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Appropriate Referrals
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Appropriate Referrals - January 25, 2006 3:45:00 AM
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TLB
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From: Arizona
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Am I the only one who thinks PT's shouldn't be giving advice or treatment options on how to deal with certain types of pt's (example would be hand pt's) to other disiplines such as Chiro's, LMT's, Ex. Specialist, ect.? My advice would be refer to a PT hand specialist or whatever might be appropriate for the case. I just believe we have enough competition without actually training other professions to handle something were we have competent certified specialists. It's kinda like the guy who trains his less competent colleague and is fired weeks later. I also believe it is not appropriate for me to treat in an area where I feel another discipline is more appropriatly suited. Any thoughts on this.
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Todd
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Re: Appropriate Referrals - January 25, 2006 3:51:00 AM
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FLAOrthoPT
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um..yes? maybe some background needed here?
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Re: Appropriate Referrals - January 25, 2006 4:10:00 AM
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GLASGOW
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Best to keep things in house.The chiros cover full spine and also peripheral joints(extremity).They are balooning rapidly into rehab and indeed seeking to employ PT's to do the work for them.They are amalgamating with MD practices and indeed some chiros directly employ MD's.Pt needs to get a clue and develop a better market strategy or else they will end up as MD/DC aids with no particular area of expertise.Already massage therapist are covertly offering PT services and other do the same.Chiros have included a boards part 3 or 4 which(not sure which) certifies them in physical therapy.That was a clever move to outmaneouver physio and claim physio ground.
The writing is on the wall.I wonder who else can see this.
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Re: Appropriate Referrals - January 25, 2006 4:30:00 AM
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SJBird55
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Whoa... there's a 25 center: amalgamating! (I had to look it up!) LOL I don't think I can remember that word to use it 5 times today. LOL
Todd, I'm a bit lost on what you are conveying too.
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Re: Appropriate Referrals - January 25, 2006 4:40:00 AM
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drbuddy
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Is this regarding the recent post on DeQuervains?
Concerning the rapidly 'balooning' into rehab, I'll say that this is not really the case. Rehab, modalities, etc. have always been a part of chiropractic education. I've read a few texts on the history of chiropractic and chiropractic education. WHat I gathered is this; aroung 1903, an MD that graduated from DC school opened up a competing chiro school in the same city (Davenport, IA). He felt that chiropractors should do more than adjust and also have a greater understanding of human anatomy and physiology and the basic sciences than what was being taught at the time. In the curriculum he included all of that, plus rehab and modalies.
Even BJ Palmer, the son of the founder of chiropractic, developed rehab clinic that was said to be the largest in the world at the time. Most people mistakenly think he was a hands only spine only guy, but from his writings we know he was not. Basically, we've always been this way, but for some of you, you're just finding this out.
So, that is one part of it. The other part of it is we are becoming more EB as a profession. The evidence is telling us that rehab plus manipulation is beneficial in many conditions. So, being EB, of course many of us are using rehab in addition to manipulation.
The chiro profession and PT profession both work with similar conditions and are trying to be EB, so of course are paths will collide at some point.
If I were a PT, I would not be so worried. You are a part of the system already, unlike us who are constantly trying to become a part of the system. In my opinion, working under MDs gives you a huge advantage. You have to do less marketing to the public and can focus on the referring MDs. With the referral, you also have greater compliance from the patients. I see a patient off the street and some will not follow even lighter treatment plans like 2 x per week for 4 weeks. However, if they come in with a script from their MD for 3 x per week for 8 weeks, they dont miss one.
Plus, isnt this only one area of PT practice? The only place we really overlap much is in the ortho setting. DCs cant do woound care, treat spinal cord injuries, post stroke, and in most cases immediate post surgical anything.
BTW, the physio part of our national boards is a seperate or 5th part. It doesnt certify us anything, but it allows states that require an additional lisence to use the test as a standard measure that we have competence to use modalities and rehab. In PA, I have a chiro lisence and an 'adjunctive procedures' license. Without that I couldnt use any modalities and probably not rehab.
