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compromise of direct access campaign
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compromise of direct access campaign - July 4, 2004 4:26:00 PM
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FLAOrthoPT
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From: West Palm Beach
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I understand that there is some problems in the fact that our profession is sooooo broad that someone highly trained in wound care can also be the same one to evaluate and try to come up with red flags. Therefore, some are leary as to whether direct access should exist for the benefit of the patients. What is a patient was granted permission to seek direct access via an "approved" clinician. This "approved" status would make sure that the PT is licensed, up to date on CEU, and has passes the specialty board for which the patient would be seeking care. This way, the clinician has gone above and beyond to show that they are the "specialtists" in this particular field, and they should have the knowledge to Dx and exclude red flags, and treat within their specialty without precription. I also do not get how "joe public" is allowed to seek alternative practioners like "Egoscue Clinic" and like personal trainers, massagers, etc, to "rehab" without referral, but why is it so taboo when they want to come see a therapist? I think we need to draw a line between being reimbursed as direct access, and between being able to see patients/clients without prescription on a LEGAL basis. In virginia is was illegal to treat without prescrption. Well this made it difficult to even runa golf performance program, because I was technically always practicing as a PT (my highest license) and so therefore, I had to wait until an MD/DO signed off on medical approval to particiapte' yet this same patient do a similar program taught by an exercice phys. or an atc or trainer does not need such "approval." I think we need to tackle direct access in parts before just going for the whole, that way it gets passed in stages. I feel that the first step is allowing our prefession to treat wihtout prescription...not saying that it is medicare reimbursable. Next we can possibly allow specialtists (APTA recognized) to see patients within their scope of specialty for direct access and be paid for it. Finally, when all is looking good we can press for global direct access. Any thought, opinions?
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Re: compromise of direct access campaign - July 5, 2004 12:41:00 PM
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Andrew M. Ball PT PhD
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What if a PT understood differential diagnosis to the degree to which patients could be referred appropriately?
What if a PT understood radiographic imaging to the degree necessary to suggest to the PCP which views would be most helpful in terms of both diagnosis and treatment? --- What if ALL PT's were given the right to order the images they need, as is the case in the military?
What if a PT were trained as to how certain medications could interact with the rehabilitation process? What if there was a list of medications (as is the case for PT's working in the military) that PT's could prescribe to patients? What if a PT had the knowledge with which to identify Digoxin toxicity in their patient referred to them by an orthopod?
There IS such a mechanism for identification of someone with the minimal educational background sufficient for which to assume this role --- the doctor of physical therapy.
While it is true that it is DANGEROUS for a new-graduate to think that he or she is deserving of the role without experience, it is JUST AS DANGEROUS for an experienced PT to think that he or she can assume the role without the pre-requiste coursework of the DPT.
While I am FOR the development of physical therapy into a portal-of-entry profession, I am AGAINST multiple means of certification to that ends. Furthermore, I am firmly against endangering the public with "wannabe docs" with either no clinical experience, or no requisite coursework.
It is for this reason that I suggest, and continue to push-for, direct access and direct reimbursement for physical therapy as a profession --- BUT in order to qualifiy to practice in such a role, BOTH a DPT AND 5 years of full-time clinical experience should be required. No exceptions. No shortcuts. No confusion.
That said, I also do not get how "joe public" is allowed to seek alternative practioners like "Egoscue Clinic" and like personal trainers, massagers, etc, to "rehab" without referral. I am, and have been a strong proponent of the APTA, and interdisciplinary cooperation between the APTA, AOTA, and ASHA --- but in this regard, they are miserable failures. The APTA in particular, has been so focused upon direct reimbursement under Medicare, that it has lost sight of life in the trenches that may very well prove a bigger threat.
I too get frustrated with therapist self-limiting themselves from practice due to issues of reimbursement, as opposed to access. PT's are, in my opinion, too self-limiting and afraid of taking risks into new business models and/or statements of clinical domain/expertise.
