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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 28, 2008 9:38:50 AM
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proud
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The CPA has a position statement on evidence based practice. It's fluffy to say the least.
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RE: One expert will lead to better care - June 29, 2008 4:38:02 PM
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rwillcott
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I always cringe when I see the MFR ads in the CPA journal. I know it provides money to the CPA but at what cost? There is always a cetain level of professionalism that must be maintained. Those pics or John Barnes are just weird!
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RE: One expert will lead to better care - June 29, 2008 5:05:02 PM
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Sebastian Asselbergs
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Creepy indeed: the guru smiling benevolently....
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RE: One expert will lead to better care - July 1, 2008 11:02:47 PM
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bonez
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quote:
ORIGINAL: Sebastian Asselbergs
.
In the 25 years as a PT, I have seen the trend continue unchanged : the patient looks until they find some fancy explanation that "fits" and are willing to pay for for whatever.
Hence the statement I made earlier about listening to our customer. That we can be really evidence driven but our patient population still is seeking their own direction in their healthcare. They don't read the research and often don't care if we do they just want a solution and often fall victim to the marketing of said solution.
It takes time and careful effort to deprogram these people and may add to the potential for long term disability.
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RE: One expert will lead to better care - July 2, 2008 7:23:33 AM
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SJBird55
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bonez, consumers can be changed. I talk about research specific to each patient's problem all the time. I had a return patient just the other day - she's one loyal patient (I've treated her for a variety of issues over the last 6 years). She knows without a doubt that I read all sorts of stuff AND use what I read. This time she's being referred secondary to a potential transient ischemic attack. The beginning of her symptoms occurred quite coincidentally after a heart catheterization procedure. She had one burning question in her mind that her neurologist refused to answer - could a heart catheterization procedure cause a TIA? (Talk about getting put in the hot seat!) I gave her the song and dance that her question wasn't within my expertise because cardiologists should know that better than me, but I told her we could take a look right now with a literature search and see what comes up. After I did a search right there in front of her on my tablet, I decided that yes, a heart catheterization could potentially cause a TIA. She was now 3 days out from the beginning of the severe change and about 12 days out from the heart catheterization procedure. I told her I wasn't sure about the timing - seemed kind of late after the procedure, but I wasn't an expert in that area. I reviewed her meds again and let her know that being on Plavix was probably a good thing, but didn't know if it was the best option for her current situation. I then asked if her cardiologist knew of her sudden change in condition. He didn't know, so I told her I needed to contact his office now. I let her know that the cardiologist may want to have her on different meds, but I wasn't sure about the timing since her symptoms were now 3 days old. I told her that for her particular situation that chances were the best way for diagnosis would probably be the MRI she will have next week explaining that since she also has multiple sclerosis and technically, because both conditions affect the brain, I honestly had no idea if her symptoms were a TIA or a new presentation of her multiple sclerosis.
You CAN listen to your patients AND make it sound really cool that a certain piece of new literature just might be the ticket in addressing their complaints. You can't expect any patient to change their seeking behaviors if you don't start planting the "evidence" seed. Give them a really short, genuinely enthusiastic rationale citing evidence in laymen terms. I don't experience what you are saying in my area, bonez. The problem is that consumers don't need physical therapy in their lives at a high frequency. A patient that has had the opportunity to compare will be loyal to the evidence-based practitioner IF the evidence-based practitioner can create that patient-practitioner relationship. Those patients will seek you out AND request your services.
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RE: One expert will lead to better care - July 2, 2008 12:46:39 PM
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john M
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I agree with you SJBird that consumers can be changed one at a time by understanding the difference between EBP and non EBP. However, this is not going to have an impact on who consumers go to in the big picture.
I attended a business lecture once in which a marketing/public relations guy who specialized in assisting dental practices was speaking. He had plenty of evidence via polls/surveys etc. to support his points. What I was shocked by was how low the competency of the practitioner ranked in forming the consumer's decision on where he/she was going.
The most important factors included staff personality/appearance, clinic appearance/clenliness, appearance and charm of doctor/therapist. Competency was not even in the top 5 or 6 factors. If you've been to any dentist's office lately you'll see waterfalls and indoor landscaping, LCD TV's and video games, etc. (Not much wrt research and clinical literature.)