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Re: Appropriate Referrals - January 25, 2006 4:53:00 AM
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GLASGOW
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Working under the MD does have advantages.You do not have to think for yourself.He takes all responsibility when things go wrong.You are guaranteed an income.No overheads.You do what you are told till you get a pension from his clinic.
Physio wants to go it alone to some degree.We need to ask ourselves the important question.Is there enough meat on the bones of the profession to make an independent discipline which can compete with the established doctors MD/DC/DO.Many say categorically no way.
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Re: Appropriate Referrals - January 25, 2006 4:58:00 AM
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JLS_PT_OCS
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Todd-
I think advice is good all around. One of the hallmarks of a true profession is that it shares it's knowledge with other professions.
No one became competent at something based on advice obtained on a forum board (IMHO).
If any DC or LMT or ATC is here asking for advice on something, I'll gladly give it to them. Sometimes the answer is a recommended consult to another provider such as a PT. Sometimes it's just treatment advice.
I think there are members of all these professions who would rather focus on patient care and excellence and less on partisan bickering, so to speak. Most of my efforts go toward improving the quality of care provided by PTs, but sometimes I can also educate others.
Buddy learns, hey these PTs out there are really good. I learn, hey there's some great DCs out there doing good work for patients. Everybody wins.
Many in the DC community would disagree with Buddy's assertion that non-adjustment care has long been part of chiro practice, but in any case, it seems he's providing it competently and impressively, so no big deal to me.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Appropriate Referrals - January 25, 2006 5:00:00 AM
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JLS_PT_OCS
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Buddy-
Just FYI, I know you would like PTs to have direct access so you can refer to them (I'm sure they'd love to get a good relationship with you also) but your profession's organizations consistently oppose it.
Sounds like they should hear from you...
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Appropriate Referrals - January 25, 2006 5:01:00 AM
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drbuddy
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"I also believe it is not appropriate for me to treat in an area where I feel another discipline is more appropriatly suited. Any thoughts on this."
If this is regarding my recent request for help with DeQuervains, I would say I disagree. I am trained well in a variety of areas, not just spinal manipulation. Plus, my patient was through 6 weeks of PT with little to no help. I am out in the sticks, so my patients do not have access to a PT hand specialist. So, if I were to refer her for more PT, it would be a crap shoot.
I am relatively comfortable treating something like this, but I had never seen a case this severe, so I was asking for opinions. It's just like any other PT on here that posts asking a question about a particular case. Dont think of this as me vs you, PT vs DC, but us against our patients' problems. Afterall, take the title away and we are both clinicians trying to do the best for our patients.
I think you would have a valid argument if a hand PT were to give seminars to DCs about treating various hand pathologies. Then I think you would have a good argument.
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Re: Appropriate Referrals - January 25, 2006 5:06:00 AM
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drbuddy
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Jason,
Now that I think of it, I think PTs do have direct access in PA. We traded that for the right to remain sole providers of spinal manipulation.
The problem is with reimbursement. Most ins companies wont pay without a script from an MD. So, I guess what I would really like is that requirement to be relaxed altogether or to allow DC scripts as well.
Does anyone here know for sure if PA is direct access?
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Re: Appropriate Referrals - January 25, 2006 5:34:00 AM
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TLB
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From: Arizona
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Back on topic. Buddy no disrespect intended but if your speciality is manipulation would you be giving advice to a PT on a chiro board about the best way to use or perform manipulation on a pt. or would you suggest referral out to a compently trained manipulative specialist? The question I'm asking is ( and the Dequervain's thread reminded of some other situations as well both in the clinic and elsewhere)is why do PT's not have a problem giving other disciplines or competing disciplines advice or treatment options and in some cases actually training them when we have very competent specialists where these people could be appropriately referred?
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Todd
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Re: Appropriate Referrals - January 25, 2006 5:44:00 AM
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TLB
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Good points made by all. I got busy with a pt. and wasn't quick enough so posts have crossed.
