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Re: PTs working for Chiros?
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Re: PTs working for Chiros? - March 3, 2005 2:15:00 AM
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VagusX
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From: Savannah, GA, USA
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It is all about communication. The need to be able to break the barriers between the the professions to allow us to feel confortable and noncompetative will allow for better treatment. Maybe I should understand he "medico-legal" ramifications of joint treatments. I never really had to think abouut it working for TriCare. At Winn Army Hospital a data sharing program called CHCS-2 (If I remember properly) shared all medical treatments that are being done by each health professional on each patient. It was easy to see what a chiro was doing at the same time as the PT treatment.
In the outside world I can see what you are saying. But I can imagine that you feel this way because the chiro that your patient hypotheically could be getting treated by at the same time as your treatment isn't communicating well with with you and you have no idea what he is doing. Or maybe you just feel that you can do everything that a chiro can do. Thats great. I don't feel that I am qualified to do most manipulations yet. I would also imagine that you would have a hard time computing a person who is taking pool therapy as well as ground therapy at the same time or somebody that is taking mobic along with their therapy. Medications and dual therapies are variables that get worked into my treatment. Why can't you work in chiropractic?
Dan
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Re: PTs working for Chiros? - March 3, 2005 9:04:00 AM
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JLS_PT_OCS
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I see nothing wrong with treating the same patient as a Chiro treats.
I think someone earlier made a great point, that a good PT and good Chiro will probably practice the same way.
For example, to complement Greg Priest and to stoke my own ego, let's say Greg's the good chiro and I'm the good PT.
From Greg's posts, there are probably more similarities between he and I then there are between me and some PTs posting on this board...
I don't change what I'm doing because a patient is recieving Chiro care any more than I would change it if they were getting massage, or acupuncture, or an NSAID.
In fact, I manipulate those patients as well. From what I have heard from some Chiros I have worked with in the past (and in the military we get along quite well and enjoy each other's company) they and I approach a patient case completely differently, they are "adjusting subluxations" and I am "manipulating".
So it isn't even the same thing. So I'm told.
And to agree again with Dr. Priest, I think he's right in that some people just prefer to be employees and not the one responsible for the business. Private practice is a hell of a lot of work and dedication, as far as I can work out. Maybe all of us don't want to do that. I'm not sure I do.
It seems the big deal is the underlying assumption with employee/employer relations... that they are directing the care, and you are supplemental. If you work for someone of the same profession, it is assumed independent, whereas perhaps working for another healthcare provider puts you in a subordinate/tech type role. I'm not sure if that's true, but that's one way to look at it.
Many other professions such as CPAs and lawyers have rules written explicitly that they must be independent, and use it as part of their ethics approach. I don't see how that isn't applicable to all of us in the medical world, either.
Would it be ethical for a Chiro to work for me? I'm not sure. Perhaps it would seem to that DC that he/she is giving up their autonomy to work for someone else who is directive in the care. Whether true or not, if that's the impression, then that certainly creates a tricky situation. And I would understand if they did not feel comfortable in that situation.
However, to give them their due, the Chiros have done such a good job with their practice acts and state boards that they have far more flexibility and freedom than we do...we could learn a lot from them, in many ways...
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: PTs working for Chiros? - March 3, 2005 1:02:00 PM
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TMondale
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Dan, and Jason thanks for your responses,
Jason if you are manipulating the same patients that a chiropractor is also seeing and "adjusting" you are doing the same thing. Perhaps your dogma is different but there would be little difference in the application or effect. The problems associated with treating the same patient with the same or similar approaches should be obvious. Of course you as the good PT would be appreciating the improtance of exercises in support your treatment as well. Yes as I said earlier a good chiropractor would also. Again I can't speak about how things go in the military
Dan, I don't know what all a chiropractor can do, but what I do know is that I am able to provide a full compliment of treatment options to a patient case with musculoskeletal and central processing issues that includes but does not focus soley on the ability to thrust or non-thrust manipulate.