The point is SJ, while you have converted that one patient using your evidenced based practice approach, the clinic down the street with the big beautiful office, busty blonde receptionist and charming thrapist has just converted 9 more to his/her side. Even though the whole time they receieved electrical stimulation and hotpacks for the last 12 weeks for acute LBP.
It will be a losing battle for the EBP if we plan on competing for patients based on consumer choice. Change must come, 1st at the academic level, 2nd at the level of the regulatory bodies, 3rd thru 3rd party payors and lastly from government. As someone said earlier though, governments don't use a scalpel they use a sledgehammer (or something to that affect).
From what I've noticed, most of the good clinical thrapists/doctors suck at being good marketeers. Maybe we spend to much time with our noses in the books. Why couldn't we do both and fight fire with fire?
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RE: One expert will lead to better care - July 2, 2008 1:38:42 PM
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SJBird55
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I actually don't know, John. I'd tend to believe that consumers believe we are all equally competent. From tracking how patients choose me, there is a lot of word of mouth occurring. At the same time, I'll admit, I play the game - nice office, great personality ;) , customer oriented attitude. I don't think EBP is a losing battle - patients are paying more and more out of pocket, they WILL care and WILL want to know what PT can do for them and what it will cost. My practice is in a small town and the sweetest of sweet things is whenever a patient chooses my practice over my competitor. You also have to remember the impact an EBP can have isn't limited to one patient... it has the potential to happen with each and every patient that walks through your doors.
Competency is low because there is no data out there; there is no definition of quality out there; we have no real standards to meet; and we truly don't measure our performance. Have you ever tried to find a PT for someone? I'm telling you, it isn't easy.
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RE: One expert will lead to better care - July 2, 2008 3:23:41 PM
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proud
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Still, patient satisfaction is the "outcome measure" of choice among pseudo clinicians. Those of us who know the difference still have to ensure our patients are "satisfied" but we have to balance that with actual long term outcomes. But what if patient satisfaction does not jive with what the patient "needs"? I had posted the full copy previously but:
http://www.ncbi.nlm.nih.gov/pubmed/16003661
Ever have those patients that score very high on fear/avoidance questionnaire and your evaluation suggests they require education on hurt versus harm and graded exposure to exercise. This very often is not congruent with what they have been told by other practitioners. Patients LOVE....LOVE....the elaborate yet innaccurate explaination for their pain and to suggest anything else is met with marked resistence( ie low satisfation).
To be clear....patient satisfaction is NOT an outcome measure.....yet currently....we are held somewhat hostage by it. And the result is worse outcomes overall as patients get drawn to that NASA machine that apparently picks out the "hot spots"....( eyes rolling). Patients would rather that than education grounded in pain science.
Will it change? You bet it will. To think otherwise is just being naive. Those practitioners who have remained commited to a level of EBM will be the cream that rises.
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RE: One expert will lead to better care - July 2, 2008 5:43:09 PM
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SJBird55
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I'll somewhat disagree, proud. Patients sometimes have pre-conceived notions that are inaccurate. Sure, they love the elaborate... but at the same time, they also want the security in knowing they can do something to overcome whatever life has tossed them. All they want is to get back to life. If you think about it... if a patient comes to you, and you've been planting your "evidence" seeds consistently and you have a solid reputation for your knowledge and your effectiveness AND the patient that is in front of you had 2 or 3 outside sources recommend you because of what you do, I do believe it is a lot easier for the patient that has incongruent notions to be more willing to let them go and trust you.
In my opinion, the "art" of what we do is the compromising, negotiating, selling of our services - the relationship aspect - figuring out how to have patients adhere to our suggestions/recommendations, figuring out how to negate the inaccurate notions and change pre-conceived notions, and having the patient sold on our plan AND committing to it. If you think about it, we have "sales" as part of our career every single day... we are "teachers"... we are motivators... and yeah, we do physical therapy on the side. LOL Reading the evidence is easy... implementing the evidence can be somewhat more difficult... selling what it is that we want to do is the hard part - creating that solid relationship.
I believe we are whacked in measuring satisfaction - those tools don't tell us anything - behaviors tell us more. Tracking loyalty is far more important because the patient is choosing to attend based on previous experience, the word of others and you can even track physician loyalty.
