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Re: how would you handle this one?
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Re: how would you handle this one? - February 17, 2006 10:19:00 AM
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JLS_PT_OCS
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This is odd.
I have never had a problem treating a patient in addition to another healthcare practitioner.
I'm unconcerned if a patient is also seeing a DC while they see me, just as if I'd be unconcerned if they were taking a medication while in therapy. I don't consider this duplication of services or anything like that. From what I can tell, the purpose and meaning of manipulative care is different between the two camps.
Certainly reports of "mommy/daddy" on exercise programs might be a problem, always best resolved one-to-one between providers. So I agree I would call the chiro to straighten everything out. Who knows, maybe the patient misinterpreted something?
If one of my spine patients is seeing a chiro and could benefit from manipulation or manual care, then I give that as well as my exercise intervention. I don't think I could give a patient a sort of ultimatum (ie it's them or us).
Certainly I've had many of these patients who stop going to the chiro b/c they can get both manual/manipulative care and exercise rehab in a "one-stop-shop" with me. I've also had patients who prefer passive care and end up just with the DC. I'm fine with either of those situations.
Unlike some others, I don't think that chiros and PTs really compete for the same patients. There are definite differences in outlook between patients who end up in PT and those who end up in Chiropractic, and in fact it has been said that belief in alternative care is a big part of that:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11805694&query_hl=7&itool=pubmed_docsum
Like Tim, I don't disparage anyone and let the patient make their own call as to who to see, either exclusively or together. I am happy to entertain calls from other providers (PAs, MDs, DCs, DOs, FNPs, etc) to discuss a case and share perspectives.
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: how would you handle this one? - February 17, 2006 12:19:00 PM
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johnczyk1
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Well good points by all.Basically it is a spinal problem.Extension exercises and flexion exercises are prescribed.Didn't even get a chance to see if ext was working before patient stopped doing them.
Doctor agrees that both disciplines bring something to offer the patient. I agree-just not at the same time...Patient should decide where he wants to go and then conflict is resolved.I once had someone seeing three different practitioners.Ridiculous.Patient wants to get better but give me a break.I once had someone who asked if they could leave PT a few minutes early as they had to get to the chiro office.
In regard to the point of "the pt should be feeling somewhat better by visit 2" - I would like to believe that but we all know that that's not reality in all cases.In this case pain has been present 6 weeks.Radiating pain down the leg and back pain.In a best case scenario I wouldn't expect rapid improvement anyways!
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Re: how would you handle this one? - February 17, 2006 12:30:00 PM
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johnczyk1
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also I have never seen a chiro refer a patient to PT.I have seen some chiros give notes to patients to tell me what to do or add to my treatment plan."Please add massage to rx for LBP"
In most cases I find the comments insulting and I do not appreciate them.
After visiting chiroweb web site I can see waht some of the chiros think of us anyways but I know it is not representative of the whole profession.There are a lot of good DC posters on this board.
With that said though I feel that Chiro is not superior to PT and is an alternative type of care-no more -no less.So is osteopathic and massaage therapy.Everyone has a shot at the pie.
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Re: how would you handle this one? - February 17, 2006 12:53:00 PM
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Lehmkuhler
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Did you just claim that osteopathic doctors and massage therapists are equals?
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Re: how would you handle this one? - February 17, 2006 12:56:00 PM
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Lehmkuhler
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By the way, no disrespect to any massage therapists... sorry if it came across that way.
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Re: how would you handle this one? - February 17, 2006 1:01:00 PM
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johnczyk1
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To the patient who knows no difference between PT OT ATC CHIRO osteopath massage therapist ---they are all equal.Whoever helps them the quickest wins!
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Re: how would you handle this one? - February 17, 2006 1:04:00 PM
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johnczyk1
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Of course educationally I realize the differnces in all these professions..The public doesn't,including PT.I once had someone ask if we had to go to school for PT....
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Re: how would you handle this one? - February 17, 2006 1:04:00 PM
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Lehmkuhler
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If speed is the only criteria, I'd bet osteopath almost every time. They get to use drugs... :)
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Re: how would you handle this one? - February 17, 2006 1:11:00 PM
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nari
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jackyl2
In this case, where pain has been present for 6 weeks, it is borderline chronic pain. Nevertheless, one should expect some change in 2 visits. Even if it is a somewhat better night's sleep. If no change at all has occurred, by re-evaluation on the third visit, then the patient is more likely to go somewhere else, if offered by the doctor. Would you continue to see another PT where nothing has happened after 2 visits? I certainly would not...
Nari
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Re: how would you handle this one? - February 17, 2006 1:24:00 PM
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Lehmkuhler
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I agree with nari, 2 visits should yield "something" or the patient should be re-evaluated.
And I think the public is more savvy than to believe that all of those professions are equivalent. Way more savvy.
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Re: how would you handle this one? - February 17, 2006 4:09:00 PM
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TMondale
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Jason,
Fascinating. While the dogma may be different if you think the effect of manipulation is different if applied by PT's or chiro's I have to respectfully disagree. I sense from posts here and elsewhere that you are an advocate for evidence. Where is the evidence that we should be for patients seeing us and seeing other practitioners that may be doing the same sorts of things? As far as the medication thing, if you prescribed meds and someone esle was prescribing the same meds, because that is what they did, I would hope you might have some concern about that.
Unlike many of the chiropractors that post regularly here, the profession is dominated by people who use language like subluxation, and tune up, and misalignment. I don't feel that those are helpful concepts when trying to create self responsibility and primary active participation.