I would think chiropractors would not appreciate us working on their patients at the same time either confounding the results of their treatments, and potentially exposing their patients to small but accepted harm in the process, just as the patients we treat are exposed to that same potential harm when they see chiropractors at the same time.
Dan acquire those skills of thrust manipulation if you don't now have them. In this age we should be able to make a decission wheather to use it or not based on our clinical process not based on our innability to provide the service.
Again thanks for wading in.
Tim
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Re: PTs working for Chiros? - March 3, 2005 1:57:00 PM
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aconcors
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With all the responses I'm not sure if didn't lift the cover off Pandora's box.
again, my two cents. I once spoke to a PT who was also a DC and I asked him what he does differently as a DC than as a PT. He told me it's 85% the same.
On the topic of simultaneous treatment, I have in the past worked on patients who were seeing DCs. This was in the "bad old days" when I specialised in TMJ Dysfunction. I had no problem at first, although the treatments they were getting from me, the DC, and the DDS (who was doing daily iontos) ahd a lot of overlap. I drew the line when a patient arrived for her PT appointment after just having her neck "adjusted". She complained of dizziness and vertigo which the DC told her "was normal". I refused to treat her and sent her home. In retrospect I should have sent her to the ER.
I guess my point is that you should be careful of whomever else is treating your patients, be it another profession or a fellow PT.
Andy
_____________________________
Andrew L. Concors, PT, MBA, CIE
carmelvalleyphysicaltherapy.com
cptconsulting.net
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Re: PTs working for Chiros? - March 3, 2005 3:21:00 PM
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nari
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Have just picked up the thread, and some interesting thoughts emerge.
The PT/Chiro debate: It's rather like the USA/Australia debate that we have here, (don't know about over there)and that is:
Very similar,a fair bit of copying occurring on Australia's part, but quite different on a few things.
I would not ever consider working for a chiro, but would not see anything wrong with working WITH a chiro. I would NEVER consider working for a doctor, either, but on quite equal footing -yes.
Indeed, there are many GP practices with a chiropractor and massage therapist on site, each independently operating and cross referring constantly.
Thomas, one point you raised haunts me, and that is the image the public at large has of PTs, and what we see and hear ourselves. Listen to the patients across the board and what does one hear commonly?
"It was agony, twice a week, but after 6 months I was better"......"I had to double the ---ontin before and after physio, it was so painful"....
"I was so frightened coming here, after my last time with physio, I don't think I can stand the pain"..........."I never want to go near a physio again, really. I was so upset..."
Of course there is also a lot of good things said.
Everyone hates dentists...but do we have to extract teeth? I feel very uneasy about the bullying and lack of understanding that seems to go on with some PTs...and I have never heard patients talk about fear and increased pain as a result from chiropractic. Maybe I do not see the right patients?
I'm airing off, but these anecdotal comments bother me. I hear negative comments about 50/50 with positive remarks.
Nari
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Re: PTs working for Chiros? - March 3, 2005 4:05:00 PM
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Diane
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I hear +- comments all the time too. About PT, the negatives are things like:
a) went for three months to a work hardening program, and it was good.., but they still had pain. Or,
b) the PT left them with machines running a a hot pack that went cold and then popped this or that.
The positives usually are something about how nice the PT was. How hard they worked. How hard they pushed.
With chiros, the stories from true believers are generally positive, like "he's a really good chiro, I've gone to him every month for (insert number of years here), but he can't help this (insert name of peripheral joint here.)" When I ask them why they go at all, it's usually a cyclical pain that they've been told is a boop, and I see how they've become a domesticated golf club payer-offer.
Or they say, "He's very gentle, he just touches my neck for a couple minutes and I'm done, he doesn't do that cracking stuff." Yeah, and I bet he doesn't touch them long enough to actually accomplish anything real, which is why they've gone to get their neck "touched for a few minutes" every month for (insert number of years here) at about $40 per 5 minute visit.
