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Re: If you want to be disgusted by other professionals practicing "PT" read this.
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Re: If you want to be disgusted by other professionals ... - September 28, 2003 8:16:00 AM
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DPTpro
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Joined: July 17, 2003
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Uh... is that "medical doctor" or osteopath?...
Dr. Wagner, I've read a lot of your posts and you do tend to have a condescending tone towards PTs as though you have "risen above" us and now have this great wisdom which we lack because you now practice as a physician.
Eclectic input to discussions is valued but not when it is with a condescending tone.
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Re: If you want to be disgusted by other professionals ... - September 28, 2003 8:45:00 AM
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Diane
Posts: 1507
Joined: March 9, 2001
From: Vancouver, B.C., Canada
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To all PTs who feel inferior to MDs, and demonstrate it by sniping at Dr. Wagner, get over yourselves. Grow out of your inferiority complex. All you do is reinforce some notion of an unfair heirarchy. Stop reinforcing it and one day it will fall away all by itself. Act like an equal and you will be perceived as an equal. Treat him the way you'd like to be treated. Not acting cranky doesn't automatically equal feeling or acting obsequious, so have a bit of dignity. Stop begging for abuse by dishing it out. It's called acting like a professional.
For anyone still unclear: DOs and MDs enjoy exactly the same legal status in the US.
Diane
[This message has been edited by Diane (edited September 28, 2003).]
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Re: If you want to be disgusted by other professionals ... - September 28, 2003 1:57:00 PM
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PTstud
Posts: 86
Joined: March 8, 2002
From: Texas
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DPTpro, Amen. Dr. Wagner, my name is short for student, not stud. DPTpro hit the nail right on the couffin. Diane, it is Mr.Wagner who keeps reminding us about the heirarchy through his tone and underlined message on most of his posts.
M
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Re: If you want to be disgusted by other professionals ... - September 28, 2003 2:26:00 PM
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Diane
Posts: 1507
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From: Vancouver, B.C., Canada
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PTstud, you wrote:
"Diane, it is Mr. (sic) Wagner who keeps reminding us about the heirarchy through his tone and underlined message on most of his posts."
Your statement exactly illustrates my point. You continue to make Dr. Wagner the bad guy for your own inferiority complex. If you hear some sort of tone buried within Dr. Wagner's posts, it's likely because you have some unconscious propensity (like an inferiority complex) that successfully amplifies such a tone until, for you, that's all you can hear when he speaks.
When someone acts like a victim it is hard for others to not treat him/her like one. So don't act like one, and Dr. Wagner can carefully remove any hint of that tone if it exists, from his posts. (Right Dr. Wagner?)
Choose to "downregulate" your own subjectivity, squelch your own nervous system reaction, and act like a professional; quit kvetching over nothing. It will get you nowhere. Responding like an adult and an equal just might.. and other PTs, MDs, DOs, DCs, etc etc will realize that we're all in this together.
Save your energy for strategic battles, like working to bring about legislative change that opens the scope for PT in your part of the world, rather than waste it complaining about someone specific on a bb. (Reread ColoradoJulie's posts for ideas on how to do this.)
A bb is for collegial communication and education, not for scoring childish points or undermining our collective energy. If you feel unfairly treated by a supposed heirarchy, ignore the heirarchy outwardly while working like blazes to change it behind the scenes. Stop giving it more visibility by acting like you're in its line of fire. You just keep your foot nailed to the floor that way.
Diane
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Re: If you want to be disgusted by other professionals ... - September 28, 2003 5:33:00 PM
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mcap56
Posts: 619
Joined: October 26, 2002
From: New York, NY
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To Diane, Julie and Dr. Wagner:
I have appreciated Dr. Wagner's comments and he has brought a unique perspective to bear on some issues. However his tone is condescending.
I am not saying this because of any inferiority complex. Just simple recognition. Many of the more respected members of this forum have communicated the same to me in private.
There have been other professionals on this board who have suffered far worse insults and yet there is no defense for them? Why?
As a professor, I would prefer to see students and others stick up for themselves where appropriate (without personal attacks of course).
mcap
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Re: If you want to be disgusted by other professionals ... - September 28, 2003 6:01:00 PM
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PTstud
Posts: 86
Joined: March 8, 2002
From: Texas
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Thanks for the lecture Diane. Like a typical PT, passive, never trying to offend, must walk on egg shells around other health care professionals. I provided no personal attack, just asked a simple question. Anyway, I respect DR. Wagner's accomplishments, being a PT DO is no small feat. But it is obvious to see someone that is here to keep building on their high horse instead of being a SINCERE contributor to the board.
