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how would you handle this one?
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how would you handle this one? - February 15, 2006 12:08:00 PM
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johnczyk1
Posts: 22
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Here's a good one...patient has been seeing you for PT for 2 visits....not clear if he is really improving yet,but it's only been two visits. MD send s pt. to chiro stating he would benefit from both therapies.Chiro promptly tells pt to stop the PT exercises and start his own....Kind of felt like calling the MD and asking him what size hydrocallator he would like on his patient as that is about all we do right? The old phrase too many chiefs ......rings true. oh brother..I am not sure people really know what we do....
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Re: how would you handle this one? - February 15, 2006 12:21:00 PM
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Lehmkuhler
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Or maybe you could call the Chiro and see what's up???
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Re: how would you handle this one? - February 15, 2006 1:30:00 PM
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drbuddy
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From: Pennsylvania
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How do the chiro's exercises differ from the ones you prescribed?
This is a tough situation. If a patient is seeing a PT first and they want to come see me to be co-treated, I leave the exercise and modalities up to the PT. Unless I thought the treatment was way of base or hindering improvement. Then I would give my own recommendations.
If they've been to PT and what they were doing wasnt helping, then I scrap the plan and start over. This doesnt seem to be the case in this instance.
Hmm, sticky situation. In this case, it seems like the patient is going to have to chose one or the other. They either chose to follow your recommendations or you discharge them.
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Re: how would you handle this one? - February 15, 2006 4:24:00 PM
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docb
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I agree; I would call the chiro!
If your doing Mckenze and he's doing cox flexion your doing ice he's doing heat then no one especially the pt is going to win.
As long as the chiro's not egotistical they should be able to coordinate care for the benefit of the patient.
Also sounds like you need to make an office call to educate the MD as well (only 2 days of PT care and he's having the pt see another healthcare practitioner) sheesh
good luck
Bryan
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Re: how would you handle this one? - February 15, 2006 7:43:00 PM
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Alex Brenner PT MPT OCS
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I would speak to the patient and let them know that by co-treating there is a possiblity that the PT and Chiro's treatments could conflict and cause more problems than good. I have also been in this situation before and I don't like it. I would let the patient decide who they want to see. If they are truly happy with your intervention then they will not go to the chiro but by all means if you are not getting them better you should offer the referral.
_____________________________
Alex Brenner, PT, MPT, OCS
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Re: how would you handle this one? - February 15, 2006 10:21:00 PM
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Jeep
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What is this patient's problem/diagnosis?
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Re: how would you handle this one? - February 16, 2006 12:22:00 AM
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GLASGOW
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What is this patient's problem/diagnosis? That is the crux of the matter.
It is my experience that chiropractors are generally unconcerned as to what the PT is doing as they see such a gulf between each method of practice.So this seems to be mainly a PT concern which is legitimate but seemingly not shared by the chiropractic community.
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Re: how would you handle this one? - February 16, 2006 1:28:00 AM
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PTupdate.com
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I have always told patients exactly what Alex Brenner said. One may be doing something that interferes with the other's program. I would also contact the physician, and while his intentions may have been good (adding more and different things to speed up the process), he'd probably be glad to know that in some cases, the added on service may not blend with the others.
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: how would you handle this one? - February 16, 2006 4:07:00 AM
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matotoms
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tell the pt that his current md is an idiot and he should switch doctors...recommend someone in the same specialty......
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Re: how would you handle this one? - February 16, 2006 5:03:00 AM
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drbuddy
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From: Pennsylvania
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Thanks for the well thought out response, mt!
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Re: how would you handle this one? - February 16, 2006 7:04:00 AM
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tnpta2
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HAD A CAR WRECK PATIENT
LAWYER SENT HER TO HIS CHIRO. (HIS?)
M.D. SENT HER TO US (P.T.)
GAVE HER A CHOICE
SHE CHECKED WITH HER LAWYER
SHE WENT WITH THE CHIRO
HUM?
