued an impactful ruling that dealt specifically with physician owned physical therapy services (POPTS). But, the ruling also has significant ramifications for the use of the term physical therapy.  Details about the ruling can be found in an APTA released statement. The Kentucky Supreme Court issued a similar opinion.

The Washington State Supreme Court Opinion states:

Physical therapy is one aspect of the practice of medicine. The practice of medicine is defined by RCW 18.71.011(1) as ‘[o]ffer[ing] or undertak[ing] to diagnose, cure, advise, or prescribe for any human disease, ailment, injury, infirmity, deformity, pain or other condition, physical or mental, real or imaginary, by any means or instrumentality.’ This broad definition readily encompasses all the acts constituting the statutory definition of the practice of physical therapy.

Ouch. But, it gets worse. The Washington State Medical Association exclaimed “Big Win in Supreme Court!!!” following the ruling. They continue:

The decision represents a victory for physicians and medical practices, not only because it is now clear they can employ physical therapists, but because an adverse ruling could have outlawed their employment of other licensed health care professionals (such as nurses).

Double ouch. The ruling as well as the medical community’s reaction clearly illustrate that legislators, the judicial system, and physicians do not view physical therapy as a unique profession nor physical therapists as skilled, collaborative, unique members of the healthcare team. It appears physical therapy continues to be viewed as a prescribed or provided modality with physical therapists as mere technicians or employees under the physician umbrella.

We either need to more aggressive with our formal national, state, and local legislative lobbying and education (including legislators,  patients, colleagues, etc), or we we need to seek and secure allies within the medical and healthcare community, including but not limited to physicians. I vote for both.

What are you doing to #SolvePT? What should we do at the grassroots level?

Resources

Term and Title Resources via the American Physical Therapy Association
Term Protection Advertisement/Handout
Physician Owned Physical Therapy Services (POPTS) and Referral for Profit via AAOMPT Student Special Interest Group Blog
APTA Statement on WA Supreme Court Decision
WA Supreme Court Decision and Statement
Virginia Term Protection
Kentucky Court Ruling Information[/list]

It’s Not About the Patient

If you have not yet viewed this video from Jack Bert, MD, from which the above screen shot was taken, please check it out now. Brace yourself. At the 8-minute mark, he discusses PT. He gets excited that a physician in SC was able to hire a chiropractor and “athletic trainers to do the PT” and bill for it, and ran 60% of the physical therapy business out of town.

Is there not some really big problem with this situation? Does this not border on breaking the law? The unrestricted medical license of physicians allows them to bill for whatever medical service they want. Thus, the athletic trainers can indirectly become physical therapists. As a licensed physical therapist in the state of SC, I wonder why I’m paying a fee for licensure, when the state could simultaneously allow non-licensed individuals to perform the service that I’m trained to provide. Why are consumers not being protected from this action?

In the comments on the site, which by now are littered with offended physical therapists, Jack Bert responds:

“Now that I have thought about this, the discussion on ancillary services really has nothing to do with physician arrogance or greed. It really has to do with what is best for the patient.”

I simply don’t buy it. How is having patients be treated by providers with less training and a different skill-set than PT’s (the athletic trainers) equate to something better for the patient. Yes, physicians do medicine. They do it well. Physical therapists, well we do rehab and do it well. Can’t we both exist together?

He goes on to suggest:

“For ancillary providers, such as physical therapists and chiropractors, to believe that they have the same training and ability to diagnose musculoskeletal pathology as a boarded orthopedist with a minimum of 5 years of post-medical school training, excluding a fellowship, is truly astounding.”

Perhaps Jack Bert is not aware of the body of research that suggests overall, that physicians are not adequately trained in musculoskeletal care either. In fact, I find it astounding that a general practitioner with little specific training on the subject finds themselves capable of diagnosing the specifics of an injured shoulder or neck. I fully agree that Jack Bert, a board certified, fellowship trained, orthopaedic surgeon has very capable musculoskeletal examination skills, but I also feel that his disregard of physical therapists to also have those skills offensive and reflective of an old-school physician mentality whose time has passed. There is research to support my claim. Physical therapists are musculoskeletal experts!