The negatives are like, "I went once and never went back. I hated the cracking. It seemed so violent." Or.. "I went for awhile but it seemed like after a couple months nothing was happening, so I quit." Or.. "He wanted me to come back forever, and wanted me to bring in my relatives."
And PTs worry about having a cash practice? Jump for the chance! People are waiting with baited breath for someone real out there that they can easily access. Of course, you gotta do better than hot packs and electro and a pop for drama. You've got to learn how to actually treat people who are in pain...
I can see how the army trained PTs who love to pop find themselves in an affinity with chiros. There really isn't a lot of difference, except in phiosophical underpinnings. Those who love to pop will pop. Those who love to be popped will find them. The rest of us will get along somehow, I guess...
PS: Any PT who would work for a chiro needs a brush up on professionalism.
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Re: PTs working for Chiros? - March 4, 2005 7:11:00 AM
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JLS_PT_OCS
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Tim, I respect your opinion that my manipulation and a chiros adjustment are the same. In fact, I think I agree with you. However, most Chiropractic organizations would disagree.
I respect and acknowlege that everyone has a right to bring something to the table, and I do not pretend to practice chiropractic. At least as far as the law is concerned, there is a big difference between manipulation and adjusting a subluxation. In fact, for Medicare beneficiaries, the "adjustment of vertebrae to correct a subluxation" is a physician (in this case chiropractic physician) service. Hence, not something I can provide.
We're on thin ice here, but perhaps one of our chiropractic colleagues can weigh in?
Diane- I'm not Army trained, actually, though I practice in that setting. My preference for manipulation comes from the strength of evidence in the literature, not an affinity with another profession.
Why do you single out chiropractic and not, for example, medicine, in your statement about PTs and professionalism?
Much of my fellow professional's perceived negativity toward the chiropractic profession seems misplaced, to me.
For every story about weekly treatment for life, there is a story about getting useless diversionary rehab approaches and home exercise sheets?
Surely we are all to blame to some degree when it comes to utilization and evidence based practice??
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: PTs working for Chiros? - March 4, 2005 7:31:00 AM
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chiroortho
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I've tried to avoid participating in this discussion so that you folks could flesh this out. There is a range of opinion here, all to be respected. I can only offer you my take, which is that your manipulations are essentially the same as mine, since I do not subscribe to the subluxation theory. As far as working together, for me there is no problem whatsoever, as I recognize that PTs do some things better than DCs on average, and if the goal was to create a multidisciplinary center for the treatment of musculoskeletal injuries, I think a well-trained, experienced PT is indispensable.
I don't want to get caught up in cross fire. I just wanted to offer an obliquely different viewpoint. There are one or two here that would choose not to have anything to do with DCs on any level. Out of deference to their intelligence and experience, no offense taken. There are however a number of you that would thrive in a DC/PT relationship, and I would encourage you to explore it further if it interests you.
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Greg Priest, DC, DABCO
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Re: PTs working for Chiros? - March 4, 2005 8:45:00 AM
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steve
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At one point in my career I looked into a job with 4 chiros. I met them and discussed options with them. I was looking for a true interdisciplinary type of oppurtunity where there would be a sharing of knowledge and different ideas and perspectives. They, unfortunately, were looking for someone to bring in GP referrals and I was absolutely not to manipulate the spine. Obviously I didn't take the job. Too bad Dr. Priest wasn't working there, I'm sure I would have taken the job.
Diane, with respect to your comments about what patients say that is negative about physio, I would certainly argue that there is a portion of our patient population that would not be happy with the treatment that they recieve irrespective of their outcome. There is also a portion of our patient population that will continue to have pain irrespective of treatment.
Steve
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Re: PTs working for Chiros? - March 4, 2005 8:47:00 AM
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JLS_PT_OCS
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Thank you, Dr. Priest, for yet another polite, articulate and respectful post.
Well said, sir.
And no surprise, by the way, that you are not subluxation-based. But I do respect those who choose to practice that way, and it is those providers who I have had the most experience with. We got along quite well, despite our differences in approach.