There are many reasons for this, heck I spent a dissertation on that issue, but all is to say that we'd do better to (for better and worse), have a bit more athletic trainer/massage therapist political skill and chiropractor unsubtantiated claim of NMS turf domain/expertise. These professions stand because no one challenges them. Our profession stands still because our rank-and-file have a LONG history of passivity, perhaps borne from the virtue of clinical nurturing.
If we hope to survive, we'd better learn to separate the two, and quick.
Finally, I'm getting tired of experiened clinicians (and I've no idea how experiened you are FLAOrthoPT, so this isn't a direct stab at you) throwing their fist in the air when they're at the same time not taking the steps to become the experienced PT with a DPT that the profession despirately needs before we're over-run with brash, novice DPT's with no clinical experience. It's as bad as complaining about a politician . . . and then admitting that you don't care enough to vote!
I don't think that experienced PT's who complain about both the DPT and their personal need for direct access have much room to talk --- and I encourage those of my generation of PT's to lead, follow, or get out of the way.
Drew
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: compromise of direct access campaign - July 5, 2004 4:05:00 PM
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Jon Newman
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Drew, your passion for the DPT is clear. I don't share the view that having one ought to be a requisite for direct access practice. If there is to be a "you can" practice and "you can't" type approach to direct access, I think this would best be served by a national exam. Of course those with a DPT would have the deck stacked in their favor but those without a DPT would at least have a chance to demonstrate their competence. After all, isn't it about competence and not the title?
As for reimbursement for direct access, that is political. While I'm all for rational thought being the primary factor upon which political decisions are made, it is continually apparent that this is not the case. Instead a critical mass of issue voters seems to be a better motivator than something so boring as reason. Divisive comments such "get out of the way" or "DANGEROUS" are unlikely to earn that critical mass. In fact, it is more likely to inspire an opposition group.
Maybe someone could shed some light on why Virginia doesn't have direct access when so many states do. Are the powers that be simply waiting until enough PT's have their DPT's?
jon
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Re: compromise of direct access campaign - July 5, 2004 5:24:00 PM
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PTupdate.com
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In the not too distant past, I saw a patient who was referred to PT by a physician who wrote "hamstring strain", and was seen before me by a DPT. They evaluated the patient and began them on a hamstring strain type program.
After watching him walk into my clinic and talking to him for 2 minutes, I knew I was not dealing with a hamstring strain, but rather a lumbar radiculopathy.
I was able to give him some relief from the increased pain the "hamstring" program gave him, but he still underwent surgery within a week.
My point is that the DPT is still not enough for me. There are still too many "oafs" that will make it through the program, either because they got in by knowiing someone, are text smart but common sense stupid, or for some other reason.
Granted, they will be better than the BS PT's from 10 years ago, and even better than the MPT's of the past 5-10. But, the degree and even 5 years of clinical experience are still not enough for me. The fact that someone has CEU's means nothing. For all I know, the guy might have taken courses in Reiki, cranio-sacral voodoo babble and a canine course to get these credits.
The APTA specialization process is (or at least used to be) strict enough to weed out those who really don't have a clue what they are doing. You can't "buy" the degree by going to a bunch of courses, but have to earn it by taking a very tough exam.
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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Re: compromise of direct access campaign - July 5, 2004 5:32:00 PM
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Andrew M. Ball PT PhD
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You guys are missing the point.
I'm not a DPT cheerleader. At least not in lieu of experience. At this stage of PT's march toward being an emerging profession (and make no mistake, we are NOT a full profession yet), I support the post-professional transitional DPT. Despite my wife being a DPT at the entry-level, I have always been, and continue to be against, the DPT at the entry-level --- but that train has long left the station.
What we need is experienced PT's with t-DPT's, not a flood of DPT's wet behind the ears. The latter cannot be left to lead the profession.
