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RE: One expert will lead to better care
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RE: One expert will lead to better care - June 24, 2008 10:31:32 AM
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Sebastian Asselbergs
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From: Barrie, Canada
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What the governments FUND is another question: that should be driven by research and outcomes (of all kinds) and common science. In that case, the manipulation effectiveness is shared by any therapeutic professional allowed to do those - as are the risks. Even as we speak, we have standards of practice that are squeezed daily in our own profession, and I am sure that quite bit of government funds are going to waste in PT clinics.
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Mundi vult decipi
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RE: One expert will lead to better care - June 24, 2008 10:31:50 AM
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rwillcott
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TexasOrtho,
I do agree with you that as health care providers we don't want the government getting too involved and dictating what we do. However, it is the responsibilty of the government and elected officials to protect the public. In Alberta the provincial government dropped the ball on upper cervical manipulation and are now facing a lawsuit. And rightfully so.
A start would be for provincial governments to run public service announcements about the appropriate treatment of LBP. These ads would indicate that passive treatments should be avoided. They could also indicate university trained health professionals trained to treat LBP. I believe the government in New Zealand took this approach with LBP recognizing the extreme costs it was having on the healthcare system. I'll have to look for the article.
I think proud has it right. Too many people with questinable training all claiming to be able to treat LBP. The dentist example is right. If you need contacts would you go to a person who claimed they do eye exams but is not an optometrist? Or how about taking your prescription for antibiotics to the guy that works out of his house and also claims to provide an 'antibitotic'? I could go on and on.
We now have massage therapists in the area I practice performing teeth whitening. Where does it end?
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RE: One expert will lead to better care - June 24, 2008 12:44:14 PM
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proud
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quote:
Proud you are off the deep end here. Government involvement should be minimal. For better or worse, consumers need to be left to make their own decisions. It is up to US to win their hearts and minds.
Governments fund treatments( in the US via Medicare/medicaid) and in canada, we have universal healthcare and insurance.
There is NO third party payor that will pay for someone to go have their tooth ache rubbed with magic dust. Why? No evidence and it would result in increased cost long term. In other words, third party payors and Government have established the expert with regards to teeth( Dentist).
Why should it be any different for conservative NMSK managment? Explain that to me?
And Seb you said:
quote:
....And without having to denigrate another PT or professional.
It's not about denigrating anyone. It's about protecting the public, both in terms of their health but also their ability to fund healthcare long-term. Wait for it. with the baby boomer generation upon us, they will be taxing the healthcare system like no other generation before them. You think your blue cross premuims are high now? Soon....millions will not be able to afford the premiums.
Conservative NMSK cost is skyrocketing. why is the Alberta government paying for maintenance chiro? Why is the New Brunswick government paying for cranio-sacral therapy? Why do insurance plans cover a rub down? Tons of things "feel good"...but why should the government pay for a "feel good" item. For that matter...why not pay for a day at the spa and a cucumber scrub? It's foolish.
The only way that this is going to head towards is a recognized expert in NMSK management. It is that way for everything else in healthcare.
You are right Seb, It's going to be the research that will eventually land on the table of third party payors when they have to start squeezing out payment for certain things due to skyrocketing premuims( read a book by Garth Turner called after the boom for all the demographic info about how healthcare is going to present a problem by 2015). All I can say is...thank goodness I am a Physiotherapist :)_
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RE: One expert will lead to better care - June 24, 2008 2:12:08 PM
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Sebastian Asselbergs
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From: Barrie, Canada
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I agree with most of what you say, proud. But it is NOT evidence leading the governments and ministries towards funding this-or-that; it is political pressure. Most of these decisions are coming from grassroots pressure or from opportunistic lobbying of BIG players. So, I agree with the portayal of shortcomings of the system, but they are an outflow of the democratic system as we know it.
I believe it is by grassroot-work like ours in the clinic, that the most change will occur - thus we are swimming uphill....
I got lucky: a Federal Minister, a Provincial Minister, three Members of Parliament and two mayors were under my care at some time or other - some seeds WERE planted! Did it make a difference: I will never know, but I`ll keep plodding away.
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Mundi vult decipi
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RE: One expert will lead to better care - June 24, 2008 2:32:01 PM
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bonez
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Proud you REALLY miss the boat sometimes.The important part of the post is that what you do and what I do will not rank highly in the funding world as most of our work is NOT life threatening care. As such there will be a move for governments first and insurers secondly to quit funding our care collectively as they try to get a grip on the spiralling critical care costs. These costs are set to climb astronomically as we move the baby boomer generation forward. By extension patients wil dig deep in their pockets to pay for the services they preceive they need and often on the frequency they can afford or some comprimise to what you wish them to do.
