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I-do-not-care-just-give-me-my-paycheck
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I-do-not-care-just-give-me-my-paycheck - February 13, 2003 10:05:00 PM
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goodlooks58
Posts: 418
Joined: October 21, 2002
From: CA
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Today is a sad and a shameful day for all PTs. I saw female client for my functional capacity evaluation. In the couse of my history taking, I sadly found out that this patient was seen at a prestigious medical school's out patient PT dept. for a Dx of CTS. She was seen for a year 2-3 times a week with ocassional moist heat, e-stim and 1 hour of exercises including ex. bike. She obviosly did not get beter so she goes to a DC who sees her for another year with modalities and a CMT doing massages. She is mildly improved, however, I did a vertical distraction test and her symtptoms in her hand got 50% better. She obviusly has some cervical disc problem going on. No one for 2 years has properly diagnosed her. I have seen chiros milking the system, however, I was geatly saddened that these so-called hot shot PTs from this Medical school were so incompetent that they did not even bother to look at her neck afer 6 months of no improvement. If we as PTs continue to act like this then we deserve DCs, OTs and ATC taking over our profession! I wonder, is this incompetence or I-do-no-care-just-give-me-my-$35.00 per-hour-paycheck attitude.
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Re: I-do-not-care-just-give-me-my-paycheck - August 14, 2003 2:45:00 AM
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Daniel PT
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Joined: August 13, 2003
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I concur. Sometimes, I have been surprised by the treatments that are delivered by other practitioners. Not that I always have the best answers, either...
I think that in general, nobody is the wiser, whether a given patient could have made better progress if he were treated by someone else, or if he simply was a worse case.
Lack of knowledge is a big part of the problem. There were many times in the past, when I would have liked to have had some wise therapist by my side to ask, "What is the best approach to this problem?" And I would have gladly taken his advice.
Now I am 19 years down the road from PT school. Experience has been a great teacher. But I must admit to being in ignorance about many of the techniques out there. I'm sorry, but I feel that the seminars cost too much, and it is a hardship to my coworkers for me to be away- my company does not seem too anxious to send me, but I haven't asked too much either. But, I feel like I get generally get good results with mobility and pain problems, and my work is generally regarded to be good. But I know that there are approaches and techniques I do not know about.
Knowledge should not be in the domain of so few. If I were in the Teacher position, making my living by giving seminars, perhaps I would be looking at things entirely differently.
There should be treatment protocols set up for different problems. It would be a big job, but I think there are 'best' approaches for many problems. I am sure that there are therapists out there who consistently achieve better outcomes. We need to put down on paper what they do. It is not that I believe in cookbook PT, but we need to get things more systematic.
I think we live in the stone age; we haven't established what is "appropriate PT". I once asked the patient case manager of an insurance company, what their criteria were; did they want me to just take care of the patient's present problem, or did they want me to do what was best for the patient's long term benefit, both in term of his well-being, as well as to try to reduce his future morbidity? She had no answer for me.
For most any given patient, I can map out several levels of care- do I want to just do the minimum necessary to help the present problem? Do I want to go a little further, or even more, to improve his quality of life, including addressing problems that I know that I can impact, even though they may have been preexisting for years and years- things that did not prompt the PT referral?
There is so much more that our profession needs to address, to define what we can do. And we have so much housekeeping to do ourselves, first, to upgrade our skills and practices.
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Re: I-do-not-care-just-give-me-my-paycheck - August 15, 2003 1:29:00 PM
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mcap56
Posts: 616
Joined: October 26, 2002
From: New York, NY
Status: offline
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Your coworkers would certainly benefit if you went to quality seminars (not many of them out there....I know) and came back and shared techniques with them.....even if it meant a few days of extra patients.
Seminars aside......there is no shortage of quality information to be had by reading!!! PTs do not read enough. The APTA offers decent home study courses....the orthopedic one is good. These are usually cheaper than courses and can be done on your own time.
You may also want to check the PT update site. It's inexpensive and has lot's of information.
mcap
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Re: I-do-not-care-just-give-me-my-paycheck - September 2, 2003 4:36:00 PM
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OAK
Posts: 183
Joined: September 1, 2003
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I find it hard to believe that a cervical disc problem would last several years. Also, cervical disc problems usually do not respond well to traction. What were the signs and symptoms that led to a CTS dianosis?
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Re: I-do-not-care-just-give-me-my-paycheck - October 24, 2003 2:46:00 PM
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Wisecracker
Posts: 70
Joined: November 15, 2001
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Well I don't know how "obvious" her C-spine disc is, as she could gain relief from that type of decompression from a few other reasons, ie; IVF stenosis, adhesions, even Alf Breig's pet "adverse mechanical tension of the CNS".
But your point is well taken. Of course, aren't you the one who posted not too long ago about your mirth concerning the WC visit cap on chiros in Calif (due to DCs overutilization), and then became rather defensive when I opined that the cap was for DCs and PTs?
