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Toni Talks about PT Today

What's the Purpose of a PM & R Doctor?

Published September 10, 2013 11:39 AM by Toni Patt

Until recently, I had never worked closely with PM & R (physical medicine & rehabilitation) physicians. When I worked at the "evil empire," I dealt exclusively with neurologists. Some were good. Some weren't so good. Either way, their purpose for being involved in the patient's care was clear. There was a PM & R service. From what I could tell, they ran interference on the rehab unit with other services.

Now I have three that cover my facility. I've yet to figure out what they do or why they are needed. This is long-term acute care. These patients are sick. Rehab isn't their biggest concern. They don't need a multitude of physicians writing orders for their care. It's not a question of what kind of therapy they need so much as whether they can tolerate it in the first place.

One of the physicians doesn't read the chart. He has written orders to continue care on patients we've signed off on three or four times. Another simply copies our notes into his, then writes that therapy should be continued. At any given time, either one of them is apt to write an order for something beyond the patient's capabilities or that has already been accomplished. I don't understand why they think PTs need to be told what to do with patients in the first place.

Last week, an order was written for an Achilles tendon brace to prevent foot drop. A PRAFO would have worked just as well. So would an off-the-shelf leaf AFO since the real problem manifested itself during gait. No one asked my opinion. I don't see myself discussing brain injuries and presentations with these guys. I'm not sure they would know what I'm talking about.

Maybe the specialty is better served on a rehab unit. I can see having someone to oversee the care and management of meds. Discharge, prosthetics, spasticity management and community reintroduction are also areas where I can see their value. Of course, I'm assuming my crew is the exception rather than the norm.

To me it comes down to the one question. Why do I need a physician to tell me what kind of therapy I should be doing? That's what I went to school for. That's why I have specialty certifications. I'm assuming the majority of practicing PTs and PTAs are more than competent at what they do. Why do any of us need someone else to tell us how to use our skills?

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I've worked with amazing PM&R physicians in pediatric rehab. in 1 state. Now that I'm living and working in another state but still in peds., the PM&R physicians are horrible here! When they are good, they are great... and vice versa! I would imagine they are in your facility to maximize reimbursement any way possible.  it sounds like they are actually draining the bottom line.

Jeanne September 10, 2013 4:13 PM

My PMR doctor for stroke  had obviously never opened a research paper since school. He wrote 3 prescriptions, for OT, PT, ST all for ET. From talking to my therapists none had ever seen my MRI or received any directions from this doctor.  Its why I now firmly believe in Pay for performance. I had my OT running interference to get botox instead of him.

dean r, stroke - survivor, home September 10, 2013 1:22 PM
east lansing MI

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