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Re: would you if you could
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Re: would you if you could - April 13, 2007 4:01:00 PM
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ginger
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From: Melbourne Victoria
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In a direct access scenario physios/PTs need to have their clinical reasoning in order, common sense in abundance and a sense of logic that gives emphasis to a combination of insight and observation. Having more machines that go ping or any other noise , adds nothing to those whose attention to musculoskeletal and other disorders already exceeds those of those whose clinical reasoning is more often defined by an endless and often fruitless search after pathology.
Leave the machines to those with mathematics for souls and bedside manners of robots.
We have hands.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: would you if you could - April 13, 2007 5:23:00 PM
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FLAOrthoPT
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From: West Palm Beach
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and we should do spinal mobs on every patient. Unfortunately, here in the US there is a high deman from patients for a concrete diagnosis. Not that I need one to practice, in fact you have seen me 1000 times on here say who cares about the diag, treat the dysfunction, but in reality, if we were gatekeepers into the system, we better be prepared to give a concrete diagnosis, which included testifying on a stand as to such, which would mean I sure as heck would want some sort of diagnostic test to agree with my findings.
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Re: would you if you could - April 13, 2007 6:52:00 PM
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Rwantz
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From: Middletown, PA
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I think that you can gather enough information without diagnostic tests to come to a rather accurate clinical diagnosis that will stand up in court. I agree - treat the dysfunction. But how difficult is it usually to come to a conclusive diagnosis that differentiates between tissues. If you aren't 100% sure that there is ACL deficiency then shouldn't they be seeing an ortho anyhow.
Direct access will be great someday. I think that it is sensationalized. If you are autonomous then yes, you certainly need to be able to run tests.
This leads to establishing good relationships with doctors that you can call and say "this patient presents with this, do you want to get x-rays started so that when you see them they are already taken care of?"
Let the doctors be doctors.
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Re: would you if you could - April 14, 2007 2:57:00 AM
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PTupdate.com
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From: Pittsburgh, PA USA
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Ben says: "in fact you have seen me 1000 times on here say who cares...." And, just below, we see he has only posted 871 times. Typical dude, always saying he's got more than he has.
But, I can see where Ben's point is going. If we really are going to MSK gatekeepers, are we setting ourselves up when the rest of the medical community uses diagnostic testing to confirm/refute other problems, while we claim our diagnostic skills and hands are all we need? It almost makes us sound arrogant and somehow better and above the rest of the professions.
Duffy
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John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: would you if you could - April 14, 2007 12:08:00 PM
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FLAOrthoPT
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duff, I lost the password to FLOrthoPT a while ago, so it is still coceiveable that 1000 may be true! Smart as$!! But I think you see what I am saying, if an ortho surgeon was reading this, we'd sound like some real arrogant people.
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Re: would you if you could - April 14, 2007 3:41:00 PM
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ginger
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From: Melbourne Victoria
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Duff,
"arrogant" , maybe, "better and above", well, if by that you mean capable of insights and methods that are specialist by nature and more than likely at a level of realistic competence beyond that of the average GP and many medical specialists, then yes ,definitely.
All that without machines to assert the state of "pathology' we all know to be a poor indicator of the manner in which wise interventions should proceed. Treating dysfunction and not "diagnosis" has always made good sense.
I'm aware of course of the themes popular here in Oz , and how most , if not all , care not for diagnosis, but for what I can do about their pain and dysfunction.
Seems lke a wierd world to imagine this would be so totally opposite in the US. Many things there are different , so maybe you do operate in the confined world of fear disposed by what you are least likely to be sued for. How awful.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: would you if you could - April 16, 2007 4:34:00 AM
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orthotherapist
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Can anyone say "defensive Medicine" and we wonder why health care costs are high in the US. Physicians order tests without using critical thinking skills. This occurs bacause:
1. they are scared of getting sued
2. The patient expects a diagnosis
3. Because they have it
4. Because it makes thme $$
This list is not all inclusive and in no particular order - that being said all diagnostics are appropriate when they are ordered using sound clinical judgement.
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Re: would you if you could - April 16, 2007 5:59:00 AM
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Sebastian Asselbergs
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From: Barrie, Canada
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For this discussion, it may be interesting to hear of my testifying as "expert witness" in about five cases (so far) - meaning I was accepted as an expert by both claimant and defendant. I was also twice a witness for the claimant.
I have always been able to defend and clarify my "PT-conclusion" without the need of bells and whistles - references and logical explanations were sufficient. Mind you, this is in the "milder" legal climate of Canada compared to the US....So Ortho's point is very salient....