A DPT is NOT a substitute for the experience necessary for direct access --- but what you guys fail to see is that experience isn't a substitute for the education encompassed in the DPT either.
I'm not for DPT education alone --- I'm for BOTH education and experience leading the profession. That can ONLY happen if guys like us with 10+ years of experience, go out and obtain a DPT --- PRECISELY so that new grads who should know the difference between hamstring pull and lumbar radiculopathy don't miss the obvious.
Such a case, by the way, and I trust you understand, has nothing at all to do with differential diagnosis so much as being an experienced clinician. Diff. Dx. would have more to do with, for example, distinguishing pain at the T12/L1 level from radiating pain from the gastrointestinal system. A DPT can do this. I submit that most experienced PT's can't.
Drew
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Re: compromise of direct access campaign - July 5, 2004 6:45:00 PM
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Jon Newman
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I am not against the existence of the tDPT (or DPT) for that matter. Either are nice ways to publicly demonstrate your professional development. However, I believe my points are still valid even if you substitue a t in front of the DPTs in my last post. I don't think I missed your point at all.
I am curious, how do we know when we are full profession? I am asking this honestly.
jon
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Re: compromise of direct access campaign - July 5, 2004 7:16:00 PM
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Bill Egan
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This is an intersting debate for me having practiced in the military and now as a civilian PT. Although we all have reservations about some of our colleague's abilties, I think we need to stand united in our push for direct access. In all honesty, detecting red flags and knowing when to refer on is not that complicated.
How many of your have dealt with this scenario? Your patient has suffered with LBP for several months. After imaging studies, referals to specialists, and multiple medications they finally land in your clinic. Money, time, and increased pain and worry by the patient have been wasted. You know full well that had they been treated by you within a reasonable amount of time, the whole mess could have been avoided. Situations like these are, to me, the main reason why we need direct access. Who out there is better at directing conservative management for musculoskelatal conditions than PT's?
Bill
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Re: compromise of direct access campaign - July 5, 2004 7:46:00 PM
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goodlooks58
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Bill, your comments are full of common sense which directly appeals to my type of BS PTs who have been PTs since 20 years. Every conscientous PT who cares to give the best possible care, knows that he/she lacks some skills as we are not always able to treat every patient who walks into our clinic. Thus the absolute need for continuing education. With common sense and basic knowledge many a times I am able to better diagnose than an MD becuase sometimes we intuitively know that this particular patient needs something more that what he has gotten. In these instances, I have made recommendations for further diagnostics and have had excellent outcomes for certain patients. I believe PTs should all stand united, be focussed and try to get direct access in its full totality. Starting with Medicare patients is excellent focus.
BS, MS, tDPT or DPT, in my experince has little meaning, yes , I do beleive that certain differential diagnosis, radiology, pharmacology continiing ed. courses approved by APTA and our malpractise insurance companies should be mandatory.