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RE: One expert will lead to better care - July 2, 2008 7:18:17 PM
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proud
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SJ,
quote:
....and you have a solid reputation for your knowledge and your effectiveness AND the patient that is in front of you had 2 or 3 outside sources recommend you because of what you do, I do believe it is a lot easier for the patient that has incongruent notions to be more willing to let them go and trust you.
Yes, I know this to be true. I actually do not have much difficulty getting patients to trust me. I work closely with MD's and for some reason....they always "talk me up" with the patients they refer along. It spills over to the direct access patients I see. All reports I send along have one or two references to the literature in them. The MD's could care less but it sends a message that I 'get it".
But you said:
quote:
I believe we are whacked in measuring satisfaction - those tools don't tell us anything - behaviors tell us more. Tracking loyalty is far more important because the patient is choosing to attend based on previous experience, the word of others and you can even track physician loyalty.
This I do not agree with. Behaviors mean nothing. I know patients who will return time and time again to a cranio-sacral therspist despite declining function year over year. I detailed a history of this not long ago on here.
I see alot of patients who were sent to me by their physician becuase they have been seeing a Chiropractor for 6 years....getting worse in terms of overall impairment and disability...YET THEY ASK THE PHYSICIAN TO GO BACK! when I see them they tell me that they LOVE the chiropractor. Greatest treatment ever. Then I say....how is you neck pain doing....worst it's ever been they tell me.
Then I say...." well that doesn't sound like a great direction you are heading in...". They say...." yes but without the chiropractor I'd be far worse...."
hmmmm.
Behavior means nothing.
< Message edited by proud -- July 2, 2008 7:23:48 PM >
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RE: One expert will lead to better care - July 2, 2008 8:20:00 PM
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TexasOrtho
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Proud...sorry mate, but you are again way of base. Don't you think the behavior of constantly going back to the [insert idiot provider here] plays a significant role in their recovery? Of course it does mate...in these cases it likely means everything. It's your job to shape their behavior to achieve a good functional outcome. Do you routinely see excellent functional outcomes in the absence of a patient being satisfied with your care? Not very often.
Behavior influences activity which in turn influences the outcome. It doesn't routinely occur in the opposite direction. That may be your perception / version of what occurs. However the vast majority of providers out there would disagree.
It is beyond me how a licensed provider could imply, let alone directly state, "behavior means nothing". I think you need to think harder before you type sometimes.
< Message edited by TexasOrtho -- July 2, 2008 8:24:47 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 - July 2, 2008 9:03:19 PM
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proud
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Rod,
First off, I do not appreciate being called "mate". It's condescending and not called for. Done.
Secondly, I'm not sure we are discussing the same thing. When I speak about behavior, I was referring to the context in which SJ was speaking. I believe( correct me if I'm wrong SJ), she was referring to the behavior of patients returning to a provider based on past experience( meaning they return because they were happy with the outcome...I think SJ?). I disagreed with that based on numerous chart reviews and patient interactions I have had( along with the work there by George etal).
Yes...I think going back to[insert idiot providor here] plays a role in outcomes. If they attend an idiot providor repeatedly....the long term outcomes are not so good. Patients routinely return for the NASA thermal scan of their spines....does that mean they are getting appropriate treatment likley to result in less impairment and healthcare costs long term?
The article I posted spoke to the dichotomy of patient satisfaction and outcomes. And I have experienced it. Over 11 years of parctice, I've had my share of patients that just did not do well under my care. Yet....filling out our Patient satisfaction forms, I come to find out I was rated very high. I'm personable, respected, have a sense of humour( although never liked the term "mate" or "boss"...or "big guy".....regardless of the context). Yes....it's common, patients can report being satisfied...but that does not translate well to function all the time.
Please, let me know if we are speaking about the same thing. Because I missed your point above.
< Message edited by proud -- July 2, 2008 9:14:58 PM >
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RE: One expert will lead to better care - July 2, 2008 9:26:41 PM
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TexasOrtho
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I've called folks mate or boss numerous times on this and other websites and personal conversations. Where I am from, these are not meant to be condescending. You seem to have a pretty thin skin and are the first to throw a clot over that. I will be more attentive to your sensibilities in the future. I'm no more likely to change my tone than you are yours so we might just have to get over that. Done.