M
[This message has been edited by PTstud (edited September 28, 2003).]
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Re: If you want to be disgusted by other professionals ... - September 28, 2003 7:44:00 PM
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hmgross
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From: Minnesota
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Dr. Wagner was not the only one who thought PTstud was a "stud" not short for student. I appreciate the input of a physician on this forum and I don't recall any condescending posts. Lets focus our energy on trying to learn from each other's experiences and not be so defensive.
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Re: If you want to be disgusted by other professionals ... - September 28, 2003 9:33:00 PM
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DC_Student
Posts: 24
Joined: March 27, 2003
From: California
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I'm at a loss to see why everyone is griping about the MD doing PT. Their lisences are unlimited. I think MD's & DO's should be able to do Chiropractic adjustments (whatever the hell that is) as well. Their education is commensurate with either.
Now if you are just criticising their techniques,that is another story...But in principle, MDs & DOs should be able to do PT.
Nemo
[This message has been edited by DC_Student (edited September 29, 2003).]
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Re: If you want to be disgusted by other professionals ... - September 29, 2003 9:13:00 AM
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mactherapist
Posts: 4
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From: Texas
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The reason for physician supervision is for billing purposes which means all the PT procedures need to be billed together with the physician billing. However, the physician cannot be related to the PT nor his/her immmediate family own the PT facility due to the ban on self-referrral.
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Re: If you want to be disgusted by other professionals ... - September 29, 2003 9:29:00 AM
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coloradojulie
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Joined: November 10, 2002
From: colorado usa
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The problem with MD, DC, OD etc. claiming to "do PT" is wrong. Certainly any of the above can show exercise, or use an ultrasound unit, or have very strong diagnostic skills. The difference between a PT who does physical therapy is the depth of understanding of the functional basis and the complex integration between several aspects of anatomy (neuro, muscular etc) to develop very specific and targeted programs.
For example a respected MD lately wrote an article in a running magazine (He refers to our practice). The topic was anterior knee pain with runners. His writing style was excellent, however the points he expressed lacked the depth of understanding that PTs possess.
He talked about PFS and the mechanisms for its cause. Pronation, tight ITB, weak VMO, tight hamstrings. Sounds good. But when you really know alot about PFS, like PTs do, you know that most of this stuff is outdated thinking or ineffective. EMG studies refute the possibility that the VMO is an independent muscle (trained independently, and having deficient contraction timing). Does the ITB really stretch out? Are the stretches typically given doing what we think they are? Or is it really "tight" because of biomechanical issues at the hip? Is hamstring tightness the problem or is it a reflexive tightness countering a tight anterior hip? Are their muscle imbalances in the hip leading to overuse of the anterior hip muscles including TFL? Does this translate to a weakness in the abdominals? What about eccentric quad strength, and what exercises would be most effective? What about proprioception in various points of the range of motion? What about Q angles and structural predisposition? What about dynamic strength deficits, how would you return someone to sport without the risk of reinjury? ETC ETC ETC.
I went to a sports med conference this past weekend in Aspen, with some very respected surgeons from all over the US. More and more interest is being placed on Physical Therapy by this group, as they understand the role of physical therapy in the success or failure of patients post surgically. With this increased interest, they start talking about PT techniques like Jenny McConnell, like they just discovered her, and the role of patellar taping. How fantastic this is for patellar realignment. But what about the recent literature pointing towards improved proprioception as being the only benefit of patellar femoral taping?
The point is PTs know why they are doing certain things. They understand the complex nature of joint interaction and how to expose points of compensation through neuromuscular assessment and coordination. I have had patients with anterior joint laxity in the shoulder given doorway stretchs for pec acutley by their MD. I have had patients with lumbar spine DJD given hamstring stretchs by their chiropractor (he has a huge practice and is highly respected) despite the fact that I could take her leg in a SLR test in supine behind her ear. Sounds good, back hurts, stretch hamstrings. Clinically that is only applicable to about 5-10% of back pain patients, and I wonder how many MDs or DCs or DOs would know why.
A personal trainer knows how to stretch the hamstrings, so does a chiro, and MD or even a massage therapist. Do they know why they are stretching it and what impact if any it will have on the patients problem? Do they know about lumbar spine mechanics that predispose patients to increased lumbar hypermobility if you can't show them how to stretch their hamstrings and protect the back at the same time? Do they know how to stretch all aspects of the hamstrings to insure balanced flexibility and not to simply reinforce faulty movement patterns? Do they know about neural mobilization contraindications if the patient has nerve compression or entrapment when stretching the hamstring, or how to differentiate the two?