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Re: compromise of direct access campaign - July 6, 2004 5:30:00 AM
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FLAOrthoPT
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I still do not see the benefit for me to get a DPT. I am not totally opposed to getting it, nor am I one of those who is against the entire concept. I wouldn't mind getting one, it just doesn't seem to be cost efficient to spend about 10000 dollars to get a degree that will do nothing to advance my clinical skills or professional career. I now only treat patients based on word of mouth referrals and I leave the insurance game out of it. I do refer these patients back to one specific ortho for diag tests and to r/o red flags, or get Rx if I feel necessary, in exchange he gets them in on no notice, which makes me look good. I guess just through experience of looking for dysfunction, be it neurological, biomechanical, musculo-skeletal, etc that I can pretty much tell which s+s is following a treatable pattern, or which ones need to be referred out. I think that back to your point about the T12/L1 question, I mean if it is following the entire dermatome, nor is is provokable with closing the facet of that segment, or stress testing the area, or based even upon the time of day or activities that provoke pain, I do not think that I ever needed to know what the gastrointestinal system could refer, as long as I have ruled out musculoskeletal, etc from being the factor then I have done my job by referring out. I do not think it is our job to medically diagnose, we treat dysfunction of the musculo-nervous-skeletal system be it central or peripheral chronic or acute. We needt o recognize how other medical pathologies can influence the s+s and how they can affect Tx, but I do not think it is our role to Dx such conditions. For example, I had a 14 year old Dx with Chondromalcia Patella, well s+s were vague, noone of the activities that she did that should have aggravated it did, and and no clinical exam tests could provke the pain. There were a couple of biomechanical factors, at the hip and feet, but nothing that screamed that it should be unilateral. Well, the ortho was very prominant, so I treated her for 3 weeks to help her tracking (which was slightly off) and posted some orthotics for her pronating feet. Well, she was in good shape, so I had her stop after three weeks and follow up in 2 more after she resumed her normal activities. Well, when she said nothing had changed, and in fact the pain was getting worse at night now, I knew RED FLAG. She did not look like normal s+s, she did not respond well with good Tx, so it was time to refer back to the MD. Did I think something else could be going on? Sure, could have it been from her back, sure, could have it been from undiagnosed Lyme's Dx or something, sure, but I did what was best for the patient, I referred back to the MD. Turns out she had cancer in her knee, and needed a knee replacement. This was missed by 2 orthos, and one PCP. Did I necessarily pick it up? Kind of, not really, but did I realize that it was looking or acting like a typical dysfunction, you bet. So where I am going is, what would advanced medical (not PT clinical) diagnosis come in hand when we can just as easily know what it IS NOT, rather than worrying about what it IS? Once again, when my family members (several states away) need to go to a PT, I always tell them to look for one that is either/and/or OCS, manually certified or FAOMPT, etc...I think this will better dictate an expertise of care...I have no idea thow long that DPT has been practicing. So, for me the more advanced physical therapy degree would be the post professional clinical degrees such as the OCS. Anyway, I rambling now, but my main point is what would a DPT do for me now? Ecen if I was in a clinic seeking referrals, I still do not see what it can do for the already seasoned clinician. I am all ears though, not opposed, just do not see the benefit. I am for the new grads being DPT, just as much as the BSPT can honestly say that us MSPT graduate with a much higher knowledge base of spinal mechanics and differential Dx techniques, I am sure the DPT will be better than me in the same amount of clinical time assuming they have the same professional/clinical experience, and CEU courses, certifications etc. Then again, I'd much rather see someone who is dedicated to a specific area of the field, such as the SCS, OCS, or any of the manually cert. or NAIOMT certified, etc practitioners who only practice that specialty. Kind of like seeing an ortho surgeon who only does knees compared to one who does backs hands hips and knees. I just feel that the one who only sees knees all day will be more experienced in knees. More food for thought I guess,
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Re: compromise of direct access campaign - July 6, 2004 6:03:00 AM
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Diane
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One way to stop all the fuss over who should or shouldn't have direct access within the PT ranks would be to simply 'grandfather' (or mother) all PTs at once, regardless of educational"rank", up to a certain date, allowing direct access to all who graduated prior to that date (the fossils); after which point all PTs who graduate must have DPT standard (or whatever) in order to be licensed (to satisfy the purists). This is a simple solution that confers no more stress on individuals who graduated before this set of social needs became apparent. The 'fossils' eventually retire/die and clear the way for the 'purists'.
This strategy has been used here in Canada through the years as educational levels rose and rose. Here, if you are a fossil and ever 'stop work' for a few years and lose your license, you won't get it back until you make up for your missing levels of education; however you can retain continuous lisencing with no problem by proving that you have remained continuously in the work force whether private or public, and submitting proof of cont. ed. if such info is requested.
Here (in BC), we've always had direct access just by applying for it, which many private practitioners did, especially the army trained types of PTs who practiced HVLA manipulation. Then, suddenly we were all granted it, 10 years ago in this province, whether we were educationally updated or not, and we either sank or swam in the market place.