If you don't come to grips with this and by extension listen to your customer base you will be the smartest man left out in the cold. It is important to be the best at what you do but your care still has to fit with what your patient wants. While it is noble you can't force them with your father knows best approach either.
While you can rant about how I have not made sense my experience in this market far exceeds yours and I have seen all of what I describe and have counciled young DC's starting out as they have experienced the same thing.
< Message edited by bonez -- June 24, 2008 2:38:13 PM >
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RE: One expert will lead to better care - June 24, 2008 5:48:06 PM
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TexasOrtho
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Proud I sincerely appreciate your passion. I can't believe I am counseling someone to tone it down a bit, but that is my recommendation. Bonez and I are likely to disagree on many issues, but it is hard to disagree with the civility of his posts particularly in reference to yours. I think you could get your message across with much more strength if you stopped and read them first before hitting the submit button. As someone with a few good internet battle scars, it's just a recommendation and you are welcome to do with it what you like.
Our profession needs pit bulls and I like to think of myself as one at times, but learning to temper our message with a degree of civility will get our message out there to a much broader audience.
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: One expert will lead to better care - June 24, 2008 6:48:57 PM
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proud
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quote:
ORIGINAL: TexasOrtho
Proud I sincerely appreciate your passion. I can't believe I am counseling someone to tone it down a bit, but that is my recommendation. Bonez and I are likely to disagree on many issues, but it is hard to disagree with the civility of his posts particularly in reference to yours. I think you could get your message across with much more strength if you stopped and read them first before hitting the submit button. As someone with a few good internet battle scars, it's just a recommendation and you are welcome to do with it what you like.
Our profession needs pit bulls and I like to think of myself as one at times, but learning to temper our message with a degree of civility will get our message out there to a much broader audience.
Rod,
Direct me to where within this thread I was not civil? I re-read and all I see is truth regarding pseudo-science in healthcare. I did not directely offend Bonez....he is obviously very acedemically saavy. I in fact never suggested PT's are deserving of the expert status.
All I suggest is that it has to be someone.
So now I have two questions for you.
1. How was I not civil?
2. Previously asked: quote:
Why should it be any different for conservative NMSK managment? Explain that to me?
Submit....
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RE: One expert will lead to better care - June 24, 2008 7:03:46 PM
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Sebastian Asselbergs
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I have to add that this is a laudable idea: quote:
recognized expert in NMSK management.
but A) by whose standards?
B) whose definition of NMSK expert?
I think you are mistaken in saying that THAT is the way in everything else in healthcare. It isn't. See my examples of ortho/neuro/general surgeons competing over the same diagnosis. Look at a Psychologists and Psychiatrists, Ophtamologists and Optometrists, Podiatrists and Chiropodists etc etc. Heck, even the dentist in my building competes with the orthodontist for straightening out teeth and jaws with "new" braces, or fixing TMJ problems.
I think you have too rosy a view of the other professions. There is a place for choice, and narrowing it down to one profession only for MSK with the plethora of practitioners, is an unrealistic pipe dream. Patients would not stand for it.
I like your fire FOR PT but proud as I am of my profession too, I am still disgusted by many of my colleagues' practices as well. Until that gets fully cleaned, I am more mellow towards other professions. After all, no matter how much we want to be "the one", the patient is much more fickle.....
< Message edited by Sebastian Asselbergs -- June 24, 2008 7:09:17 PM >
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RE: One expert will lead to better care - June 24, 2008 7:19:37 PM
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proud
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Seb,
I notice a theme with both yours and Rod's response to my posts....
You both make the error to assume that I am bashing other professions. In fact, I equally discussed the frustrations I have within our own profession.
I am not proclaiming that PT owns the right. Far from it. All I am suggesting is that it has to be someone.
As for the optomitrists, opthomologist arguement. Although I see the point, in all those examples, each one of them has a more or less defined role. As well, there is no room for pseudo-science within them....becuase their colleges would not allow it.
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RE: One expert will lead to better care - June 24, 2008 7:30:09 PM
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TexasOrtho
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Proud I think it's important to understand I do agree with your sentiments. I just think our different styles betray our perceived solutions to the problem. You seem to think governments should step in and regulate the jokers out of the equation. On a certain level I might agree with you. I think so much of chiropractic still has it's head too far up Palmer's yoo-hoo to recognize some of what they do is a legitimate threat to health, and relies heavily upon the placebo effect and patient satisfaction.
However as most chiros are quick to point out, the adverse events associated with chiropractic are on the same order, and in some cases lower than, many of our medical interventions. This is the standard comeback and results in a stalemate as we really can't argue this point. What's the government solution? Outlaw things that are harmful or don't have evidence to support them? Be careful or WE might find ourselves regulated out of a great many things as government regulation isn't a scalpel, it's a sledgehammer.