PT looks simple. What is the big deal? I know how to do core strength...that's just PILATES anyways right? Modalities, piece of cake. When you have knee pain, strengthen the quads, what is so special about that?
It is the thought processes and functional understanding that is complex. I could rehab your socks off and you wouldn't have a clue what I was talking about, and we might just be talking about a shoulder with MDL. Do MDs know rotator cuff anatomy and function? DO they know the arthrokinematics of this or any other joint? Do they know what inferior border scapular winging could indicate? Do they know what happens when you have a spinal accessory nerve palsy and what impact that will have on the shoulder?
Probably not. Good thing we have PTs who do. Be a really good practitioner and understand your limitations. Refer to practitioners who really know what they are doing and why.
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Re: If you want to be disgusted by other professionals ... - September 29, 2003 11:34:00 AM
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Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
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Holy Crap, people still talking about that??
Good lord I appologize if I ruffled PTStud's feathers, simply defending my self...not that I hurt from "Studly the students'" comments, but defending myself is allowed correct? The only reason I mentioned I was a Dr. (in the original post) was to state that I COULD charge but that I consider it self referral for PT services...but instead you focus on a PART of the sentence as opposed to the spirit of the argument.
Mcap, you dislike me for unknown reasons, for that I am at a loss. It honestly sucks when one goes onto a board where you hope to bring unique persectives as one who has gone through a PT program, was a PT clinical instructor then medical school and residency...guys, I am no where NEAR as critical as medical attendings typically are! And some how I have INSULTED YOU? Give me a break, you gotta have tougher skin that that! As a "professor" you certainly show an amazingly biased attitude toward any kind of criticism.
As for clarification, I meant to have put Doctor of Osteopathic Medicine as is the terminology in the US (does it matter, do you call an MD an allopath??). But I have always considered myself a PT first (as it certainly made me a better doctor)...but it is YOU who have been so quick to point out I am "no longer part of the CLUB". Perhaps if you knew me in person, you wouldn't think in such a way.
[This message has been edited by Dr.Wagner (edited September 29, 2003).]
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Re: If you want to be disgusted by other professionals ... - September 29, 2003 1:18:00 PM
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nrl
Posts: 121
Joined: May 23, 2002
From: israel
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Dr.Wagner,
Do you know of other countries in which a DOs have the same status as MDs ? Not for argument's sake. Just interested in the info.
Thanks
Nirit
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Re: If you want to be disgusted by other professionals ... - September 29, 2003 1:32:00 PM
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Sam B
Posts: 73
Joined: August 6, 2003
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Dr Wagner,
Yeah, didn't see anything in your response that required those comments either. As Diane so thoughtfully pointed out, it must only be a professional state of mind from some PT's(inferiority); good communication between all professions is the key to building trust and mutual respect.
I personally enjoy your perspectives and usually learn a thing or two. Thats worth it to me to check on these boards when I get time.
Cheers,
Sam B
[This message has been edited by Sam B (edited September 29, 2003).]
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Re: If you want to be disgusted by other professionals ... - September 29, 2003 2:33:00 PM
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EWDC CSCS
Posts: 42
Joined: November 14, 2001
Status: offline
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ColoradoJulie,
To answer your questions (do they know etc.).......yes this one does.
[This message has been edited by EWDC CSCS (edited September 29, 2003).]
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Re: If you want to be disgusted by other professionals ... - September 29, 2003 5:59:00 PM
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mcap56
Posts: 619
Joined: October 26, 2002
From: New York, NY
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Dr. Wagner:
We have had disagreements but I never took it personally. Nor have I ever indicated that I don't like you personally. Neither of us know each other.
As for tougher skin.....what ever I get on this board pales in comparison to what I get when I defend my research at school. So that isn't a problem.
I was reacting to a general tone of some of previous threads and posts. Other people have commented on the same thing. However, I am willing to consider things differently.
Passivity is a major problem in this field. I have watched as most PTs just sit around and fail to stick up for themselves. I apprecitate it when younger PTs are aggressive and fiesty, even if they run the risk of overreacting.
mcap
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Re: If you want to be disgusted by other professionals ... - September 29, 2003 6:20:00 PM
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Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
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NRL,
A US trained DO may practice on medical missions worldwide as any surgeon or physician. To practice full time in another country takes the same "jumping through hoops" as any physician. Non-US trained DOs can NOT practice in the US as full physicians as they do not undergo the same training as we do. Medical school is 4 years long, MCAT to get in, residency following graduation and 3 steps to licensure (3 standardized tests in year 2 and 3 of medschool and in year 1 of residency)
So to conclude, US DO's = MD's in every sense of the word...except we get extra training in manipulation and manual medicine.
