Outside referral to another discipline (Full Version)

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drew64 -> Outside referral to another discipline (August 17, 2018 7:36:13 PM)

Wanted to post this and see if I’m over reacting. I am working for a large corporate PT company. They took over all the orthopedic run PT offices in this county but still get a large referral base from these orthopedics. Recently I evaluated a patient with bilateral Achilles tendinitis. At the time of evaluation I recommended she may want to look into getting a pair of orthotics. This person walks/hikes a lot but wears wedges at work. I recommended a flatter heel as well since tight gastocs. She asked for a name of podiatrist and I gave her one I’ve used many times. She went back for a follow up to the referring orthopedist. I’m assuming she stated what I recommemded. The next day the patient was off my schedule and I was not allowed to see anymore of this orthopedics patients. He felt I was taking a patient away from him and gave the patient bad advice. Rather than back me up my regional manage told me this was a serious issue amd we were lucky he didn’t stop referring to entire practice. Now patients can go to where they want amd this company has 8 facilities in this county. I felt like I was thrown under the bus because the Dr was throwing a tantrum amd felt like I was taking a patient away from him. I was referring to another discipline that specializes in orthotics as this Orthopedic is a hip and knee guy only. He also has a reputation of being very conceited. I’ve heard this from a few patients. So now my productivity maybe affected because I can’t see his patients which I think is uncalled for. I do what’s best for my patients not a drs pocket book.

ginger -> RE: Outside referral to another discipline (August 19, 2018 3:50:17 PM)

the other term that more accurately describes the achilles problem you mentioned is sciatica.
I agree with your boss, if you don't understand the problem, discuss.
You at least have the luxury of being in a group with experienced practitioners around you, what's not to like.

If you had referred to a podiatrist as my employee, you would have had a sound talking to at the very least.
They know next to nothing about referred pain and are not able to deal with it anyway.
Store bought anti pronation orthotics work just as well as definitive ones . The problem is not the achilles.

drew64 -> RE: Outside referral to another discipline (August 20, 2018 10:42:19 AM)

Well thanks for the reply but it’s definitely not sciatica. Don’t know how you came to that conclusion based on the little info I gave you.

Tom Reeves DPT ATC -> RE: Outside referral to another discipline (August 21, 2018 10:00:05 AM)

Ginger is right about the off the shelf orthotics. Unless they have a truly messed up foot, off the shelf orthotics are just as good as the custom ones. That said, I would run away as fast as I can from that practice. you should be able to refer your patients to whomever you think would give them the best care. Period. I probably wouldn't have referred but I am old and wise and have orthotics in my clinic. Maybe talk to your co-workers about what they would have done.

drew64 -> RE: Outside referral to another discipline (August 21, 2018 2:33:24 PM)

Well I see in my schedule I have a meeting set up with director now. I’ve been doing this 28 years never an issue. All this corporate PT is ruining this profession.

Tom Reeves DPT ATC -> RE: Outside referral to another discipline (August 21, 2018 3:16:51 PM)

walk away if they give you anything but respect

drew64 -> RE: Outside referral to another discipline (August 24, 2018 11:03:09 AM)

Just wanted to follow up with original issue. Yesterday I had a phone meeting between my immediate supervisor , myself and regional director. First flag she couldn’t even do it person, I was handed a written warning. By my supervisor. We were in room together. A written warning because I didn’t give this Dr any progress notes from his patients amd also some knit picking issues with my notes. I bit my tounge as the regional supervisor tried to explain to me how o almost cost everyone there job because this orthopedist wanted to pull all his referrals away from all their facilities. Second she went over five patients and tried to show me how I was t using “ best practices “ with my patients. So first we don’t get that many referrals from this MD. He just is the head of this entire ortho group in the county which has like 5 offices with multiple Drs. Now for a few examples of what the regional director thought were not best practices. First a patient with only pain at night in right hip. Did my Evaluation could not reproduce the pain. Spoke about doing once a week for a couple of weeks to stretch and try some exercise. The first thing that director says is night pain should be a warning. Now I know that cancer comes to mind. I think this guy had Prostate cancer which is cured. She wanted me to call the MD to tell him I could reproduce the symptoms and see what else could be going on. Oh DX was OA of hip. Another example was a patient who came to me with neck arthritis about 80 years old. Had tingling in his right hand as main symptom. She went through evil and picked out that I didn’t do an Alar test. She’s big on special tests I could go on but this is what I’m dealimg with at this job and not even a year here yet. I’ve started looking again. I only plan on working 10 more years I hope. Thanks for letting me vent.

Tom Reeves DPT ATC -> RE: Outside referral to another discipline (September 24, 2018 11:14:32 AM)

Unfortunate. I don't disagree with the point on the hip patient though. If you can't reproduce the pain and they have night pain, I would for sure contact someone who can order imaging. If I misunderstood what you wrote, I apologize but there were lots of typos and some of them could change the meaning of what you typed.

aR3Vk -> RE: Outside referral to another discipline (September 27, 2018 12:08:59 PM)



Talk to your state PT board.

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