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Re: how would you handle this one? - February 16, 2006 7:14:00 AM
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TMondale
Posts: 131
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From: Newton-Wellelsley Hospital
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J,
I agree with Buddy. Respectfully ask the patient to choose one or the other. Both only leads to confusion of message and effect. I've had this discussion with many of my MD colleagues who think it's appropriate to refer to both.
Tim
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Re: how would you handle this one? - February 16, 2006 7:32:00 AM
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paulpt
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I should think that it remains possible for the MD and the chiro and the PT and the patient to work together, in a team based manner.
If not, then you may have a tough choice or 2 to make.
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Re: how would you handle this one? - February 16, 2006 7:57:00 AM
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GLASGOW
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It is usually out of your hands as the patient will go where they think they will get the best and quickest results.That's consumer choice.That is also why there is a conflict between Orthos,chiros and to some extent PT's.
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Re: how would you handle this one? - February 16, 2006 9:26:00 AM
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tnt
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In these instances, and many others involving chiro/PT/physician care, COMMUNICATION is the key, and often where the system breaks down. I would (and have) been on the phone immediately to the chiro, to verify if he truly said this and if so, what was his clinical reasoning. It very well may be legitimate, and if not, it makes a good opportunity to tactfully and professionally confront/discuss your side of the plan of care.
I was in this exact situation several months ago, and have since spent time discussing with the chiro my approach and what PT brings to the table. We now see 2-3 referrals from him weekly!
We all need to be receptive of one another's skill set and open the lines of communication. I find a great deal of benefit working with pt's who are simultaneously receiving chiropractic care, as long as we work together to avoid duplicated or contradictory services.
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Re: how would you handle this one? - February 16, 2006 9:45:00 AM
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GLASGOW
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Good point.TnT.
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Re: how would you handle this one? - February 16, 2006 3:39:00 PM
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ginger
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Just seems you may have failed to convince your patient you had a decent handle on the solutions to his/her problem Jacki. Two treatments ought to be enough to have kick started effective change, and if not at least to have convinced patient of your strategy being likely to have effect. I wonder if the central thrust of your intervention was/is exercise. If so then you are up against a hands on therapist who , even if he only has manipulation as his emphasis for change ( short term but at least convincing of some immediate effect )
I don't think there is much refuge in the idea that PT's are there to sort out muscle problems and DC's are on about joint problems, we all know we both compete for the same groups and offer solutions if we have the skills .
The message in this may in fact be all about you and not the MD or DC after all.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: how would you handle this one? - February 16, 2006 11:14:00 PM
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nari
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From: Australia
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Ginger and Glasgow - good points.
The patient will certainly stay where there are positive results within 2 visits, and that is a reasonable expectation, I think. It doesn't have to be an astounding success; some things take time, but there should be changes for the better that are subjective and objective. (The exception to that is the complex pain patient)
Apart from that, politics aside, why is the patient looking for therapy in the first place? Do we assume it is a spinal problem?
Nari
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Re: how would you handle this one? - February 17, 2006 12:32:00 AM
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Alex Brenner PT MPT OCS
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[QUOTE]I've had this discussion with many of my MD colleagues who think it's appropriate to refer to both. [/QUOTE]Tim,
I am curious as to the rationale your MD colleagues have as to why to refer to both.
_____________________________
Alex Brenner, PT, MPT, OCS
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Re: how would you handle this one? - February 17, 2006 1:26:00 AM
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TMondale
Posts: 131
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From: Newton-Wellelsley Hospital
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Alex,
Thanks for the question. The answer is mostly not well thought out, but rather a perception that the two disciplines hold something different and unique that will benefit the patient by working in conjunction. In all cases they mean well, but just don't understand enough about what PT's qualifications are to make the idea of us working with a patient that is also working with a chiro unnecessary at best and counterproductive at worst in their minds.
It's our job to educate both the patient and the referring MD's and DO's. It's a difficult job, and I still get referrals of people who are currently seeing a chiro. In these cases without exception I don't disparage anyone, but ask the patient to make a choice. Sometimes they choose to stay with the chiro; I haven't convinced them.
Tim
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