[QUOTE] No one became competent at something based on advice obtained on a forum board (IMHO). [/QUOTE]So true but why not give the best advice which I believe is refer to a CHT if available. Buddy this is not meant as a slam on you only a general question to the PT's out there that feel it is appropriate both in the clinic and yes even on PT message boards to give advice or demonstrate techniques to other disciplines and not necessarly chiros but all disciplines.
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Todd
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Re: Appropriate Referrals - January 25, 2006 6:28:00 AM
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TMondale
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GLASGOW,
I don't think you have to worry about the future of PT being one of an aide to anybody. Especially not chiropractors. As Buddy says they read the evidence too. And as such on an individual basis they are doing as good a job as we are. As long as they as a profession cling to the buoy of the subluxation theory, that has sustained them but will never allow them to become current as a profession as a whole, we have little to worry about. With regards to chiro's doing rehab; can somewhone tell me what that means, and why we would be threatened by it? As long as they don't call it PT why should we care?
I think our future looks very bright, especially as we continue to generate the evidence that Buddy refers to.
Tim
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Re: Appropriate Referrals - January 25, 2006 6:29:00 AM
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drbuddy
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"but if your speciality is manipulation"
This is where there is a misunderstanding. Saying that my specialty is manipulation would be just as wrong as saying your specialty is therapeutic exercise.
Some, and in fact many, chiropractors choose to make spinal manipulation their focus in practice. However, to many of us, it is just one of our tools.
My specialty is chiropractic. I diagnose and treat musculoskeletal and related conditions. Note that I didnt say anything about spine only. Methods of treatment include manual therapy and manipulation, modalities, therapeutic exercise, and advice (ergonomics,ADL modifications, nutritional, etc.)
With that said, in my practice I choose to focus on spinal conditons and that is how I market myself. However, I tend to see people that have tried everything else with no help, and I do see many extremity complaints. So, I will ask about previous interventions in great detail and determine if I can offer them anything the others have not.
I guess the important points to take away from this discussion is:
- not all chiropractors are the same, but for some, I agree that non-spinal conditions would be out of their area of expertise.
- chiropractors have been using rehab and manual therapies since the early 1900's, it is not a new trend
- the first point depends entirely on the chiro college one graduates from. In general, grads from these schools are more likely to be competent with most musculoskeletal conditions and not spine only: NYCC, WSCC, NWCC, NUHS, TCC, and SCUHS (New York, Western States, Northwestern, National, Texas, and Southern Cal)
Oh, and if a PT was asking for advice with manipulation related topics, I would be more than happy to offer my opinion. If you asked me if I had any experience with manipulating someone with an acute disc and asked for tips, I would certainly offer help. I try to offer help when someone asks about diagnosis too.
You did have one really good suggestion. They could have asked if the patient had access to a hand therapist. Since it was DeQuervains, maybe there isnt much more a hand therapist could offer than I could, so maybe that is why they didnt suggest it. If there was serious nerve damage and the patient had lost hand function, then I think it would be more important. Correct me if this is a wrong assumption.
Oh, and no offense ever taken. You can tell me I'm a quack and that I should never touch any patients ever. Just tell me why and we you feel that way and I'll tell ya where you're wrong : )
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Re: Appropriate Referrals - January 25, 2006 6:55:00 AM
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JLS_PT_OCS
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I'm with Buddy and Tim on this one.
Buddy- I don't believe spinal manipulation is restricted in PA, BTW.
Todd-
Would you suggest we all break ourselves up into tinier groups and narrow our focus such that you can't get knee rehab unless you go to a "Knee PT" and can't get your ankle taped until you go to an "Ankle ATC", etc, etc.
Would you/should you refer every musculoskeletal sprain and strain to an Orthopedic surgeon? They're the 'specialists' right?
I don't see DCs giving PTs CEU courses on manipulation or PTs giving DCs "rehab for chiropractors" courses. If a lot of this was going on, I can see where you might have a point.
But advice is good. Advice is harmless. I am more interested in (for example) helping Buddy's patient with DeQuervain's disease than I am in trying to do turf protection. I have no need to "hide" treatment "secrets" from some groups to keep some sort of status quo. In fact, we publish all the good stuff in freely available journals, right?