If this was truly about the patient, we would give the patients choices. We would empower them to choose their providers. We would act to reduce limited providers and wait times and work towards an equitable distribution of resources. There’s enough demand for everyone to play together. Comments like those of Jack Bert simply shed light on what these turf battles over physician-owned PT services and direct access restrictions are really about. It certainly isn’t about the patient.

Physician Owned Physical Therapy Services (POPTS) in California. The anti-POPTS movement goes Web 2.0

Physical Therapists in California are taking to all forms of the web and utilizing Web 2.o Principles to oppose recent efforts by the California Medical Association and Legislator Mary Hayashi to LEGALIZE Physician Owned Physical Therapy Services in California through AB783. This bill would provide explicit language legalizing the employment of physical therapists by physicians. Those who have followed the POPTS debate in California are left scratching their heads because…

Interestingly, the State of California Legislative Counsel recently rendered an opinion on September 29, 2010 that it is illegal for PTs to be employed by any professional corporation except for those owned by physical therapists. The California Physical Therapy Association provides details

The opinion from Legislative Counsel confirms that, because the California Corporations Code does not specifically include physical therapists on the list of those who may be employed by a medical corporation, a physical therapist is prohibited from providing physical therapy services as an employee of a medical corporation and may be subject to discipline by the Physical Therapy Board of California for doing so.

Now in response to this new, proposed legislation the California Physical Therapy Association released an electronic memo opposing the new bill.

But, a group of concerned consumers (and I am assuming physical therapists) has leveraged technology and taken the movement to a whole new level. They have crated a campaign entitled “Stop POPTS.” So, what Web 2.0 tools are they utilizing? Well here is the list:

But, wait, that is not all! They have also created a Stop POPTS iPetition which currently has over 880 electronic signatures. They were able to amass over 500 within the first 24 hours of creation!

While it is important for our professional organizations to disseminiate opinions, information, and press releases on the national, state, and local level I am always left wondering: Are they effective? Do they even reach, and more importantly affect, the target audiences: the public, legislators, and other health care professionals? Now, the California Medical Association has been able to provide some information through news paper articles and other publicity. Unfortunately, they are able to use their clout as physicians in such outlets, and Joe Public will likely accept what they present at face value (with little questioning or skepticism). Which is a point we sometimes miss. Yes, it is important to spread this information to our PT colleagues, but we need to be reaching the public, legislators, and other health care professionals. Patients, small business owners, and legislators should be outraged! And WE need to light that fire.

Maybe the APTA, the CPTA, AAOMPT, and other organizations should take notes from the Stop POPTS Campaign in California. They are leveraging the web and technology to spread this information virally and aggressively. I believe such an approach is more effective. So, if you support the profession of physical therapy and oppose POPTS please spread the word via facebook, twitter, you tube, and even sign the petition! The Stop POPTS website has an abundance of great information.

Want more Information about POPTS?

Tim Richardson of the blog Physical Therapy Diagnosis recently wrote a post entitled Is Physical Therapy in California a Zero Sum Game?

Last year I authored a long post about POPTS and Referral for Profit on the AAOMPT Student Special Interest Group Blog detailing current rulings in Washington State as well as providing links and information about Stark Laws. The post has a TON of links to other information including APTA press releases and the American Academy of Orthopaedic Surgeons (misguided) view points.

What’s your story and opinion about POPTS? How do we spread it? Can we empower patients to tell their stories?

Healthy People 2020: Physical Therapists in Health and Wellness

CSM kicked off with a talk about how physical therapist’s can fit into the Healthy People 2020 initiative . Further, the roles and potential roles of physical therapists in health, wellness, health promotion, and public health.