My alternative is to win the patients over, and I believe we are in a position to do so. We often have high patient satisfaction rates (although not as high as the chiros BUT higher than many physicians) AND we have a greater body of evidence behind what we do. Patients still go to the chiros in fair numbers so I doubt very seriously they care about evidence. They want to get better quickly and cheaply. With 3rd party reimbursement, the chiros can thrive. However, their reimbursement is shrinking like Duffy in the pool. (Just seeing if you are reading John) Patients will be left with more out of pocket expenses and begin looking elsewhere: enter the physical therapist. Reimbursed evidence based care (relatively speaking) with fairly high patient satisfaction rates.
The natural history of the chiropractic profession will be to adapt or die. Hence my first post in this thread on "debating latin grammar". Another analogy is rearranging deck chairs on the Titanic. The profession as we know it is going the way of the dodo. Kicking dirt over them is a poor use of energy compared to the numerous advocacy issues we have in front of us. I just think your energy would be better used on these fronts. You are almost literally beating a dead horse.
Your inflammatory wording isn't likely to reach it's intended target. Remember, I am with you on these issues, I just think you need to chill a bit.
< Message edited by TexasOrtho -- June 24, 2008 7:53:32 PM >
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: One expert will lead to better care - June 24, 2008 7:34:03 PM
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Sebastian Asselbergs
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From: Barrie, Canada
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Proud, I know that some" PT" stuff drives you nuts as it does me (and Rod), but I really do not see the "one" MSK professional becoming reality - I hope to see the fluff and crap and garbage being removed steadily from our profession (AND others - like chiro). I just expect that there will be more than one "expert".
And I have read the whole thread here again - and you are right: here you have not said ONE bad word about any other profession!
Rod - you are quoting from another thread altogether!
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RE: One expert will lead to better care - June 24, 2008 7:39:58 PM
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proud
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quote:
ORIGINAL: TexasOrtho
However as most chiros are quick to point out, the adverse events associated with chiropractic are on the same order, and in some cases lower than, many of our medical interventions. This is the standard comeback and results in a stalemate as we really can't argue this point. --------
I have not yet completed reading your entire post but had to stop here. Yes you can....
When the adverse effect card is pulled out...often the statistics compared against are all encompassing and do not take into effect demographics . Take the average chiropractic citizen.....they WALK into the clinic....likley drove there. They are by medical standards....healthy.
When looking at medical adverse effects...this includes 99 year old Betsy who was admitted last night for renal failure. Slight incorrect dosage and Viola....adverse effect on the charts. This however is an unhealthy population....
The other argument is that simple prescriptions have adverse effects. The difference here is that the patient leaves and is in control of the dosing( this is BTW why childrens dimetapp was taken off the market....not because it was flawed....but parents were not careful enough with the dosing). Whereas with a cervical manipulation....this is an invasive procedure wherein the locus of control is out of the patients hands. The only way to compare the two would be to have the pharmacist stand there and GIVE you the incorrect dose....or tell you to take it 6 times a day when it should have been once.
Now throw in the risk/benefit aspect in comparison to medication prescription and traditional medical care and the arguement is cooked
Okay...back to reading
< Message edited by proud -- June 24, 2008 7:56:36 PM >
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RE: One expert will lead to better care - June 24, 2008 7:51:06 PM
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TexasOrtho
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Bas you are hilarious and right. I must be having a small stroke. I took the quotes out as they were from another chiropractic thread on this forum. Sorry 'bout that proud. Not about the "chill" part, but about the "quoting"!
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: One expert will lead to better care - June 24, 2008 8:04:27 PM
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proud
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quote:
ORIGINAL: TexasOrtho
Bas you are hilarious and right. I must be having a small stroke. I took the quotes out as they were from another chiropractic thread on this forum. Sorry 'bout that proud. Not about the "chill" part, but about the "quoting"!
I never saw it. What did I say? believe it or not...at one point in my posting Hx here, I held out no hope for the chiropractic profession. Ex posters like bird007? and Jeep did not help matters as they generally served to underscore my beliefs about the acedemic ineptitude of chiropractic. So the tone of previous posts might have been extreme.
However, posters( I cannot recall them all), like Buddy, Marc, Bonez has made me realize that chiropractors can avoid the traps. These posters often post in the medical complexities section and are extremely knoweledgable. It's unfortunate for them that the profession tends to attract some strange people....of course my wife thinks I'm strange for posting on here...and she's also a PT!
< Message edited by proud -- June 24, 2008 8:12:03 PM >
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RE: One expert will lead to better care - June 25, 2008 11:12:48 AM
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john M
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i have been lurking around for a few weeks and thought that I would jump into this particular thread. I am a chiro. From what I've read I seem to think and practice much like bonez does. And for the record I do not perform upper cervical manipulation. risk/benefit analysis just does not compute for me.
I am of the mind that having one expert would not benefit the public in the long run.
