I Can't Treat That
I remember my neurology professor at physical therapy school would frequently joke that her friends didn't understand what type of work she did. She would say "physical therapist" and they would assume orthopedic injuries and ask for help with their necks, backs, and other musculoskeletal concerns. She would politely correct them and explain her focus on traumatic brain injuries, spinal cord injuries and strokes, and encourage them to find a physical therapist with the skills to help.
This happens to me occasionally, but not frequently, and I'm usually able to find a resource for my patients. For cases needing a women's health or significant hand rehab, I have community contacts for patients. Within my own department and network of colleagues, I know the experts on vestibular treatment or rib mobilizations I can connect with for refreshers when I'm a little rusty on my skills.
But, what happens when you have to say no? I recently had a friend from high school email me asking for advice for treatment for her child with ambulatory deficits due to a congenital disorder. She and her family live in a rural area in Alaska with no nearby options. I shared her story with some of my pediatric physical therapist friends, but we all agreed the case was too complicated to discuss remotely. We considered using FaceTime or Skype to provide some solution, but the child's needs required hands-on care.
I felt terrible. A big reason I chose to become a physical therapist was to help other people, and this felt like a major failure. It was hard to know the child needed help and I knew physical therapy could help, but couldn't provide any intervention. My friend responded with, "That's okay, I understand," but I still didn't have a good feeling about how the story ended.
How do you handle cases like that? When you have to tell patients you cannot treat them, what alternatives to you provide? What's the best way to promote physical therapy when our specializations may leave us limited in scope.