  • Work towards health focused practices
  • Health as an outcome
  • Physical Therapy is about movement and function
  • Address societal needs of movement, function, living with disability, and health/wellness
  • Ethics > Meet the health needs of people locally, nationally, and globally
  • Link to our work to individual patient’s, societal needs, overall healthcare
  • How to obtain reimbursement for preventive care?

The speakers gave broad information about health promotion and physical therapists. Each gave some interesting case examples. Each advocated for physical therapy in serving the societal needs of not only health, but living with disability. I absolutely agree! But…

Especially in private practice how do we not only incorporate health promotion, but make it fiscally sustainable and or profitable? Sometimes it is difficult enough to obtain reimbursement and or private pay for a current condition let alone chronic health conditions such as hypertension control, obesity, healthy exercise habits, and smoking cessation. But, on the other hand, the personal fitness and health industry (i.e. weekend trained personal trainers at 24 hour fitness) is booming. How can PT’s obtain a slice (or a big chunk) of this market?

I think they speakers brought a good point that we need a critical mass of not just PT’s, but legislators, public policy makers, patients, and other healthcare professionals committed to societal health in various practice settings. And a recognition of rehabilitation and physical therapy as essential parts of not only health care, but health promotion.

Why aren’t we moving in that direction? Do we all need to broaden our view of our professional role? What is the SWOT [Strengths, Weakness, Opportunities, and Threats] Analysis of the PT profession, and each us as individual practitioners, in regards to health?  I think there are a lot of opportunities, but many, many barriers.

Do we have what it takes to step up to the plate? Or, at least get a place at the table?

  • How do we measure health and outcomes related to health?
  • How do we market and spread the word to: patients, physicians, legislators, payors (ha!), the media, educators, public health professionals, and thus society?
  • What role does technology play in our promotion of health and wellness?
  • Can we leverage technology to achieve and spread the above goals and ideas?

I think the first talk brought up many, many questions, problems, and ideas…

Mrs. Smith: you have an upcoming PT appointment…

Another guest post from Bronwyn Spira, PT, and Tejal Ramaiya, DPT, CSCS, this one an apt follow-up to my post on Physical Therapist Use of Smart Phones:

One of the most frustrating issues plaguing physical therapy practices has to be no shows and late cancellations of scheduled visits. Poor patient attendance results in lost revenues and poor patient outcomes. Practices traditionally employ rudimentary strategies to counter-balance the impact of missed appointments including reminder calls and charging hefty cancellation fees. Unfortunately, these solutions require additional administrative time and effort and can create poor relations between the patients and administrative staff. There must be a better solution!

The answer may be one that 78% of Americans keep in their pockets or purses: a cell phone. The average American spends 619 minutes per month on their phone and, according to a ComScore study from March 2010: 63% of Americans are using text messaging. The use of SMS or text alerts as patient reminders has been shown to reduce the ‘noshow’ rate by 73% (or 1,837 fewer ‘lost’ visits) according to a recent study for Kaiser Permanente by mobilStorm. Kaiser was able to contain their communication infrastructure costs, while saving $150 per appointment (their no-show cost) which equaled a total cost savings of more than $275,000 at just a single clinic.

Ideally, SMS text and/or email alerts should be integrated into a clinic’s scheduling system; automatically alerting patients to upcoming appointments or schedule changes. And why stop there? The potential impact of these alerts could extend to reminding patients to complete their home exercise programs, or give therapists updates on symptomatic responses to new treatment regimens.

A study conducted by comScore found that daily use of Smartphones to access emails rose by 40 percent in the last quarter of 2010. Laptops and desktops it seems, have become primitive mediums for real-time communication. As our patients become more and more tech-savvy, they will begin to expect these type of mobile conveniences from their service providers. In addition to the considerable cost-saving benefits, automated communication can also serve to improve patient/therapist interaction, increase patient participation in their rehabilitation regimen and thereby improve patient outcomes. Have you considered integrating automated SMS text or email alerts into your clinic?

