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Re: PT Code of "Non-DC Referral"
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Re: PT Code of "Non-DC Referral" - February 19, 2004 11:13:00 AM
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Scanner
Posts: 71
Joined: March 17, 2003
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Alba,
Your post disappeared. I hope this addresses your questions.
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Re: PT Code of "Non-DC Referral" - February 19, 2004 11:16:00 AM
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David Adamczyk
Posts: 305
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From: Cleveland
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Scanner,
Alba was banned. She is not a healthcare professional. The forum is not intended for the general public.
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Re: PT Code of "Non-DC Referral" - February 19, 2004 11:31:00 AM
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nrl
Posts: 121
Joined: May 23, 2002
From: israel
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He is disclaiming his statement with "many" and "mosts" - it was not coincidental . Not all. that would make life easy but dull. That is an o.k. admission? BTW, it is my experience, that with athletes, more then the general population, you can find the cause of the problem.
Can be identified to something he/she is doing sooner or later – again, your “rephrasing” is with a little spin. I mentioned predisposing factors. That’s a major part of why athletes have injury and pain. Those predisposing factors are neuromuscular, structural , physiological and not a patient’s “fault”. I’m not suggesting all women should stop playing basketball because they have a stiff landing strategy. But not acknowledging that they are more prone to injury is counterproductive. Since, as a profession, we do acknowledge that, we came up with excellent preventive programs for athletes, pre and post injury.
One more thing – she not he.
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Re: PT Code of "Non-DC Referral" - February 19, 2004 11:59:00 AM
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Scanner
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Administrator,
This is the first forum I have been in with a very active presence from an administrator. I applaud that. It makes me watch me P's and Q's.
NRL,
Sorry with the gender confusion. It figures. I usually write he/she too. . .
It could be our different patient population affecting our different conclusions.
I would imagine, but not necessarily conclude, that most of my colleagues see athletes who have been well and dutifully advised by the PT (again, since I imagine you are going to be more often a first point of contact - referral from family MD or orthopod). I know I do.
In that, we are seeing more "idiopathic" pain syndromes than your profession. Unless the PT and other docs have missed something and I beleive usually you have not. At least that's my experience - they have been "exercise-advised" out the wazoo.
And another point - PT's as a rule don't foster a continuing relationship with the patient, even if DC's do it for "abberant philosophical reasons". You rehab. You're done. As you have pointed out. We assess. We manage. We're never done (well, not exactly true but for the chronic pt. this can be a reality). The last statement can seem offensive but I guess it is virtue of the types of patient a lot of us see. Beleive it or not, a lot of DC's do see acute cases, at least, that's my impression from talking to them. I don't but many do.
Are you assuming the athlete is without pain because you are not seeing them (no news is good news?)? Actually, I beleive even the family doc falls into this trap with LBP. "The patients must be doing well because they aren't here." In fact, a study in Britain supported this statement I am making. Of course, no MD/DO/PT is that assumptive but their global approach is like that. Our assumption can be a little more negative I guess: "I beleive you are going to need future management."
Anyway, I think the discussion is coming to a close. I think it has been fruitful.
I'll take any concluding statements now and let anyone have the last word, assuming there are no questions for me.
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Re: PT Code of "Non-DC Referral" - February 19, 2004 4:03:00 PM
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nrl
Posts: 121
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From: israel
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You make quite a few assumptions about my profession which I think are incorrect. I also think the comparisons you make about the patients we see are sometimes incorrect. I think we actually see similar patients .of course we can assume that those who come to us are smarter based on their smarter choice of practitioner (sorry, couldn’t resist).
A few points:
we are seeing more "idiopathic" pain syndromes – I’m not sure that’s true. But I think we concentrate on the pain mechanism at play and there for the “idiopathic” becomes less important. We know what’s going on and address that even if we don’t know what’s caused it.
"exercise-advised" – that’s over simplifying things.
We're never done (well, not exactly true but for the chronic pt. this can be a reality) – that goes to the core of our differences. My goal, as a PT, is that the patient becomes self-reliant. I’m not so naïve as to think this can be 100% achieved and patients will come back. However, encouraging or creating anticipation of a need for further treatment perpetuates chronicity.
"The patients must be doing well because they aren't here." – like I said, I’m not that naïve. My view is “the patients must be coping well because they aren’t here”. I hope some of them are doing well.
Thanks
Nirit
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Re: PT Code of "Non-DC Referral" - February 20, 2004 2:05:00 AM
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Andrew M. Ball PT PhD
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From: Charlotte, NC
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I'm bound to take a lot of heat from both sides of the aisle for the following --- but's let's all step back, take a breather, and consider a few things from a different perspective.