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Re: compromise of direct access campaign - July 6, 2004 1:48:00 PM
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Dr.Wagner
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Drew stated : What if a PT were trained as to how certain medications could interact with the rehabilitation process? What if there was a list of medications (as is the case for PT's working in the military) that PT's could prescribe to patients? What if a PT had the knowledge with which to identify Digoxin toxicity in their patient referred to them by an orthopod?
Well, I gotta argue with this...a PT trained like this is called a Physician MD or DO. Bar none, there is no substitute. If you wish to continue rehab, but wish to take it to the next level, do so in the gold standard and safest way...not by lobbying, but by medical school and residency training.
WHile I appreciate the excitement in Drews breath, I don't quite understand what he is looking for. The avenue exists already, a safe and proven avenue. PT should concentrate on what it does better than anyone else, practicing the art of THERAPY and leaving medicine to Physicians. He has no idea what he suggests...his description is that of a Physiatrist or Rheumatologist...and when he speaks of Digoxin toxicity (Drew, stop now) that is something that takes years of training to interpret with precision in Emergency Medicine residencies. And WHY all of this for 50k a year while opening up substantial liability at the same time? Makes no sense, and in fact it sounds like he is a bit frustrated and simply NOT happy with what he does and wishes to MORPH his degree into something else. I just chose to go back to school, call me old fashioned.
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Re: compromise of direct access campaign - July 6, 2004 3:39:00 PM
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Andrew M. Ball PT PhD
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With all due respect Wags. You're wrong. This is the DPT vision, not my vision. It is what is entailed in all DPT programs. It is what physicians like yourself should be asking for --- doctors of physical therapy who can be your eyes and ears in the clinic and make the provision of care to your patient's much safer.
Let me assure you, however, if I saw what appeared to be possible digoxin toxicity --- which happens more often than it should --- rest assured that I'd contact the physician to express my concerns. I'm not above being wrong, but if the signs where there, if it were a frail 85 year old woman with congestive heart failure, on HCTZ 25mg qd, and digoxin 0.25 mg qd --- would't you as the referring MD want to know about it?
Wouldn't you take comfort in a DPT who realized that HCTZ can increase risk of Digoxin toxicity secondary to decreased potassium levels?
Wouldn't you take comfort in a DPT who knew enough to know that a change in cardiac rhytum is worth calling you about, as opposed to dismissing that exercise induced "thud" (maybe a PVC, mabye not) that the patient compains of "coming and going" for a few minutes during exercise?
How about noticing the patient's weight loss and then finding out that patient states that she's had a "stomach virus for quite some time now," and that her children are noticing changes in mental status, including what sounds like halucinations?
While I agree that a DPT shouldn't be making a diagnosis of digoxin toxicity, they sure as hell should be able to recognize the symptoms of it and coordinate care or even refer to the appropriate provider of care.
The development of physical therapy into a clinical doctoring profession helps YOU the medical physician. You're still in the driver's seat, don't worry --- but don't let your ego get in the way of elevation of the level of care that your patients will receive.
I'm not morphing a DPT into anything that it is not. It is what it is, and I can't understand why your ego seems to get in the way of using properly trained DPT's as an early warning system in the clinic. We don't have to be right --- we just need to know enough to be able to recognize what objective information needs to be passed along. If such information is passed along and dismissed because I'm a physical therapist and not a physician --- that's on the physician's head.
Drew
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: compromise of direct access campaign - July 6, 2004 5:41:00 PM
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Dr.Wagner
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My main concern is that you know enough to be dangerous...a vague sense of medical knowledge in an ego that could fill a room.
I ask you, why propose such a vision when a more complete form exists? Why open liability concerns to a peaceful and litigious free profession by "half learning" medicine?