I would like to take this opportunity to express my personal appreciation to you and other Chiros who post here, working towards cooperation and a "cease-fire" in general.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: PTs working for Chiros? - March 4, 2005 11:28:00 AM
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Diane
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Steve, the people I've met who aren't happy with physio aren't happy with the withholding of placebo elicitation. I think. It wouldn't hurt us to be a bit more accomodating in our treatment culture. A bit less blah, a bit more spa. A bit less puritan and spartan, a bit more relaxing to be around.
Jason, I suspect you have a case of chiro-wannabeism. At least it seems to me your efforts to be so graciously inclusive cast you in that light.
[QUOTE]Why do you single out chiropractic and not, for example, medicine, in your statement about PTs and professionalism?[/QUOTE]1. Scuse-me, I thought that's what the thread was about.
2. I don't think PTs should work for anyone, except maybe another PT, not any other health professional of any stripe.
3. MDs/DOs versus DCs are like real eggs versus Easter eggs. One provides nutrition and the other is a hollow egg-shaped shell made of sugar and foodcoloring or chocolate wrapped in tinfoil. Both can come cracked..
...But generally you can make all sorts of good things out of the first kind of egg; it is more useful as food, versatile, blends with other ingredients, contains protein and support for embryonic life, whereas the other is mostly decorative and will ruin your health if swallowed in large doses.
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Re: PTs working for Chiros? - March 4, 2005 12:11:00 PM
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steve
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Diane,
I actually like that - "Placebo elicitation" - I can see your point, I hadn't interpreted your post that way.
Steve
I can gaurantee you that Jason is not a chiro wanna be - He seems, from the posts that I have read, very evidence based, using science to guide his clinical decision making and not a specific theory that guides treatment.
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Re: PTs working for Chiros? - March 4, 2005 3:41:00 PM
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chiroortho
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I've been working on my egg shape at the gym. Give me a little time. :)
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Greg Priest, DC, DABCO
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Re: PTs working for Chiros? - March 5, 2005 5:07:00 AM
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TMondale
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Greg,
Thanks for weighing in. I don't think you want to interpret any of us who say we are reluctant to involve ourselves with chiropractors as it pertains to employement, or working with the same patients as being anti-chiro. My brother in law is a chiro. and we have the best discussions about musculoskeletal care. Conversations I dare say would completely miss other health professionals. There is very little difference in the way he thinks and the way I think (he's a little more into modalities than I). We both base our treatment of joint dysfunction on motion palpation, and even a strong understanding of the myofascial system.
My criticism to him has always been that chiropractors in general need to bring themselves into the dialogue with other health professionals, instead of wanting to play the misunderstood role, and act as if there is some larger truth of conspiracy acting against your profession. The lashing out in litiginous ways to restrict PT's practice beyond their practice acts can't be a proud moment however. We are all searching for the truth, or to get as close to it as possible. I for one would relish a more closely held colleageal relationship with your profession in general. for the record I wouldn't treat a patient at the same time another PT was treating that patient either.
Patients who come to me that have seen chiropractors very frequently tell me this or that bad thing about the chiro. I tell the patients standard; We all see each others patients that don't do well, and everyone is doing their best to help you.
Tim
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Re: PTs working for Chiros? - March 5, 2005 9:39:00 AM
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chiroortho
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Tim, I understand completely, and I try to avoid generalizations if at all possible. And frankly, I don't blame PTs for a little bit of defensiveness about DCs for the reasons you mention. I'd probably be a bit annoyed too if PTs were trying to constantly restrict my scope. Diane has good reasons to be skeptical about certain aspects of chiropractic, and she and I have a little history so I deserve a few good shots from her. She makes some very good points, and I greatly respect her experience and expertise. I can learn from just about anybody, and I choose to assume the best about folks. I really appreciate the enthusiasm that I see here that PTs have about caring for their patients.
