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The "Guide"
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The "Guide" - October 30, 1999 3:36:00 AM
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Randy Moore
Posts: 102
Joined: July 6, 1999
From: Columbus, OH USA
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I recently got a newsletter from our local APTA chapter which has an emphasis on the importance of maintaining, or joining the APTA. They discuss the important contribution of the Guide to Physical Therapy Practice, that only an organization like the APTA could have made possible. They report that it is now being used by clinicians, academicians, the insurance industry, and others. They state "this document is proven to be one of the most profound representations of our profession"
Are you using the "Guide"? Are they teaching with it in school? What are your thoughts on its purpose, and what has it accomplished?
[This message has been edited by Randy J Moore (edited November 01, 1999).]
[This message has been edited by Randy J Moore (edited November 01, 1999).]
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Re: The "Guide" - October 30, 1999 4:29:00 AM
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Rose
Posts: 122
Joined: September 19, 1999
From: Ohio
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I received mine last year, scanned it and put it on my bookshelf where it has remained. I guess it didn't "grab me" when I scanned it and forgot about it until you jogged my memory today. I guess I'll give it another scan and see what happens.....
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Re: The "Guide" - October 30, 1999 6:03:00 AM
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Cranial
Posts: 46
Joined: September 4, 1999
From: Plainville, CT USA
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A Guide to pactice stifles the creativity that made our profession grow in its early years(1813-1945) and will restrict its growth for the future(which will be the end of Physiotherapy). A guide restricts practitioners from a legal and a monetary standpoint as it is deemed the standard of practice, when it is merely an introductory manual for new graduates. Hopefully we will survive its publication.
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Re: The "Guide" - October 30, 1999 8:13:00 AM
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Andrew M. Ball, MS, PT
Posts: 500
Joined: October 8, 1999
From: Chapel Hill, NC, USA
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Folks,
As is usually, my "Devil's Advocate" positioning on these postings, I'd have to disagree. Though I do find that THE GUIDE has dismally left out children with disabilities and treatment in the educational setting. I have found the guide to be an effective means of establishing guidelines for "expert clinicians" with whom I graduated who have not picked up a journal article in the past 20 years who either overtreat, do not always consider every approach to a given clinical problem, or view the patient as a body part rather than a person. This however, is a lesser benefit of the guide.
I am utilized in my clinical practice as a consultant to community therapists treating children under the IDEA law. I tend to to the eligibility determining examination and evaluation, they tend to treat. I have found THE GUIDE to be an effective starting point toward standarizing terminology. Examination and Evaluation are not the same thing. A PTA, for example, can examine (but never evaluate) in most states. If we don't have objective definitions for these terms, then we can't communicate with each other and have meaningful debate on the subject.
The same holds true for any of the practice patterns, especially in demanding of clinicians toward the use of the "Hypothesis Oriented Algorithum" (Rothestien and Echternach). In which not pathology, not impairment, and not even functional limitations, drive treatment. Evaluation and treatment is driven by sociological challanges, then we work retrograde to find the root of the daily life problem (e.g. SC to FL to I to P). To do otherwise may be to focus on a clinical pathology or impairment that has NO IMPACT WHATSOEVER upon the patient's desired outcome. Most good clinicians do this already, the GUIDE describes this process better for the novice and antiquated clinician.
All too often in pediatrics, children are treated on the basis of their diagnosis. This is wholly inappropriate as an individual with cerebral palsy will always have the diagnosis, but (If we are anywhere near as effective as we say we are) should not always need physical therapy.
The GUIDE does an excellent job of moving novice and antiquated clinicians away from diagnosis driven practice. A child with CP, a TBI, or and adult with a CVA do not require therapy in an of themselves . . . it is the byproduct impairments that do. Impaired Motor Performance due to congenital abnormality, Decreased Endurance due to systemic disorder, etc. It sets a reasonalbe amount of time with which to achieve a related goal, and provideds standarized terminology for which it is appropriate to ask of a 3rd party payor for a renewed episode of care. I have found this a wonderful means for cutting time in communication and clearly describing treatment needs to my community therapists.