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Mundi vult decipi
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Re: would you if you could - April 17, 2007 11:37:00 AM
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ragempt
Posts: 111
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From: linden, michigan
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id rather have a machine hat tells me how to fix the patient. such as "ping" anterior grade 3 mob to the radial head. now that would be sweet.
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Re: would you if you could - April 17, 2007 11:43:00 AM
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Sebastian Asselbergs
Posts: 1191
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From: Barrie, Canada
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LOL Rage - You mean you don't want the one that plays: "Goldrush" when it "finds" the problem? Better yet: "Money" by Pink Floyd...
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Mundi vult decipi
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Re: would you if you could - April 17, 2007 12:52:00 PM
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FLAOrthoPT
Posts: 1011
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From: West Palm Beach
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then again wouldn't a more precise diagnosis lead to better efficacy of treatment? sorry beating a dead horse i know
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Re: would you if you could - April 17, 2007 1:39:00 PM
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ginger
Posts: 658
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From: Melbourne Victoria
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Sounds like you've made an investment you are seeking to justify, rather than seeking to strike a balanced outlook on the nature of diagnosis. It is as well to remember that EVERY diagnosis is a best guess. The only ones who can speak with certainty about, for instance , cause of death, are the forensic pathologists.
Basing diagnostic and therfore treatment certainty on machines is to lessen the viability of a clinicians best and most incisive tool. His/her common sense attached to a disciplined series of observations matched with logic and experience.
I regularly work now in wards where individuals have arrived after a barrage of science in the business of diagnostic inquiry, only to find they have a stiff neck causing symptoms just like the ones I treat in an outpatient setting each day . The list of tests and machinery some of these poor buggers have suffered their way through is sometimes amazing . The more so if they have been unfortunate enough to be under the care of a specialist. Sometimes it takes just one person to say ,let's look for the simple before we consider the complex. Let's use our hands and senses to establish a setting for this pain or dysfunction ,based on the ordinary rather than the extraordinary.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: would you if you could - April 17, 2007 2:42:00 PM
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FLAOrthoPT
Posts: 1011
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From: West Palm Beach
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no need to justify sound medical diagnostics, nor am I ignorant enouogh to ignore the importance of a clinical exam, nor am I less arrogant to think that PTs are the best ortho-neuro clinical examiners out there. I actually as art of my service have PTs do a clinical eval as well as the neurodiagnostic tests to get a whole complete picture. but i always know where you're coming from, just wish kangaroos hopped aorund here too...
cheers
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Re: would you if you could - April 17, 2007 3:12:00 PM
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ginger
Posts: 658
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From: Melbourne Victoria
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There was a big red road kill on the trail to the lake this morning, Lots of roos out here, wallabies, euros and other marsupials. I'm immune to strong emotional attachments to most road kill, other than the wombats, love the wombats. Poor little rolly polly things, they waddle across the roads and just beg to be hit by trucks.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: would you if you could - April 18, 2007 8:30:00 AM
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ragempt
Posts: 111
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From: linden, michigan
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Flaorthopt,
I think my hang up on the Dx. word for muscle/bone type pathology is this: patient comes in and says the doctor figured it out "he says I have tennis elbow" almost as if the doctor just solved all the problems of the world. In my head I’m saying lady you can call it Bettey-Sue or you can call it what ever you want but fixing it is the hard part.
the Grand Looser
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Re: would you if you could - April 18, 2007 9:58:00 AM
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FLAOrthoPT
Posts: 1011
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From: West Palm Beach
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i totally agree, trust me, but it psychologically is something most american patients want. a word for their pain.
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Re: would you if you could - April 18, 2007 1:47:00 PM
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ginger
Posts: 658
Joined: February 26, 2005
From: Melbourne Victoria
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Maybe you could draw a ring around it with felt pen and lable it 'the hurty bit ',
Rage, your ingenious misspelling of 'loser'in your new tag , adds subtle confirmation of its intended meaning.
Cheer up mate , there's always your mum.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: would you if you could - April 20, 2007 6:21:00 AM
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ragempt
Posts: 111
Joined: August 14, 2006
From: linden, michigan
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Ginger, I was not mocking you relax. What is a mum? Do you mean Mom? like the person that created me?
The Grand Loozzer
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Re: would you if you could - April 22, 2007 12:50:00 AM
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ginger
Posts: 658
Joined: February 26, 2005
From: Melbourne Victoria
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Loozzer is better,quite creative really. I took no umbrage good fellow, a mum is your mother, rhymes with bum, like you would call a butt. WE don't eat fries , we have chips, enjoy sauce on our rissoles rather than ketchup on burgers. biscuits, not cookies. I'm a staunch resister of americanisation of our precious language. The way you spell is perfectly fine of course, just not our way.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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