You said the following:"To be clear....patient satisfaction is NOT an outcome measure....."
This is an opinion not shared by the vast majority of the medical community for a few reasons. Firstly, it is a partial representation of quality care. I know I know...do we call the chiros "quality"? Well based on their willingness to sit and take a detailed history absolutely. Do you think a 2 minute historical consult by the orthopedist constitutes quality care? Sure the orthos are a product of their fast-paced environment and often make very good choices, but it opens the doors for a lot of bad things to happen in the form of a missed diagnosis or an unhappy patient. The missed diagnosis is bad you migh say, but why should we care about the satisfaction of the patient? Lawsuits baby...lawsuits. I have no idea if you are aware of the legal system in the US, but patients get VERY litigious when not satisfied. In my mind better care and not getting my ass sued off are two pretty good reasons to keep patient behavior and satisfaction on the radar.
< Message edited by TexasOrtho -- July 2, 2008 9:32:15 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 - July 2, 2008 9:26:54 PM
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proud
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Actually, i was speaking to a Physician the other day about patient satisfaction and he commented on these "rate MD" web pages. He indicated that patient satisfaction is partly what drove many Physicians to prescribe antbiotics for every throat ache they saw. What patient wants to drive 30 mins to the appointment, wait 45 mins....then be told nothing should be done....drink lots of H20 and wait 7-10 days and the viral infection will pass?
Not many. Most would much rather feel their time was well spent walking away with an antioboitic despite the potential long term negative consequences of this medical behavior. But at least the patient is satisfied....
Many MD that get rated poorly are the ones that simply tell it like it is.
Edit: rod...no thin skin trust me. "Mate" comined with "your way off base" and "It is beyond me how a licensed provider could imply," and "I think you need to think harder before you type sometimes.".....well that tends to rub people the wrong way FYI.
I've always found your thoughts excellent Rod, here, EIM and on your blogspot. So I'll assume it's really really hot right now in Texes and you are agitated by the extreme heat lowering your threshold for my views. I've visited Texas this time of year...could cook an egg on the pavement!
< Message edited by proud -- July 2, 2008 9:40:14 PM >
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RE: One expert will lead to better care - July 3, 2008 1:16:45 AM
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bonez
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quote:
ORIGINAL: TexasOrtho
I've called folks mate or boss numerous times on this and other websites and personal conversations. Where I am from, these are not meant to be condescending. You seem to have a pretty thin skin and are the first to throw a clot over that. I will be more attentive to your sensibilities in the future. I'm no more likely to change my tone than you are yours so we might just have to get over that. Done.
Well I read this as thin skinned a bit too. Proud I have been on your receiving end and did not fly off and lose my temper at you because I read too much into a comment.
I do believe that there is a happy successful balance between evidence and interest in what the consumer wants.
Some of your posts that travel along the line of I'll tell you Mr patient what is best and you will follow sound a lot like the present direction of medicine. My feeling is that it has a lot to do with why patients are not happy with their MD's and all the konwledge aside it will keep you fighting for a patient population.
SJ on the other hand seems to have got to that happy medium place that allows for balance although I agree with John converting them one at a time will never beat the place down the street.
I hope that I have been able to offend nobody this time with ths post!
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RE: One expert will lead to better care - July 3, 2008 7:23:56 AM
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SJBird55
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I tried posting last night and all of the above might have been eliminated. LOL This site had some error and my post wouldn't go... so you boys had your own little deal. LOL
proud... go back to this: quote:
Behavior means nothing.
From my perspective, you are in your own catch 22. Your examples in that post are definitely behaviors that indicate loyalty. You don't like seeing that behavior of returning and returning for crap. Behaviors DO matter. Those patients that continue to seek the craniosacral therapist and the chiropractor are loyal. Loyalty does not equate to satisfaction, in my opinion. People are fickle. Just because one is satisfied with a product or a service doesn't mean that person will always choose that product or service. For example, I'm satisfied with the chicken at a large chain store - it's fine... but I'm loyal to a little local meat company because the chicken is somewhat better, but the guys behind the counter are fun, friendly and they make me feel as though I matter and how I want my chicken matters. (It's all about me, ya know? ;) )Those patients return to the craniosacral therapist or the chiropractor because of something... I'd bet it was something in the relationship that was created between the patient and the provider. I don't know what that something was, but that something was and is valued more than satisfaction and outcomes.
