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Transition to Rehab Management

PT Advocacy

Published October 18, 2012 1:19 PM by Karen Schiff

As a therapist and candidate for a doctorate in physical therapy, I have several opportunities to speak up and make a statement for the patients we treat on a daily basis. Over the past year and a half, I've learned it is in our scope of practice to make the determination if a physician's orders are appropriate or justified for our patients. Just as a physician may be a doctor of medicine, osteopathic medicine, dental medicine or chiropractic medicine (just to name a few), we are doctors of physical therapy (or at least working on it). A collaborative approach to treating a patient is the goal, so sharing knowledge, opinion and what it is that may best treat the patient is what we are aiming for.

The past week has brought additional challenges to the clinic, in the financial (Medicare cap) as well as clinical aspects. An ongoing patient who previously had hamstring lengthening and now attends therapy for ROM (with concurrent diagnoses of paraparesis and osteopenia) returned from the orthopedist with a photo of an X-ray that shows a distal femur fracture. Upon phoning the physician with obvious concerns, it was decided by the therapist to put the patient on hold until communication could be achieved with the surgeon. A concerned mother, wanting to do what is best for her son, strongly contested a "hold" status. After much discussion and education, without the "consent" of the physician to place this young man on "hold," mom agreed with the therapists' decision.

To you and I, it's common sense to make the same decision. It comes as a great surprise to me, however, that the general public is unaware of our ability to make the decisions we do. I overwhelmingly believe it's our responsibility to educate ourselves to the level of doctor of physical therapy, as well as communicate on a verbal basis to physicians who refer their patients to us. Only then will they accept us as doctors of our skills, but it will take our profession as a whole to come to this level.

There are definitely those of us who don't believe we need to take our education to this level, and after lightly discussing this with some, there is outward resistance to pursuing the DPT. In my experience thus far, I've noticed that their understanding of the history of our profession, the history of direct access, the current literature and scientific-based care is limited as well. I have to admit, so was mine. The most intriguing class so far has been "Direct Access," which has opened my eyes to the history of physical therapy and gives me vision for our future.


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