By the way, thanks to the excellent input on this board I've (almost) come to the conclusion that ultrasound, for example, is not all that my training made it out to be. I have wondered about it myself in years past from a physiological standpoint. I'm not ready to pitch my US units quite yet, but I'll tell you that we are certainly using it a LOT less than we used to, based upon the input I've seen here, which makes good sense to me.
In addition, one thing that I've learned in practice is that when a patient complains to me about a PT or other professional, I take it with a grain of salt. We all have treatment failures, and I realize that I don't see the successes; I only see the failures. I'm sure if you practiced in my town for long enough you'd see some of my failures.
_____________________________
Greg Priest, DC, DABCO
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Re: PTs working for Chiros? - March 6, 2005 6:22:00 PM
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aconcors
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From: Northern San Diego County
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For those interested, here is a website for a company approaching local ortho groups to set up their own POPTS:
http://www.acare.us
I don't know if they are the same company that caused all the interest among chiros as well.
_____________________________
Andrew L. Concors, PT, MBA, CIE
carmelvalleyphysicaltherapy.com
cptconsulting.net
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Re: PTs working for Chiros? - March 7, 2005 1:53:00 AM
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JLS_PT_OCS
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Steve,
Thanks for the defense, glad you had my back.
Diane,
The only thing I wannabe is the best provider of evidence based nonsurgical musculoskeletal care that I can be. As far as I can work out, that has little to do with wanting to join the profession of Chiropractic.
Your defense of your statement as being the topic of the thread is well-taken.
My effort to be inclusive with chiros speaks to my changing assessment of the role of many healtchare providers in the system, and my changing opinion about the roles of those providers.
I feel that there are very few places where real practitioners can speak their minds freely and politely in a non-political atmosphere, and RehabEdge seems to be one of those places.
I feel especially that there is a lack of dialogue between PTs and chiros that might bring dividends for both, and that is why I go out of my way to be appreciative. It is honestly felt. If it makes you uncomfortable, I really don't know what to say. Other than please don't confuse politeness and appreciation with envy and imitation.
Your Easter egg analogy is very timely, not to mention colorful.
Greg, you a pastel guy or do you stick with primary colors?
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: PTs working for Chiros? - March 7, 2005 3:40:00 AM
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Diane
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Jason,
Apologies, from now on I will consider you a gentleman and a scholar.
[QUOTE]The only thing I wannabe is the best provider of evidence based nonsurgical musculoskeletal care that I can be. As far as I can work out, that has little to do with wanting to join the profession of Chiropractic.[/QUOTE]Good. Keep a healthy distance/firm boundary. Don't be a conduit for their memes to get into our profession.
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Re: PTs working for Chiros? - March 7, 2005 5:37:00 PM
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aconcors
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From: Northern San Diego County
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The point of this thread wasn't to throw eggs, real or not, at other professions.
I think we can learn a lot from the Chiropractic profession. As the RAND study showed, more patients were satisfied with DCs than MDs for their back pain care, primarily because they spent time with the patient and actually laid hands on. Secondly, they have always been more customer service oriented, trying to give patients what they wanted and fill needs in the marketplace.
I personally feel the trend to add PT to their practices is because they too have succumbed to the lure of insurance. Insurance has caused all of healthcare to provide what is best reimbursed instead of what the patient really needs. Perhaps the change to personal savings accounts will change how we treat and charge our patients.
_____________________________
Andrew L. Concors, PT, MBA, CIE
carmelvalleyphysicaltherapy.com
cptconsulting.net
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Re: PTs working for Chiros? - March 17, 2005 7:17:00 AM
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dross
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From: NJ
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Most of the DCs looking for PTs are in No-Fault/PI practices. They can bill more if a PT does the therapy. It also frees up time for the chiro because the PT id doing the heat/stim/US etc. Its not being done for the rehab aspect, its a financial thing for the DC. It also makes their practices more attractive to attorneys for no-fault referals. Of course this is a broad statement, its not always the case. But it plays a huge role.
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