I personally don't measure satisfaction; I personally don't want satisfaction; I aim for loyalty. A patient's behavior of seeking me out because of what others have said, of what physicians have said OR the relationship we created previously is what I want. My whole original goal when I opened my practice was to be THE physical therapist those in my little town would choose first.
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RE: One expert will lead to better care - July 3, 2008 8:04:09 AM
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Sebastian Asselbergs
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Satisfaction and loyalty are very closely related. The examples you give: " A patient's behavior of seeking me out because of what others have said, of what physicians have said OR the relationship we created previously is what I want." are based on the satisfaction with your services. I think we are sinking in semantics here.
Satisfaction is what drives loyalty - simple. If you weren't satisfied with the chicken and the service at the small meat company, you would not return. Your example actually illustrates and supports the point of "other" aspects making people return to a provider: not just price and quality of product......
If my patients are NOT satisfied - they do not come back. I dare to suggest that it is the same for your practice.
_____________________________
Mundi vult decipi
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RE: One expert will lead to better care - July 3, 2008 8:16:42 AM
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TexasOrtho
Posts: 437
Joined: December 22, 2007
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quote:
ORIGINAL: proud
I've always found your thoughts excellent Rod, here, EIM and on your blogspot. So I'll assume it's really really hot right now in Texes and you are agitated by the extreme heat lowering your threshold for my views. I've visited Texas this time of year...could cook an egg on the pavement!
No worries. It is very VERY hot down here right now. I rarely disagree with the gist of your posts proud. I think the temps just lower my threshold for the "tone" of your posts. I'll get over it.
_____________________________
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 - July 3, 2008 8:36:36 AM
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proud
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yes, I agree. It's becomeing a matter of semantics. For those interested, over in the archives section at EIM there are some interesting posts and research references about patient satisfaction( from a guy named Larry).
In any case, I maintain that just becuase a patient returns to you( ie is satisfied or loyal), does not equate to excellent and appropriate care. The antibiotics example really speaks to how patient satisfaction really means nothing. A person with a sore throat from a viral infection is far more satisfied walking away from the doctor with a diagnosis and a prescription than they are with nothing and sound advise. I have doctors tell me that when they tell someone its' Viral and there really is nothing from a medical perspective to be done, often times the patient bad mouths them around town saying "that doctor did not know what to do...nice guy....but not very helpful...."
Does that example not make sense to you guys?
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RE: One expert will lead to better care - July 3, 2008 9:02:31 AM
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SJBird55
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From: Michigan
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proud, yes, your example made sense. Your example isn't necessarily one of satisfaction though as much as one of patient expectations and meeting those expectations.
I've never stated that just because a patient returns to me indicates excellent and appropriate care. It means to me that a relationship was built.
Being female, and since females tend to be the ones everyone markets to, I think my perspective is probably different than you males. :) Chicken is chicken... a Colorado is a Colorado... an oil change is an oil change, right? In general... you've got a product or a service and generally speaking, they are generally going to be comparable, right? If I like chicken, if I like Colorados and if my Colorado needs an oil change, then I am a consumer. Since I like those things or need those things, generally speaking I'm going to be generally overall satisfied with product or the service. What would make me loyal? What sets some company or some product apart from the rest? If the sales person at the dealership decides to throw in a hitch and a truck bed liner and a 3 free inspections annually - I'm loyal. That person is looking out for what I like and has made a relationship with me to keep my interests in mind. Chicken - I like to make chicken cordon bleu... I HATE pounding the chicken - it's a sloppy mess no matter how neat I try to be. I'm loyal to the local guy - he asks what I'm doing with the chicken and then asks if I'd like him to pound it out! I'm loyal - he's reducing my prep and clean up time! The oil change - I can only give the negative crap that reduces my loyalty - those darn change places that EVERY time you go in your vehicle has some problem and they want to sell you something or another. They verbalize how "thorough" they are and hide behind that excuse to make extra bucks off me. What does make me loyal - doing the oil change OR if it can't be done right then, offering to drive me to work and pick me up! I don't necessarily believe satisfaction and loyalty are the same things, they might be mixed and satisfaction might be a part of loyalty somewhat, but it's those little extra things that make me loyal.
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