Perhaps you should join this discussionhttp://chirotalk.proboards3.com/index.cgi?board=excuses&action=display&num=1086779655
It has nothing to do with "being in the drivers seat" and has everything to do with learning medicine and diagnosis of pathology the correct way. The path you speak of is learned completely in medical school...I really think you missed a calling...you just sound VERY unhappy with what you have chosen to do.
I can tell, you want to go into medicine and actually learn what you wish to learn...but you simply don't want to start over. There are no "teams" in medicine, there is no "light and dark side of the force" Drew. If you want to learn medicine, learn it completely and in an all consuming format and go to medical school.
Don't dilly dally in medicine.
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Re: compromise of direct access campaign - July 6, 2004 6:53:00 PM
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Jon Newman
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Dr. Wagner,
In defense of Drew, I doubt he is dangerous. I can't see that understanding more is dangerous unless acting overly conservative is considered dangerous. What I've read (with the exception of prescribing meds) is that Drew suggests PT's (DPT's actually) ought to recognize when something is not of musculoskeltal orgin and thus warrants a call to the doc. Hardly dangerous. At what point should PT's stop learning and be less holistic? Are blood pressures and heart rates really that important to monitor in cardiac patients? Perhaps my diaphoretic diabetic is acting confused just to get out of exercise. It would seem that inappropriately acting on the knowledge is what your concerned about. However, all boxes in the decision making scheme seem to lead to "call the doc" if something doesn't add up right. That is why I don't think a DPT is needed; it is not that complicated.
I think the most probable danger posed by PT's possesing a little knowledge about medicine is getting annoying calls from PT's anxious to find something. But you could always get those who do act inappropriately on their knowledge, but this has little to do with the DPT or direct access, just the individual. And there are laws to help minimize and correct for these situations.
As far as accepting the additional liability in exchange for direct access; thanks for your concern but many are willing to do so.
jon
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Re: compromise of direct access campaign - July 7, 2004 3:25:00 AM
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Sebastian Asselbergs
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Liability is NOT an issue in the apparently not-so-hot-on-sueing Canadian culture. In the 11 years of direct access here in Ontario, my liability rates started at CAN$125.00 and have gone up to presently CAN$215.00 PER YEAR - a big increase, but look at the amount.....peanuts compared to MDs, DCs...
Dr. Wagner,how can knowledge be dangerous? Only when used inappropriately - and proper training includes HOW to use knowledge.
Now, since I'm in Canada, I am not so sure we should be all hot and bothered to become "Doctors of Physical Therapy" - the training and education of PTs here is such that red flags, responsible monitoring of progress or lack thereof, etc etc, are very much at the core of curriculum.
My question is in this time of evidence based medicine or practice: where is the evidence that the present PTs have been doing things so poorly that a change in education c.q status has been deemed necessary?
Where is the evidence that serious health mistakes have been made that can be prevented with more university education? (not talking individual counselling here)
Where is the evidence that the mistakes that may have been made are inherent in the education of the involved practitioner and not in the sloppy application of their knowledge?
I think the DPT issue is much more an issue of status than an issue of patient safety (but that IS only an opinion...)
Sebastian
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Re: compromise of direct access campaign - July 7, 2004 8:44:00 AM
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Dr.Wagner
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First and foremost, "a little knowledge is a dangerous thing" is a pretty well established saying and it goes for medical students all the way to Drew. I have a deep sense the man is a bit too confident and needs a deeper understanding of pathology and pharmacology than his current understanding...despite his well meaning efforts.
I would love it if a PT called me and stated "I believe Mrs Jones CHF is worsening as she is increasingly dyspneic during our session"...but I would be nervous if he/she called and stated "Mrs Jones might be digoxin toxic so I told her to hold her daily digoxin"...what? Don't tell me a diagnosis, tell me the symptoms...you don't know the diagnosis as digoxin toxicity is not overtly apparent and needs tests...while SYMPTOMS lead to a diverse differential, many deadly and EMERGENT.