The experience I have had as a treater and as a file reviewer is a mixture of the good, the bad and the ugly. For the most part, PTs in our area are caring healthcare professionals who perform a vital service for the community. But there are those who work in a near-criminal fashion. 13 visits in 27 days for $4000 in billings on an episodic mechanical LBP patient; Heat, Ultrasound, Massage (yep, call'em HUMmers) on every patient on every visit regardless of Dx; shoulder rehab that starts with (and bills for) 15 minutes of bicycle pedaling at every session.
I'm not trying to get into a pissing contest, because lord knows the chiros have much to atone for, just trying to point out that there exists no perfectly noble profession. And that there are less-then-desirables in every profession.
[This message has been edited by Wisecracker (edited October 24, 2003).]
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Re: I-do-not-care-just-give-me-my-paycheck - October 25, 2003 11:20:00 PM
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goodlooks58
Posts: 418
Joined: October 21, 2002
From: CA
Status: offline
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Wisecracker: In numbers, there are way more chiros than there are PTs, so statistically, the chances of abuse of the system by chiros is significantly more than PTs. Analogy is that the more miles you put on the road driving, more chances of an MVA happening, no matter how good a driver you are. Knowing all the good, the bad and the ugly PTs in my area, the 13-visits-in-27 -days-$4000 biiling-PTs are hardly 1%-2%. And about the California: 24 visits for PT and DC issue-I have heard WC Insurance claim adjusters bitching-they feel that the chiros should either be a DC/PT or go to school and become an MD. They have a complaint that when a DC becomes a treater and does all the modalities like PTs do and on top of that, beomes a primary care doctor, they see this as a major conflict of interest. Analogy: In 1975 , MDs were banned in owning a pharmacy, just for the simple reason of writing unnecessary RXs for personal monetary gain.
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Re: I-do-not-care-just-give-me-my-paycheck - October 27, 2003 12:20:00 PM
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Wisecracker
Posts: 70
Joined: November 15, 2001
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More DCs then PTs? Hmm, I'll have to look into that, but frankly I think that you are mistaken. There exists roughly 60,000 practicing DCs worldwide, I think there are more PTs than that in just the USA (hell possibly more than that in California for all I know), but I could be mistaken. If I am correct though, your statistic analogy is wrong. BTW, your more-miles-driven analogy is a false analogy, there are other additional significant factors that must be factored into that simplistic equation. But that is a discussion for another time.
Using anecdotal examples does not improve your arguement or position. I can relate a number of WC supervisor stories denigrating PT treatment (the "$4000 PT" file was sent to me by a WC supervisor), but unless the supervisor has as their data base a very large cross section of the treating population, it is just their limited biased opinion and has little weight and cannot be extrapolated out. Thus rendering it fairly meaningless. The fact of the matter remains that there are overtreaters in all professions, as evidence by your first post and by my follow-up, and trying to dismiss one's profession by throwing out an unsupported statistic (1-2% are abusers) does not make it all better and make you less culpable.
As an aside, I can name three local clinics (all in Calif) that have their own, on-site, in-house pharamacy. Given what you stated about the 1975 law banning such, how do think this is possible?
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Re: I-do-not-care-just-give-me-my-paycheck - December 9, 2003 9:26:00 AM
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Wisecracker
Posts: 70
Joined: November 15, 2001
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Well goodlooks it appears that your numbers are off. According to the Buearu of Labor Stats the number of practicing PTs in the US in 2000 was 134,000. This is roughly double the size of all practicing DCs worldwide. So your supposition that there are more DCs than PTs is incorrect.
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Re: I-do-not-care-just-give-me-my-paycheck - December 9, 2003 9:45:00 PM
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goodlooks58
Posts: 418
Joined: October 21, 2002
From: CA
Status: offline
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No, wisecracker, my question was PTs in private practise. Compare apples to apples not oranges.
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Re: I-do-not-care-just-give-me-my-paycheck - December 10, 2003 6:17:00 AM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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You're both right, well sort of. Last time I checked (because I needed the 1996 figures for my PhD dissertation), there were roughly 140,000 PT's in the US, 50% of them working in outpatient orthopedics.
That's roughly 70K PT's in ortho, roughly half of which are in hospital orthopedics (40K in private practice), to 60K DC's. Considering that most PT's work in clusters (e.g. 3-4 to a practice) and DC's tend to "fly solo," there are clearly far more DC practices than PT practices.
Drew
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Re: I-do-not-care-just-give-me-my-paycheck - December 10, 2003 10:52:00 AM
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Wisecracker
Posts: 70
Joined: November 15, 2001
Status: offline
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Goodlooks, you are mistaken. For one you stated that "there are way more DCs than PTs". I just demonstrated that you are incorrect. Second, why would changing the type of practice lead to different levels of abuse? Any citations to back up that contention?
Also if there exists 40,000 outpatient PT clinics in the US, that is not necessarily less than the number of DC clinics. In fact, since the practicing DC population is 60,000 worldwide, I would have to say that the numbers are at least equal, but that is conjecture on my part.
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