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PT and the Greater Good

PT and Telehealth Part 2

Published July 26, 2011 4:40 PM by Dean Metz

A while back, I wrote about a new practice here in the UK where patients are referred for therapy and receive a phone call from the physio. The physio asks a series of questions and then sends out advice and/or exercises in the post. I had some misgivings about it then. I have been able to see it in action for the first time now.

One of our health care assistants (the equivalent of a CNA or rehab assistant) had developed a painful shoulder. She went to her general practitioner, who referred her to physiotherapy. She received the phone call and reports that she was asked a lot of questions, after which the physio said, "I don't need to see you. I'll send you some exercises in the post. If you're not better in six weeks, then we'll bring you in."

She came to me to show me her exercise sheet so I could clarify how to do them correctly. I was not impressed. The exercises consisted of isometrics of internal and external shoulder rotation, followed by active motion using the equivalent of a therapy band (not included). She didn't understand how to perform the exercises and had no idea where to find the exercise band.

It's been a long time since I worked outpatient orthopedics, but I took a look at her shoulder. The supraspinatus and subscapularis as well as biceps heads were prominent and very tender to palpation. The muscles were strong and the movement painful. I initiated cross-friction massage and instructed the woman to perform it on herself, then apply ice. We began pendulums and some active-resistance motions with the weight of a soup can.

Now the woman is better and I'm strongly against tele-health in this fashion.


@ Karen, she responded openly and honestly to my questions. She couldn't have gone back to her GP until the 6 week period had past that the physio had prescribed. The simple fact that she didn't understand how to do her exercises supports my belief that an in person assessment is actually more cost effective in the long run. I saw her and gave her instruction only once. The difference was that being seen in person, being able to touch and feel for findings, and to see and hear her reactions in person I was able to correct her movements immediately and ensure understanding. Had she not had myself available to consult with I fear she would have done nothing out of confusion or worse done further self injury resulting in more time off work and greater involvement with the health care system in the long term. Costs need to be evaluated not only on the single visit, but rather on the long term effects.

I believe that as a taxpayer in the UK, she has a right to an actual assessment, in person, not simply a telephone call. She has paid for it after all. Thanks for reading.

Dean Metz July 31, 2011 5:41 PM

Could it be that the lady did not answer the questions honestly and openly.  There are times when all we have to go on are the patients responses to our questions.  An order for "PT to see for sore back" would be similar.  When no clear mechanism of injury is apparent and the person is vauge about the pain how do we proceed?  Should an eval be done, yes, but when cost is a factor do we see every patient for every ache and pain?  Would the person get better in 4-6 weeks w/o intervention is the real question.  We have sent people back to the MD after 3-4 treatments when the injuy is not responding to therapy care.  Would that lady have gone back to her primary if the pain persisted after 3-6 days?  Maybe we should inform the public more about expectations of care.  

Karen July 31, 2011 4:06 PM

I enjoy reading your blogs the most! They are interesting, informative, and thought-provoking. Keep up the great work.

Jeanne July 28, 2011 5:14 PM

Hey Jeanne, Thanks for reading. The one bit I left out which your response brought to my attention...this wasn't the NHS! It was from a private company. The NHS has been trying to adopt a Medicare-esque approach and paying 3rd party providers for services. That's what this was. Cameron's team is trying the same approach that Thatcher did in the 1980's (When the NHS was not very good). I really hope he doesn't undo a lot of the progress that was accomplished in the past 2 decades!

The NHS isn't perfect, but it does have a lot of good points. Look through my blogs and you will see some examples of things they do very well.

Cheers, Dean

Dean Metz July 28, 2011 12:11 PM

This sounds like an awful idea. What do you think has prompted this tx route there? All I have ever heard are awful stories of socialized medicine. Is this what it has come down to?

Jeanne July 27, 2011 8:18 AM

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About this Blog

    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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