Finally, the GUIDE is a way to uniformly establish a professional voice as to to what we do as professionals. Our position is that PT treatment is more than clinical work. It includes coordination, education, and doccumentation . . . this being the case, we should be able to open discussion with 3rd party payers regarding reimbursement and CPT coding for these procedures . . . perhaps allowing us more time to be optimally effective with each patient we serve.
Is the GUIDE all inclusive and comprehensive? No, of course not. But other than treatment of individuals in the educational environment, and treatment of osteogenesis imperfecta, there is not much that cannot be applied to a practice pattern. The GUIDE is akin to psychology's DSM . . . a work constantly in progress. The first edition of DSM was hardly used by psychologists, but as time went on, and newer editions were published, more and more clinicians used it. As a result, diagnostic classifications were clarified, psychology research improved dramatically, as did their respectablity within the heatlhcare community. Doesn't this sound like what we want? Should be MUCH more effective than stearing PT's away from post-professional PhD's in favor of the lack-luster and wholly useless entry-level DPT . . . at least in terms of respectability.
An interesting but applicable aside from my business management background:
Most people assume that market penetration occurs in a linear fashion. It does not. Most products slowly move from 0 to about 20% market penetration at a snail's pace. An interesting thing happens at this point however . . . almost immediate market penetration to about 90%. The most recent example is the internet, cell phones before them, and cars before them. The lesson is that those of you thinking that the Guide will never change clinical practice may have your fists in the air and head in the sand. Much like how our profession reacted to the "impending doom" of managed care. Remember hearing fellow clinicians saying, "it will never happen here?" (Some said the same thing about switching from paper to electroninc database systems, or carbon paper to xerox).
The point is, if it saves time and clarifies communication, it will survive . . . regardless of how effectively it does either.
The market forces are already in place. Insurance companies eager to find a doccument clearly defining what we do and how long it should take to do it, and novice therapists much better trained to speak the same language as insurance carriers though their knowlege and use of the GUIDE in PT school. It will not take long (maybe 3 to 5 years) before the GUIDE reaches the "critical mass" of 20%.
The question is not how to accept or resist its implementation. It will happen as surely as HMO's did. The charge for our profession to FOR ONCE, not waste the time that we have before a sweeping change and become PRO-ACTIVE!!! USE THE GUIDE AND SUGGEST CHANGES FOR FUTURE EDITIONS!!! Changes that will suit our needs in the clinic optimally. Forward suggestions to the editorial board as to make the GUIDE work FOR us instead of not quite working at all . . . but nevertheless being forced to use it.
------------------
Andrew M. Ball, MS, PT
MBA/PhD Candidate
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Re: The "Guide" - November 2, 1999 4:09:00 PM
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cherylar40
Posts: 9
Joined: August 31, 1999
From: West Allis, WI
Status: offline
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I have the Guide and refer to it occasionally, most often when dealing with insurance case managers. I've even had them call me back and thank me for making them aware of it. I don't use it to direct my treatment, as I found after referring to it that I generally am within the noted guidelines. I agree that it's not perfect, but it is a good start, especially for standardizing language. I believe that the Guide will increasingly be used by third party payors, and that all clinicians should be familiar with it's contents.
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Re: The "Guide" - November 21, 1999 6:22:00 PM
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Holly Batistick
Posts: 4
Joined: November 20, 1999
From: Brooklyn, NY USA
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As a recent graduate of PT school (Boston University), I would like to first say that the Guide was taught and was used as an aid/ reference on an ongoing basis in my program. I fact, we ceased using the SOAP note format for case studies and instead used the exam/eval/diag/prog/intervention format that is utilized in The Guide to PT Practice. While we all were initially skeptical, it soon became clear to us that the Guide is truly a work in progress. I agree with all of the points made by Mr. Ball.
It is true that the Guide will eventually assist in evidence-based practice and serve as one of the most centrally important documents of our profession. Insurance companies will use it as a reference, as will other members of the health care team. It is imperative that we as PTs become active and informed participants, not just reluctant respondents, to this ongoing process.
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