Physical therapists working with children and/or adults with neurodevelopmental disability often see patients for years on end. We'd like to think that we are preventing contracture (which is likely the case, but little research supports this --- only looking at those adults in developmental centers who never got appropriate therapy over the years), and improving function. Maybe we are doing just that, but maybe evolution has found a better way, and we are hindering the process just to pad our pockets. Consider, for example, the kid with CP whose gastrocs we stretch and brace in order to prevent contracture (which we do well as PT's), then slap on an DAFO --- which does the same functional thing as a tightened heel cord, just doesn't look as pretty.
It can be argued (though I'm not one such therapist to argue this point, but I get the idea and I’d like to share it for the sake of this discussion), that many pediatric PT's provide patients with special needs a lifetime of care that they don't need --- preying on the population of families less likely to "defend" themselves than the chiropractic patient. In the end, some would argue, pediatric PT's provide a higher intensity of services than is truly necessary --- and their outcomes are more in terms of cosmetics of gait than anything else. Considering that the CHILD doesn't care how they move, as long as they can --- how ethical is it to prey on the fears of the parent that the child's movement patterns will be a source of ridicule for other kids?
Maybe it's worthwhile, maybe it's not --- but let's not delude ourselves as PT’s to what is more often then not the true source of our value to the family --- cosmetic, chronic, maintenance care so as to make the child’s movement patterns less awkward looking and reduce the potential that their child will be the source of ridicule.
It is a noble cause perhaps, but not the noble cause that the PT had in mind.
It could be said, therefore, that PT’s too engage in provision of services to chronically neuro-congenitally ill patients in terms of function and movement pathology, (or with fears of diminished future health or appearance thereof) while DC’s do the exact same thing for/to patients in chronic pain (with fears of diminished future health or appearance thereof).
We as a profession shouldn’t be so quick to judge in this regard as there is a very large percentage of physical therapists who provide care the patients under a similar philosophy of maintenance care.
We ain’t so hot --- they ain’t so hot.
Drew
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Re: PT Code of "Non-DC Referral" - February 20, 2004 3:04:00 AM
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gilbert thomson
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From: Elka Park, NY USA
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Drew -
No.
As physical therapists we have the potential to have a great impact on functional movement for children with neurological disabilities. If some therapists put too much emphasis on cosmetic problems, that is unfortunate. But don't throw the baby out with the bathwater. What we need to do as a profession is to focus on improving function through an approach that emphasizes motor learning and active movement. We are learning more and more about how intensive, active practice of motor skills may lead to actual reorganization in the brain with corresponding improvements in function (as seen in CIMT) How can you call this a cosmetic issue? In my opinion, many children with severe neurological disabilities don't get nearly ENOUGH therapeutic intervention.
Gilbert
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Re: PT Code of "Non-DC Referral" - February 20, 2004 3:28:00 AM
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Jeep
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From: USA
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There have been several posts here regarding "maintenance" care, usually as a crticism of chiropractic. That PTs give an exercise regiman to do at home and they then are self-reliant. I realize the tendency to want to criticise DCs, however "maintence" care is probably more prevelent in PT than in chiropractic care which is usually in the form of "supportive" care.
Here is my example:
A friend of mine contracted encephalitis @ 30 years ago and has been a quadraplegic ever since. He was recieving PT "maintenance" care for many years. About 5 years ago the insurance cut off PT care because, according to the insurance co., he "was not getting any better, and further PT would not get him any better". I was extremely angered by this. The PT he was receiving, although not improving his condition, was preventing him from worsening. This is VERY important!!!! There is nothing to be ashamed of in that. Not every one get get back to 100% function.
In summary: With PT, he may not get better, but without it he will surely get much worse!!(and has unfortunately).
We see many similar cases, in which, without our care, they will most certainly be much worse(that also translates into decreased quality of life and increased medical costs).
Taking care of these types of cases can be extremely rewarding!!. These pts are SO appreciative of the things that are really inportant(ie. being able to to go out to dinner with their family) Makes winning a basketball game(eg.) seem rather trivial.
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Re: PT Code of "Non-DC Referral" - February 20, 2004 3:47:00 AM
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Shill
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From: Madison WI USA
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Jeep,
The example you cite is unfortunate, however, if loss of function can be documented, your friend is someone who falls into the category of one who is appropriate for ongoing PT care. Maintenance is somewhat different from prevention of loss. Those who worsen without care (and are NOT able to self manage - consider the fact that this patient can not do for himself what many others can, but simply choose not to) qualify for ongoing care that is reimbursable through insurance (based on medicare guidelines). His therapist must document the loss of function, and the other risks (skin breakdown, etc) that occur without skilled care. THAT is the key.
Also, depending on the care he needs, another question is raised: What could be provided to the patient at a lesser cost than skilled PT, IF someone else could be taught to safely perform the necessary treatments for the patient.
In short, lets consider the perspective here, regarding the "maintenance issues". Functional loss of significant nature leading to potential infection (decubiti) and further contracture preventing proper positioning leading to more problems. This person NEEDS ongoing treatment. Those who CAN do things to self manage need to do so.