Bronwyn Spira, PT, and Tejal Ramaiya, DPT, CSCS authored this guest post. They can be found at www.forcetherapeutics.com, www.facebook.com/forcetherapeutics, or www.twitter.com/ForceTherEx.

Smart phone “use” by physicians. What do the numbers really mean?

A recent article entitled “Why industry surveys on physician adoption of smart phones could be overestimating reality”at iMedicalApps [Mobile Medical App Reviews & Commentary – A publication by medical professionals] explored what recent market research really means…

It has been cited in market research that 72% to 94% of physicians are using smart phones in clinical practice (Questions: How are they using them? And, how often?).  Josh Herigon, MPH  a second year medical student and blogger at Number Needed to Treat comments:

“Although these studies show a high degree of smartphone adoption among physicians, these results should be interpreted cautiously. These firms provide few details on how they actually conducted these studies. A major hurdle to conducting such research is sampling bias. This can occur in survey research when researchers get a low response rate (i.e.—researchers approach a large number of individuals to fill out a survey but few actually fill it out).”

A little bird told me that a PTJ internal study revealed that no more than 50% of the physical therapists they sampled used smart phones. And, while the percentage of professionals who have and use smart phones is interesting data, I think there is a bigger question to consider. How many physicians, physical therapists, and other healthcare providers who own smart phones are using them routinely and effectively in clinical practice?

Owning a smart phone and leveraging its capabilities during clinical practice are two vastly different things. I am an avid smart phone owner and user, but to be honest, I rarely use my phone in clinical practice. I actually use it most while practicing within the in-patient hospital setting to look up medications, abbreviations, surgeries, and specific diagnoses. But, that is only when I am not near, or logged into, a computer. Admittedly, in the outpatient setting I grossly underuse the capabilities of my phone.

Why are we still giving out paper copies of exercises and patient education? I believe the opportunities for leveraging this technology for clinical support, aiding in clinical decision making, and pt. education are infinite. In my opinion, routine use could actually markedly increase efficiency and quality of care especially in physical therapy. Patient’s use and love their smart phone, so why aren’t we interfacing with them using technology? [Yes, I understand the potential HIPPA considerations and that is not the point of this post]

  • Patient education
  • Home exercise programs: Pictures, videos, directions
  • Pictures and videos of patient performance (motor control, motor learning, and feedback)
  • Documentation
  • Scheduling

Do you think it would be possible to run a private practice and physical therapy LLC strictly from a smart phone. If not, why not? Paper is messy and overated anyway…

Do you have a smart phone? If so, how are you using your smart phone in clinical practice? Do you use specific applications? Any ideas for how we can better utilize this technology as we move forward?

Considering making the switch to a smart phone? Check out this article targeted towards medical professionals: iPhone, Blackberry, or Android?

Did you forget what I told you?

via Markle.orgI stumbled across this interesting little bit from the Markle Survey on Health in a Networked Life. It concerns perceptions of communication gaps between patients and physicians. Simply put, doctors think patients forget things they tell them and patients think doctors forget things about them.

While both situations are probably true, the gap in the perceptions is something to take note of. Underlying this gap is the question of responsibility of ownership of health data. The survey reported that nearly half of patients feel their “main doctor” should be responsible for owning their data, but 2 in 5 consumer and physician groups felt that patients should have the ultimate responsibility for owning their data . Check out their slideshow. (Note the 27% response rate from a small convenience sample of physicians.)

In the world of physical therapy, no one really knows much about how data is stored and what perceptions exist about ownership of data, or even if patients think physical therapists likewise forget things about them at the same rate that they perceive physicians do. We simply have not asked those questions. That point aside, rehabilitation professionals would do well to consider the concept of data ownership. Perhaps engaging in initiatives like “The Blue Button” would be a great place to start. Physical therapists: does your paper-based documentation system have a blue button? Does your EHR?