I have no doubt which profession is leading the world in excellence in research, practice, and education in nonsurgical musculoskeletal care. It's us PTs. Does that mean we should restrict others from doing it? No.
If Buddy wants to do extremity or spinal rehab for his patients, and wants some friendly advice, I say more power to him, I'm happy to help.
Buddy's opinions on his profession's focus are perfectly legitimate, though they do conflict with what many other DCs and some professional DC organizations say and promote (see my earlier links for more info). If Buddy wants to branch out and help his patients in other ways, what could my rationale be in not trying to help him over a simple forum board? If he wants to reject the subluxation paradigm on which his profession is based and embrace evidence in practice and provide a wider service to his patients, I say go for it!
If I were in private practice, I'd be happy to refer back and forth with him and get together for study and practice sessions. Just another provider doing his best for his patients.
Sounds good to me...
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Appropriate Referrals - January 25, 2006 6:57:00 AM
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paulpt
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Glasgow: believe it or not, a PT has a license that s/he must honor whether employed by a PT, an MD, a DC, a hospital, a Podiatrist, a non-profit association, a state board or a landscaper. This individual must always conduct him or herself in consistency with the law, even if the aforementioned professional or contractor demands that they do not.
And if something goes 'wrong', everyone will be named in the lawsuit, not just the owner of the company. And even if dropped in the lawsuit, this PT could have their licensed 'dinged'.
As far as specialization is concerned, there are certain niche practiced which should be referral based from PT to PT. IE, not all PTs are skilled in vestibular rehab, or women's health issues, and not all PTs have a pool. So PT to PT referral should occur more and more. And this is 'keeping it in house' if you are making a lateral referral to a fellow PT.
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Re: Appropriate Referrals - January 25, 2006 7:09:00 AM
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TLB
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[QUOTE] Would you suggest we all break ourselves up into tinier groups and narrow our focus such that you can't get knee rehab unless you go to a "Knee PT" and can't get your ankle taped until you go to an "Ankle ATC", etc, etc.
[/QUOTE]Absolutely, fianlly someone who gets it. (insert sarcasm)
Buddy I was speaking in generalities when I said IF you specialized in manipulation would it so and so... The original question posed was a simple one and people keep wanting to take this off topic.
Jason, this thread isn't about Buddy or chiropractic it's about all disciplines in general , I'm sure anybuddy that has spent any time here can tell he is compentent, well read and an asset to this board. As far as CEU's go there are generally no restrictions on who can attend that I have found so that also comes into play with the orignal question.
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Todd
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Re: Appropriate Referrals - January 25, 2006 7:31:00 AM
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JLS_PT_OCS
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Sorry, Todd, then I must not be following you.
Could you clarify your concern for me?
I think I'm just not seeing it.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Appropriate Referrals - January 25, 2006 7:54:00 AM
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TLB
Posts: 353
Joined: September 13, 2002
From: Arizona
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Jason,
Maybe it's not a good question to begin with...
I was simply asking is it in our best interest to advise or train other disciplines in what I consider to be our speciality (Musculoskeletal system), noted I'am biased and I'm not saying other disciplines dont also do a good job. If you look around we are losing ground everywhere yet we shoot ourselves in the foot by training others through CEU's, consulting services, or other avenues and PT meassage boards are also included here. If we had Direct Access like everyone else I wouldn't care one way or the other because the playing field is leveled, but we don't and are behind the 8 ball to begin with so to speak. Anyway I was just thinking out loud and usually that's not such a good thing.
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Todd
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Re: Appropriate Referrals - January 25, 2006 8:29:00 AM
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GLASGOW
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Yes Paulpt,but PT's simply do not have full diagnostic status and the accompanying responsibility that brings.The MD/DO/DC have that full legal responsibility and that is a huge fundamental difference between status levels and within the public perception.Maybe this will change a bit with the DPT,lets hope so.Although I would not hold my breath though.
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