A little bit of knowlege is a dangerous thing.
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Re: compromise of direct access campaign - July 7, 2004 1:37:00 PM
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FLAOrthoPT
Posts: 1011
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From: West Palm Beach
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And a little bit of ice cream is never enough
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Re: compromise of direct access campaign - July 7, 2004 1:45:00 PM
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Andrew M. Ball PT PhD
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Dr. Wags,
I think you've got the wrong impression of who I really am. I would NEVER, EVER tell a patient to discontinue ANY medication. Besides clearly not being within my scope of practice, as you well know, rapid discontinuation of a medication may be just as dangerous.
What you must also understand is that over the course of a 30 to 60 minute session, a patient is going to talk about every ache, pain, and health disturbance that they have. PT's need to be better filters than they currently are, so as to dismiss what isn't important, and raise an eyebrow when it is. I KNOW I'm not going to be perfect, but I do hope to catch a few important objective signs that you'd want to process into your differentials --- without annyoying you the MD with every little thing.
What you describe in positive terms is exactly what would happen --- this is what I see (GI dysfunction, mental status change, cardiac arrythmia suspected, halucinations, etc.). I'd tactfully note that she's a frail woman on what is generally considered to be a high dose, and that she's also on HCTZ. On the rare occasion that I've had to call an MD in a situation like this --- in all but one instance the MD got what I was getting at and concerned about immediately. Only once did I have to spell out that I was concerned about how adverse drug interactions may be impacting therapy.
Of the three cases, two turned out to be toxic. Unless they were saying one thing to me and thinking another, all of the MD's were appreciate of the respective calls.
Just like the hair dresser who sees a mole that looks funny and "refers" a client to a dermatologist, it is not my role to practice medicine --- only to know when it is appropriate to access the physician.
Traditionally, physical therapists haven't been all that great at recongnizing these things, it is the APTA's vision that with the advent of the DPT, that we'll do a better job with this. It is not my vision, but I certainly don't want a new graduate DPT, with emerging, yet limited knowledge of DPT/MD professional relationships, to be the first DPT to make contact with a given MD for such a reason.
It will happen with increasing frequency, and increasing appropriateness --- it is my hope, and my responsiblity as a more experienced clinician, that it also happen with appropriate tact so that that the true focus --- the patient --- doesn't get lost in physician shock that a mere physical therapist had concerns about a patient's care that were seemingly outside the scope of PT practice.
I agree that a little knowledge is a dangerous thing --- that's why I expect that when, with my limited pharm, imaging, and diff. dx knowledge as a DPT, that if I pick up on something that appears out of sync --- something that the PT of 10 years ago would have missed completely --- that it's not dismissed out of hand, but that it is appropriately processed by the physician.
Drew
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: compromise of direct access campaign - July 8, 2004 7:10:00 AM
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chiroortho
Posts: 655
Joined: February 18, 2004
Status: offline
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Drew, it is very likely that I'm misunderstanding you here, but it appears that you're purveying two separate messages.
In your comments above, I don't see a thing wrong with your proposed approach.
On the other hand, I have seen it proposed (I'm not sure whether or not by you) that DPTs prescribe medications, order imaging studies, diagnose the patient and order treatment. This seems to me to be consistent with Dr. Wagner's position that you want to bypass medical school and become de facto physicians.
The two positions that I've noted above seem to me to be mutually exclusive. You can't defer to the physician on medications while prescribing medications yourself. You would have to expose yourself to all kinds of liability, which seems to me to be a total negative.
What do you think?
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Greg Priest, DC, DABCO
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Re: compromise of direct access campaign - July 8, 2004 8:06:00 AM
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Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
Status: offline
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Exactly Greg, there are distinctly two different posts here.
One very aggressive (on caffeine...not really thinking clearly)
The next on Sanka (mello and organized).
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Dr. Wagner DO
Moderator of Medical Complexity Forum
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