Hope that helps.
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Re: If you want to be disgusted by other professionals ... - September 29, 2003 9:46:00 PM
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DC_Student
Posts: 24
Joined: March 27, 2003
From: California
Status: offline
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Julie,
Thank you for your detailed comments on this issue. I still disagree though. (Bear in mind too that I was not arguing that PTs are incompetant- I hold quite the opposite view actually.)
All you've done here is prove that some MDs do not do their homework and, perhaps, that more than a weekend seminar is needed for an effective practice. You did not demonstrate that PT is outside their scope of practice. PT is still not rocket science. Any MD willing to make the effort could capably perform PT- it's within their scope.
When I was chemist and synthesized experimental medically relevent compounds, it never occurred to me that an MD should stay out of my field.
Moreover, much of the research in PT has been performed by MD's.
They have a legal and educational right to practice PT under their unlimited lisences.
Take care,
Nemo
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Re: If you want to be disgusted by other professionals ... - September 30, 2003 3:20:00 AM
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nrl
Posts: 121
Joined: May 23, 2002
From: israel
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"much of the research in PT has been performed by MD's." i'm not sure if that's correct.but you should know that in many countries and in quite a few institutions clinical research (helsinki approval ,etc.) must be headed by MDs. so many times they get a free ride.
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Re: If you want to be disgusted by other professionals ... - September 30, 2003 2:12:00 PM
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Scanner
Posts: 71
Joined: March 17, 2003
Status: offline
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I agree, I don't see Dr. Wagner announcing his PT and DO status too much - it is just to qualify the source, like when I announce I am a practicing DC. I think it is great he has all that education and training (well actually, I may secretly think he has a screw loose ;-) )
Anyway, Nemo is right - MD's/DO's can do PT under their license. Heck, they can perform phlebotomy if they want instead of delegating that to a phlebotomist. I have seen my child's MD, during a comprehensive exam, check for cavities in the mouth (very thorough exam). Their licensure is unlimited.
Now, whether they OUGHT to is another discussion. I have an ethical problem if the only motivation is to "add to the bottom line" vs. offering a needed service to the community, which is probably the intended theme of this thread.
And really? What's the risk of improperly performing PT? Should have zigged when they zagged? Should have been doing knee-chest exercises instead of ab strengthening?
Sure, as Coloradojulie pointed out, we all have different approaches - DC approach neurologically/proprioceptively most of the time. I am a bit of a throwback and mostly structural. PT's tend to be functional. What's the difference if an MD settles on 1 or 2? Are you saying they are incapable of comprehending the different para-dig-ems?
With a few exceptions, I can't see harm coming to the patient. The patient just doesn't get better and moves on (to the DC - thus, my ulterior motive, lol ;-) )
I don't like it either that they can do manipulation and I think they find out, after their weekend seminar, it isn't as easy as they thought - it takes coordination and prep and post-education with the patient ("you might have a rx'n, Mary").
But by the same token, there is nothing I can say to stop them, just laugh silently to myself when a patient shows up in my office after they have hurt the patient (yes, it has happened).
Conversely, the local DO will manipulate at the urgent care center. I kind of like that because it suggests a follow-up is needed with a DC the next day. It kind of validates the procedure as an approach.
You PT's might find the same thing if MD's start performing PT as a matter of course.
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Re: If you want to be disgusted by other professionals ... - September 30, 2003 4:23:00 PM
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Shill
Posts: 1096
Joined: February 13, 2003
From: Madison WI USA
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Scanner,
You would do best by keeping your condescending opinions to yourself. It effectively reduces any hint of chance that someone might actually take you seriously, or start to value what you have to say.
"Should have zigged when they zagged?" Please.
Tis better to keep your mouth shut, and let them think you are a fool, than to open your mouth and prove it
I dont know who said that, but it speaks rather loudly, no?
"With a few exceptions, I can't see harm coming to the patient."
What about wasting the patient's time, with passive treatments designed at nothing but feeling good for maybe 5-10 minutes? Would you want your parents getting treatment like this? How about your kids? You might as well go to the Placebo Clinic, as it would be as effective.
You see, I value the patient's time, and respect it. Most patients have better things to do than THINK they are getting proper therapy, and then base their view of PT on this colossal travesty.
Think about it. Might this happen to "You DC's" (as you put it), if someone decides to start cracking things, and calls it chiropractic? Lets say its an MD, massage therapist, anyone for that matter. They walk into the room, make something go "pop", tell the patient he or she is out of whack, and say they need to come back 3x per week for many years. Might that patient then get the idea that chiropractic is just popping things for ever and ever, with no direction? Hmmmmmmm....
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