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Re: Direct Access to PT's - What's it like?
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Re: Direct Access to PT's - What's it like? - October 27, 2003 5:42:00 AM
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Scanner
Posts: 71
Joined: March 17, 2003
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DocWagner:
Horror of horrors! A note service in medical school? Gee, I know DC's are heavily criticized for such an invention!
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Re: Direct Access to PT's - What's it like? - October 27, 2003 7:35:00 AM
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researchdoc
Posts: 34
Joined: March 29, 2002
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My God, I have never seen such horrific bar-room lawyering, ever. Stick to what you know, guys, and keep your opinions on law private. It is apparent that many of you (Scanner especially) have no clue about the legal aspects of healthcare practice.
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Re: Direct Access to PT's - What's it like? - October 27, 2003 10:02:00 AM
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Scanner
Posts: 71
Joined: March 17, 2003
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Please enlighten me on what aspects about law I am ignorant on. And since the law is pertinent and applies to us all, why should I keep my non-expert opinions private?
You obviously didn't keep your pie hole shut so I won't keep mine shut.
If you are somehow an expert on health care risk management or are a medical malpractice lawyer, then come down off your high horse and give your opinion.
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Re: Direct Access to PT's - What's it like? - October 29, 2003 3:53:00 AM
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arufa
Posts: 26
Joined: February 23, 2003
From: Syracuse, NY
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Yes, DTPs get more diff dx training but how practical and valuable is that training. If we can't order tests is it going to be that helpful?
I feel I can tell, better than most MDs, whether a problem is musculoskeletal or not. I also know better than MDs if the pt is appropriate for PT.
We don't need to be able to Dx pathology outside of our area of practice. We only need to be able to identify what is outside or scope and what is not.
My course work in pathology and diff dx is not at par with med school, but I feel it has given me (and the rest of my graduating class) the ability to determine what is treatable and what is not.
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Re: Direct Access to PT's - What's it like? - October 29, 2003 6:55:00 AM
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mcap56
Posts: 619
Joined: October 26, 2002
From: New York, NY
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I think that's the issue. PTs primarily need to know when something is outside the scope of practice, when to refer on, and whether a patient is appropriate to PT. We don't necessarily need expanded priveleges. We need the ability to do what we already do without having a referral source dictate treatment.
mcap
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Re: Direct Access to PT's - What's it like? - October 29, 2003 6:50:00 PM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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That's an interesting statement . . .
Most of my orders say simply something like, "Back Pain" evaluate, diagnose, and treat." What of the ones that say, "Myofascial lumbar strain: US, ROM, Strenghening, Phonophoresis (Dexamethazone), etc." I had one today with this kind of nonsense on it from an ortho MD. To top it off, although the patient had some myofascial tighness, her problem was a facet joint dysfunction. Guess what I treated? Yes, both! The patient was a BCBS patient and I don't need any MD orders in the first place.
How many PT's really give any care or thought to what the MD orders? If I get a patient with an ankle sprain better with PWB-TT, high volt, BAPS, and PRE's, do you really think that they care that I didn't use their protocol of ROM, russian stim, and iontophoresis? Especially considering that in general I'm able to rehab the patient in about 1/2 the time of any other PT or DC in the area?
I suppose I'd have something to answer for if I wasn't able to rehab a patient as quickly as the MD expected AND failed to incorporate the entirety of their orders, so far that hasn't happened. Until then I don't generally look beyond the order that PT is indicated. Everything else I consider a "you may do, but don't have to do" or "I think this patient would do well with" suggestion.
In 10 years of practice, I've had only one MD get upset, and that was because I discharged the patient when they achieved their goals (two weeks before their follow-up MD appointment), and he wanted the patient seen in PT (despite no good reason to see the patient) 3x/week until they returned for their follow-up MD appointment. NEVER have I heard so much as a peep for deviating from the MD's rehab suggestions.
"Render onto physician what is medicine, and render onto physical therapist what is rehab." --- Brutus, PT
Drew
[This message has been edited by Andrew M. Ball PT PhD (edited October 29, 2003).]
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Re: Direct Access to PT's - What's it like? - October 30, 2003 7:20:00 AM
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mcap56
Posts: 619
Joined: October 26, 2002
From: New York, NY
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Drew:
In 4 years of my last position, I almost never had a specific direction from an MD unless there were obvious precautions. Even many of the post op cases came in as eval and tx.
But again, we need more professional autonomy. What about in the hospitals and rehab centers. In those settings, the team should be in the loop, but in general, there are far too many hospital PTs who take far too many specific directions. Also, in your case, if you deviate from the script, you may be fine referral wise, but legally, you may not be.
Also, as has been discussed, we need independant direct access so that we can have some leverage against POPs and other setups. If the MDs in your area decide to bring PT in house, you may not be getting as many referrals.
mcap
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Re: Direct Access to PT's - What's it like? - October 30, 2003 2:17:00 PM
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OSUPT
Posts: 45
Joined: April 15, 2002
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Mcap brings up an interesting point about PT in hospitals and rehab units. Does anybody have any insight into how direct access affects these settings? We often get general orders such as "PT/OT for strengthening" or "PT evaluation" (without treatment orders) on our inpatients, and we end up contacting the physician for changes, which can cause a delay in care. If we had direct access, could I go ahead and initiate an appropriate treatment plan without having to jump through the hoops of getting the right orders? I'm sure we'll still have to stay with the referral system to a degree because of the acuity of the patients.
Sorry to hijack the thread.
Side note: We recently got an order for "PT for plantar fascitis" on a patient in the coronary intensive care unit. Better get rid of that foot pain while he's still on the ventilator! [IMG]http://www.rehabedge.com/forums/wink.gif[/IMG]
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