Perhaps this will help your friend get appropriate treatment.
Steve
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Re: PT Code of "Non-DC Referral" - February 20, 2004 3:51:00 AM
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Andrew M. Ball PT PhD
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Joined: July 28, 2002
From: Charlotte, NC
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Jeep,
You're right, and it is unfortunate that more non-PT's don't stand before BCBS, MedCost, Cigna, etc. and preach the value of that kind of care for the appropriate patient populations. When we say it, we sound like we're protecting our own bottom line. In short, we need better bedfellows, and I'd hope that to be one positive thing that comes out of the RehabEdge discussions.
Gil,
I agree with you for the most part, I never said that the above position was my position --- it isn't --- but is IS something that should be considered by ANY PT working with people with neurodisablity and neruodevelopmental disabilitly. It should be the mantra of the proverbial little devil on our shoulder. The minute it stops asking us, "Why are you doing this . . . REALLY." We're in a lot of trouble as a profession. In short, is our position truly a position, or a justification of what we're doing regardless of our "big-picture" ethics. I'd like to think the former, but I know far too many PT's that clearly have never posed the question to themselves.
My point is really more of a call for pause. PT's often paint themselves in "good versus bad" terms --- rarely seeing the shades of grey in the way they practice. I agree that there is an apples and oranges element here in comparing what some DC's do to what some PT's do, but it's all fruit afterall, and there are some legitimate questions that PT's should be asking themselves before taking on a subtle self-righteous "we're all good" attitude (not that anyone HERE is doing that, but let's be frank about some of our colleagues --- we all know at least one).
I've been sounding so anti-chiropractic of late, that it was time to hold the mirror up to my own profession --- it's in no way a commendation of chiropractic maintenance care, nor a negative review of physical therapy, but rather an attempt to mediate a level the playing field of discussion to a more appropriately humbled position --- on both sides.
As Hamet said, "Yeah this be maddness, but there is method in it."
Drew
[This message has been edited by Andrew M. Ball PT PhD (edited February 20, 2004).]
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Re: PT Code of "Non-DC Referral" - February 20, 2004 4:19:00 AM
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Jeep
Posts: 353
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From: USA
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Shill-
RE: the case I cited: His Sister pretty much takes care of everything for him and who I know well-
What resources/information can you direct me to to get his PT re-instated? If it has been many years, it it too late?
He has been/is on SS disability or Medicare/medicaid- not quite sure, but not private insurance.
[This message has been edited by Jeep (edited February 20, 2004).]
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Re: PT Code of "Non-DC Referral" - February 20, 2004 4:27:00 AM
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Andrew M. Ball PT PhD
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From: Charlotte, NC
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What about the not-for-profits? Easter Seals, ARC, etc.? Their services tend to a bit more comprehensive in terms of hooking the patient up with funding sources and alternative care providers supervised by licensed professionals, Respite, etc.
Drew
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Re: PT Code of "Non-DC Referral" - February 21, 2004 4:44:00 AM
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Scanner
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And what was Daffney on Frazier [/i} doing if that wasn't Maintenance Care, anyway?
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Re: PT Code of "Non-DC Referral" - February 21, 2004 4:54:00 AM
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Jeep
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From: USA
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I'm not sure if this important info or not-
but he has been in a nursing home for @ 25 years. One would think he has a case worker?
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Re: PT Code of "Non-DC Referral" - February 21, 2004 4:53:00 PM
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Shill
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Joined: February 13, 2003
From: Madison WI USA
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Scanner,
Daphne was at first referred to as his physical therapist. You might notice that she is no longer referred to as this, other than in the very early (now syndicated) episodes. The reason behind this is the fact that NBC was advised that they should not refer to her as a PT, as what she was doing was not physical therapy, and that PTs dont typically live with people they treat. Or something like that. I believe that this is actually what happened, but I may also be starting an urban legend if it isnt!
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Re: PT Code of "Non-DC Referral" - February 21, 2004 4:58:00 PM
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Shill
Posts: 1096
Joined: February 13, 2003
From: Madison WI USA
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Jeep,
To get PT started once again, the patient simply needs to be evaluated by a physician, I would recommend a physiatrist, and let that physician know of the decline in function, as specifically as possible. Also letting him or her know the amount of time that has gone by since last PT treatment is helpful. Denial of PT by Medicare (B) within a reasonable time frame can mean it wont be covered, but your friend hasnt been seen in a while, so this shouldnt be an issue. I do not deal with nursing facilities and do not know the exact rules behind PT and medicare coverage for patients in nursing homes. Nevertheless, it sounds like this gentleman would benefit from at least an evaluation, and consultation with the physiatrist might help lead to further help from social workers as well, so as to set up case management.
Good Luck
Steve
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