re: This Was a Learning Experience

Jason Marketti — Thu, 14 May 2009 02:26:48 GMT

It is amazing how the profession has changed and if one does not keep up with evidence then they will be left behind.

We are fortunate that we have good research available for us to access. It is sad to see and hear that others could care less about moving on, they are not seeing a larger picture of where the profession will be.

Hopefully there will be a place for them. Toni, right on, go talk to her, educate her for all of us.

re: This Was a Learning Experience

Christie ,, — Wed, 13 May 2009 22:13:08 GMT

Toni,

I feel for ya! I am currently dealing with a similar situation only...my counterpart involves a physician.

To lay the ground work...I had seen a patient from this physician about 3 months ago. She originally came to me because she had developed numbness in the toe...saw the MD, but by the time she came to me, it was resolved. During the eval, she does report a more than 15 year history of back pain after a coccyx fracture years ago. She'd been "living" with it and it didin't really seem to affect her function, but she was willing for us to take a stab at it to see what we could come up with. Long story short, I could never replicate the symptoms through the spine, but several SIJ tests were positive. After 6 visits, we could not relive her symptoms, but she could complete all her exercises without worsening. At this point, I sent her back to the physician. A day or two later, I had a hysterical call from the physican's office manager (who happens to be his wife) freaking out that I didn't do electrical stimulation on this pateint. After a long drawn out conversation (I won't even get into the details about how off her rocker this woman was), she stated thay THEY were the doctor and that they make the decision and would send her for further testing (fine by me...that was my whole point of sending her to the doctor).

Fast forward to yesterday. I saw a patient from the same physician who is one week s/p MVA with a remote history of cervical fusion with constant neck pain and intermittend UE pain. At this point, all cervical motions increase symptoms, but do not remain worse...yet she's very uncomfortable and in siginicant pain. It obvious she's still in a chemical pain state. She also smokes and is seeking litigation. The physician's orders state "PT for modalities and HEP"...OK, knowing what happened with the last patient, I at least checked on my plan of care that modalities/physical agents would be used "prn." In the back of my mind, I really just intended to have the patient continue the hot/cold at home. Yet, I never mentioned e-stim or US and just left it at that. Really, I was just trying to avoid having that conversation with the Dr.'s wife about the lack of evidence...yet, I was perfectly willing to complete the modalities IF the patient cannot complete the needed exercises or procedures. Well, I got that phone call again...she didn't even want to talk to me this time...fine...talked to my supervisor who went around with the whole lack of evidence with modalities.

At this point, I don't know if they are mad because I was at least willing to consider modalities or that I didn't do them with the first patient who really wasn't bothered by their pain in the first place.

The point is...this is family doctor who probably doesn't know the first thing about PT. So here I am with my DPT, 9 years of experience, a certificate in mechanical diagnosis and therapy. I read the literature weekly...spine, journal of MDT, Archieves of physician Medicine and Rehab, PT, etc.

I question when the last time was that this physician picked up a PT related journal...if ever...yet HE gets to make the decision about PT treatment? C'mon!