PTS SHOULD BE ABLE TO ORDER XRAYS
This semester my class is Radiologic Imaging. It's an overview of the various radiological studies a PT might encounter, how the study is produced and what each study shows. Each week we have two discussions. One concerns how the study being covered benefits PTs. The second concerns giving PTs the ability to order some radiologic studies for neuromuscular problems. This hadn't occurred to me until this class. It makes sense. We work with the neuromuscular system. It would improve our ability to provide treatment and decrease the expense and waiting time compared to the current system of sending the patient back to the physician for one. The ability would also allow us to determine more quickly if a patient has a musculoskeletal problem we can address or a medical one a physician should address.
As wonderful as it sounds I have concerns. One is that we'll become dependent on radiological studies and lose our ability to diagnosis. Currently we develop a POC based on patient history and objective examination. X-rays and what not are used to confirm what we already suspect, not diagnosis what is going on. It would be easy to become lazy and send everyone for a study instead of performing a thorough evaluation. The problem with that is not everything on a study is painful and not everything painful shows up on a study. Back in my OP days it wasn't uncommon to have a patient who symptoms didn't match the MRI. I could still treat that patient. I wouldn't be too successful with that patient if I only looked at the MRI. What if a large OP clinic decided to buy its own machine? Would every patient automatically get an X-ray?
I'm not saying this is a bad idea. I think it could be a good idea. I just think it needs to be more thoroughly thought out. Everyone in class believes additional education, possibly certification should be a requirement. A DPT isn't enough. Radiology is covered but not in enough detail. By making it certificate based all PTs could have the privilege if they were willing to take the classes. Trust me, it would be more than an 8 hour course. There is more to ordering a study then ordering an X-ray. In order to order the right study I need to know which one is best for what I want to see. I can order all the studies I want. If I order the wrong thing I won't see what I'm looking for. I known many patients who've had multiple studies because the physician couldn't find what was wrong. If that happens to physicians I can imagine what would happen if I tried to order something without proper knowledge.
I also think specific parameters would need to be defined of what a PT can and can't order. There is no good reason for a PT to order a CT of the abdomen. That pt. needs to be referred back to the physician for medical management. The same is true of angiograms, MRAs and nuclear medicine. Those are beyond our scope of practice. If a patient needs one, that patient should be under a physician's care. I can make a pretty good argument against MRIs and CTs of the brain because, again, that patient should probably be under a physician's care. However, if I'm working in a SNF and my elderly patient is deteriorating I want to be able to order a study. Increased confusion can result from an untreated UTI or a slow ICH. A UTI can be treated with antibiotics. An ICH requires hospitalization.
I disagree with my class on one thing. I think the privilege should include PTs who practice in hospitals. Very few of my classmates agree with me. They say the physicians will have already ordered everything. I say we should because we spend a lot of time with our patients. Frequently we notice status and cognitive changes first. Or, we have a patient who just can't walk even though there is no diagnosis explaining why that is happening. Does it matter who orders the study if the end result benefits the patient? I think hospitals might be our easiest target because most reimbursement is DRG based. The hospital only gets so much money no matter what the actual costs are.
We're a long way from being able to do this. Many states lack direct access. Texas is one of them. That seems minor compared to ordering radiologic studies. I'm not sure why we absolutely have to have one to get the other. Ordering a study would change my scope of practice less than having direct access. A radiologist would read anything I order. Insurance companies probably see that differently. It's hard enough to get them to fairly reimburse now. Getting them to pay for something new will be an uphill battle. Either way we're not there yet.