And again the notion that we don't compete for the same patients is just wrong. Perhaps it's different in the environment that you practice in, but for all out patient care in non-military settings chiro's are our biggest competitors, particularly for the spinal patients.
Jason we've had these differences before and perhaps it won't change but I do appreciate your comments.
Tim
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Re: how would you handle this one? - February 18, 2006 5:22:00 AM
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johnczyk1
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nari I am not disputing the pts right to go try someone else,I am simply saying that seeing two providers at the same time is confusing to the patient and to the therapist.
By the way-with no offense-I'd love to see all of your patients who are better on the second visit.It doesn't happen as much as people would like to think. People with herniated discs for example will likely NOT show any improvement in a bunch of visits but the docs may still keep sending them to you.
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Re: how would you handle this one? - February 18, 2006 6:23:00 AM
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TMondale
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Jackyl2,
Good point. I try to get my clear herniated disc patients to interventional physiatrists ASAP (at my place physiatry, at others pain anesthesiology)for flouroscopically guided transforaminal or epidural injections. I continue to treat and apply the CPR for acute low back pain (if applicable). These injections are relatively low risk, and can save a boatload of pain,suffering and disability.
Sorry off the subject a little.
Tim
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Re: how would you handle this one? - February 18, 2006 6:33:00 AM
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TMondale
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I believe Cleland has a recent case series which showed good results from C-radic, with T-spine manip, exercise, and intermittent C-traction (not sure of the referrance). I think the effect is the same if PT's or Chiro's follow the rules.
Sorry for the jab Jason,
Tim
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Re: how would you handle this one? - February 18, 2006 4:51:00 PM
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ginger
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From: Melbourne Victoria
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We all have a perspective tied to our environment, Jason to direct access military,others to referrals from MD's who may know precious little about spinal care, others still with primary care access and a differring demographic.
My statement about chiros physios and osteos carving out their niches amongst other providers may have been better put. If we all have access to science, to learning by others, to the core models and reasoning that allow for skill and other development, then we can all arrive at the market place with something to offer.
What is offered is eventually driven by experience, fueled by fine tuning and hopefully , eclecticaly , made up of the products of success and pragmatism. We try and create change by applying the best of disciplines that are available to all of us. What we choose may be different but not because methods ( excluding the use of meds)are not able to be learned and provided.
I make a choice not to use manipulation as a primary means of intervention , because the results are just not good enough. I make a choice not to do massage, because there are plenty of others who can provide this as an adjunct.I choose also not to offer exercise based treatment because it doesn't stack up against the immediate and long term results I consistently get from continuous mobilisation. Added exercise is fine as an encouragement to self management, but is a poor second to the pain relief and problem solving that go with good manual treatments.
Most severe low back/sciatic pain patients who recieve mobs as I others do ( the continuous method)would have lost the sciatica after one Rx, and most of the LBP after two. Three to four is the standard, where discc injury is not present.
It's a warm sunday in Oz and I'm heading to the pool to train , hope the weather is passably good wherever you may be.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: how would you handle this one? - February 19, 2006 4:51:00 AM
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TMondale
Posts: 131
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From: Newton-Wellelsley Hospital
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Wow Ginger,
You need to publish those results.
Tim
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Re: how would you handle this one? - February 19, 2006 9:54:00 AM
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Jeep
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We have a lot of opinions here----yet do not know anything of this particular patient and the circumstances particular to this patient. Jackl has not been forthcoming on that.
What I do ascertain, is that Jackl has not contacted the DC in question to discuss/coordinate/maximize patient benefit. Why?
In herniatied disc cases, I expect some change, and it is highly unusual, for me, to see "no change" after the second treatment. Jackl- AGAIN- what was the patient's problem/diagnosis/findings? AND what was your treatment per DX? Everything is purely speculation, without this important information.
And to others-------Quite frankly------I am somewhat disturbed by the either/or attitude. I see no patient benefit with that. THAT attitude would seem to be more confusing to a patient. Coordination of expertise is what the *ideal* should be.
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Re: how would you handle this one? - February 19, 2006 10:41:00 AM
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nari
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Jeep
Co-ordination of expertise would be useful, and in Oz, I understand many chiros would see that as an ideal.
It's back to politics again; in some instances the patient would be confused unless it was quite clear what the PT's role is and that of the chiro's...but that seems to vary so much that in the long term, the patients end up with the common notion that PTs treat limbs and chiros treat spines.
Very few Oz PTs manipulate, out of choice, because other procedures achieve the same result in many cases. Thirty-plus years ago many PTs manipulated, before the need for careful assessment and CPR stuff eventuated.
So the story is confused; here, PTs cannot refer to chiros and vice versa. So in a way, the division is fairly well entrenched in competition between PTs and chiros for the same patient caseload.
In the end, the patients continue with the one they feel most confident with. The rationale behind that is complex and has been discussed forever in forums. Can't see it changing in the near future.
Nari
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Re: how would you handle this one? - February 19, 2006 10:48:00 AM
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Jeep
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"here, PTs cannot refer to chiros and vice versa."
WHY??
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Re: how would you handle this one? - February 19, 2006 11:12:00 AM
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ginger
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From: Melbourne Victoria
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I beg to differ on one point of nari's ,In Oz, Physio's can refer to anyone they please, certainly amongst the paramedical professions there is an open market place within chiro osteo and physio , as well as massage. It is up to the therapist wether they accept a referral or not, and equally up to therapists wether they choose to confer on treatment matters across the disciplines.
It is however a very rare thing for this to happen, and why not. We all offer solutions in our own ways.
I'm not sure Nari wether your comment about Physio/Chiro referrals related to NSW , I know of no impediment here in Vic.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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