I'll go back to the example of Dentistry. Here in Ontario there is no other expert in that field. Over the last couple of decades the cost of dental care has increased significantly faster than many other health fields. Why? The lack of competition. This has basically limited dental care to the insured or the wealthy. Dental hygenists are now trying to push for autonomy from the dentist to perform scaling and cleaning etc. All the stuff they already do within the dentist's office. This is being meet with a ton (or tonne here in Canada) of resistance from dentists mostly because of the financial impact it will have by driving down the cost of the average visit. Dentists claim that it is not about $$ but public safety.
The same is true with pharmacist. They are pushing for legislation to be able to prescribe drugs not just dispense them. MDs are against it again because of public safety claiming pharmacists lack the ability to diagnose properly, but it would also greatly impact their medical practices.
In both of these examples, I am in favour of competition. I think that both hygenists and pharmacists are competent enough to do these things and know when to refer for more complex issues. Both dentists and doctors have become complacent and some what greedy (IMHO) because of the lack of true competition for their services. Human nature would indicate that this would likely happen in almost any profession without these external pressures. Evolution is driven by external pressures.
As others have stated, there will likely never be a true winner in the claim to be the "MSK expert". And I don't think it should be based on professional designations as much as it is based on competency. I think for many on this board, competency has only come after experience, plenty of weekends spent in post-grad lectures and workshops, and a bunch of self learning, regardless of designation. But are the people on this board the exception or the norm?
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RE: One expert will lead to better care - June 25, 2008 12:21:59 PM
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proud
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That's a really solid post John M. There are two schools of thought I suppose. I do see your points however I am of the mind that Dental hygenists do not have adequate training and Pharmacists do not have adequate training to prescribe. Everyone want's to find a way to cash in but in the end it's about public safety. I trust a dentist is not going to screw something up far more than a Hygenist thank you very much. That's just me.
You did mention competency and I think you are correct. Currently competency has nothing to do with designation. It has more to do with the individual practitioner. But that's due to excess competition and poor regulation.
I think our freinds down in the states confuse professional regulation with third party payor regulation. To be clear....I am not advocating for third party payors making descisions on what will or will not be covered....that's just silly. I'm talking about self regulation in consultation with "learned" experts within the Physiotherapy field.
I'm all for random checks and enforement to some standard of EBM....as it stands now.....I could baste my patients with butter, call it manual therapy.....and bill blue cross!
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RE: One expert will lead to better care - June 25, 2008 2:46:22 PM
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jesspt
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Wait a minute - you want government regulation to raise the standard of care within the physical therapy profession when our various professional organizations won't even do it? The APTA in particular would seem to have had ample opportunity to weed out the "fringe" practitioners, but has yet to do so.
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Jess Brown, PT
Board Certified in Orthopaedic Physical Therapy
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RE: One expert will lead to better care - June 25, 2008 4:13:13 PM
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SJBird55
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Jess, the APTA has no clout. The APTA can't weed out anything. In my opinion, it will be the consumers themselves that will weed out the practitioners that suck... but that will only happen as consumers experience different companies or practioners and only then will they know the difference. The folks that are the best word of mouth patients for me are the ones that have had a previous experience with physical therapy and then learn after experiencing my services that there is definitely a difference between providers and definitely a difference in the experience between companies. Those folks are sold, hook, line and sinker AND they tell everyone they know, along with warning others about the difference.
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RE: One expert will lead to better care - June 25, 2008 4:38:39 PM
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jesspt
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SJ -
I agree with our best consumer advocates being patients who have had experience with both EBP and non-EBP clinicians. They tend to be my strongest advocates as well.
I think that the reason the APTA has no clout is because they continue to pander to the minority. They seem to be afraid to alienate those practitioners who have practice patterns that fall outside of what most of our profession would call EBP. At the very lest, they could put out a statement against use of treatmetns that aren't backed by anything resembling sound theory - myofascial release, anyone? Perhaps they are too afriad of the potential for lost memeberships and the financial impact that would have.
_____________________________
Jess Brown, PT
Board Certified in Orthopaedic Physical Therapy
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RE: One expert will lead to better care - June 25, 2008 5:32:11 PM
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SJBird55
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No, Jess... the reason the APTA has no clout is because the organization neither regulates nor enforces regulations upon members. The APTA creates opinion guidelines and defines ethical practice. The APTA may mildly assist with retroactive legislation and issues... the APTA might offer mild advice when a member has reimbursement or legal questions.... but the APTA can't control the choices members make. The greatest penalty for anything the APTA can impose is booting a member from membership. That penalty is probably embarrassing and probably pisses off the ex-member, but reality is the therapist can still practice, can still make a living and has no real ramifications. So what if the therapist can no longer be a member... no huge loss for that therapist. Most therapists aren't members because the organization is not viewed as valuable to the majority in our profession.
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