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RE: NATA lawsuit filed against the APTA/Orthopedic section 2/1/08

 
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RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 15, 2009 3:42:35 AM   
Sebastian Asselbergs

 

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Jason and Chrisatc - good posts.

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(in reply to jlharris)
Post #: 41
RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 15, 2009 7:13:31 AM   
bonez

 

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quote:

ORIGINAL: jlharris

, chiros may freak out about the whole manipulation thing, but PT's are not trying to become chiropractors. It's one treatment technique that another profession pretends they own. It'd be like PT's freaking out about chiros or ATC's giving out exercises. While that's our main modality, we don't own that.



Jason it is good to see you back. I could not agree more. I did post a reply a few months ago suggesting that EB progressive chiros could (some of us already do) learn the skills to set up rehab exercise and monitor outcomes etc . In effect providing "therapy" like services.

Some members jumped on that here suggesting that this was and will be the sole domain of PT's. I personally don't have an issue with any properly trained professional providing manipulation.

Pt's do claim to own the territory of providing "physical" therapy . Just like your quote, I believe that it can be part of other profession's skill set and if we are to be fair then qualified professionals should be able to claim to provide the service.

Would you agree?

(in reply to jlharris)
Post #: 42
RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 15, 2009 5:16:23 PM   
Dnorwood

 

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quote:

ORIGINAL: bonez

quote:

ORIGINAL: jlharris

, chiros may freak out about the whole manipulation thing, but PT's are not trying to become chiropractors. It's one treatment technique that another profession pretends they own. It'd be like PT's freaking out about chiros or ATC's giving out exercises. While that's our main modality, we don't own that.



Jason it is good to see you back. I could not agree more. I did post a reply a few months ago suggesting that EB progressive chiros could (some of us already do) learn the skills to set up rehab exercise and monitor outcomes etc . In effect providing "therapy" like services.

Some members jumped on that here suggesting that this was and will be the sole domain of PT's. I personally don't have an issue with any properly trained professional providing manipulation.

Pt's do claim to own the territory of providing "physical" therapy . Just like your quote, I believe that it can be part of other profession's skill set and if we are to be fair then qualified professionals should be able to claim to provide the service.

Would you agree?


Great post Bonez, I agree with what you are saying.  The way I look at it is this, and forgive me if this comes out confusing or not "fully cooked".  What I provided as an AT is not physical therapy, it is rehabilitation or it could even be called physical medicine.  Physical therapy is a service provided by a physical therapist.  There is no billing code that I know of, other than PT eval and PT re-eval, that are physical therapy exclusive, they all fall under rehabilitation services.  On the same note, the only AT specific billing codes that exist are AT eval and AT re-eval.  The rest of the codes used are shared between rehabilitation professions.

I would also agree with Jason in that I do not have any personal "grudges" towards PTs at all, I have worked with some great PTs, and together we do provided the best results for my athletes and when I was working for them, their patients.  I do grow tired of the "turf war" between our professions, but at the same time, as Jason stated, if a profession is not improving, it is getting worse.  We (AT/PT/OT/Chiro) all have the right to defend our professions.  But at the end of the day, we all have the same goal, and that is getting our patients functioning at an optimal level as quickly and safely as possible.

_____________________________

Denton Norwood, MS, ATC

(in reply to bonez)
Post #: 43
RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 26, 2009 1:34:44 AM   
proud

 

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Jumping in a little late here. But I have a question. What training does an ATC have with regards to differential diagnosis? Not of the athletic kind but rather the medical side?

People do tend to show up on our doorstsps with seemingly benign NMSK complaints which turn out to be much more sinister. PT's complete rotations within hospital settings where they will see such things as DVT's, Bone cancer that originally presented as trochanteric bursitis, CHF that originally presented as upper limb radiculopathy. For example.

My second question( I do not know) is...are ATC's regulated? Is there a college that protects the public? If so, what does the outlined scope of practice say about the term "diagnosis"?

Thanks.

(in reply to Dnorwood)
Post #: 44
RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 26, 2009 3:49:28 AM   
bonez

 

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quote:

ORIGINAL: proud

Jumping in a little late here. But I have a question. What training does an ATC have with regards to differential diagnosis? Not of the athletic kind but rather the medical side?

People do tend to show up on our doorstsps with seemingly benign NMSK complaints which turn out to be much more sinister. PT's complete rotations within hospital settings where they will see such things as DVT's, Bone cancer that originally presented as trochanteric bursitis, CHF that originally presented as upper limb radiculopathy. For example.

My second question( I do not know) is...are ATC's regulated? Is there a college that protects the public? If so, what does the outlined scope of practice say about the term "diagnosis"?

Thanks.


Proud this is a great post and it goes to the one I started about PMR. It is a real thing and if you plan to work in direct access then you better be able to pick it up.

Several of the PT 's posted that you need lab etc to get it. I think that this suggests some weakness in the Dx side of training and as your profession seeks direct access this will need to improve.

That really was the source of that thread I started and it was toward improving Dx skills.  Most often those skills are honed unfortunately through seeing lots of files. Medicine's internship has us all beat.

(in reply to proud)
Post #: 45
RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 26, 2009 6:59:18 AM   
Diane

 

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quote:

as your profession seeks direct access this will need to improve.

It may come as news, but in Canada (where proud is), PT has direct access, has had blanket direct access for years, and since its inception in BC.

(in reply to bonez)
Post #: 46
RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 26, 2009 7:46:39 AM   
bonez

 

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quote:

ORIGINAL: Diane

quote:

as your profession seeks direct access this will need to improve.

It may come as news, but in Canada (where proud is), PT has direct access, has had blanket direct access for years, and since its inception in BC.


That may be true but it does not mean that everyone's Dx skill set is on par with all.

(in reply to Diane)
Post #: 47
RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 26, 2009 4:38:47 PM   
Sebastian Asselbergs

 

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bonez, how would you suggest to support that assumption or check for that? That remark applies equally to chiros and their various universities....

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Post #: 48
RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 26, 2009 5:41:51 PM   
proud

 

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I cannot say for sure I am fully understanding what the few last posts were about actually. Best to ask for clarification I think. Straight forward question format is best:

1. Bonez, are you suggesting that PT's diagnostic skills may not be that good based on the recent PMR post?

2. Bonez, are you suggesting that the inability to order labs or other varios diagnostic tests lessens ones diagnostic abilities?

3. Would you agree that diagnostic ability does vary between practitioners; regardless of profession? In other words, unless the clinicians is fuly engaged in life long learning....anyone at any time can miss something?

4. Perhaps I missed it in the PMR thread but....did you ever answer RWillcott's question?

There...straight forward questions.

Now let me add a couple of my thoughts on diagnostic skill. I do believe that the PT programs are lacking...substantially. I have often postulated that for every 10 PT's....maybe 2-3 are truly skilled this way. Some of the students I have been involved with scare the beejeppers out of me. What I do know is that they graduate with all the skills required to become great diagnosticians. PT's are the only ones among the groups mentioned here( Chiro, PT's, ATC...although I do not consider ATC's  "primary" or involved with patients) that do actually intern in hospital settings. This allows PT's to have hands on true illness, see it first hand etc.

I have often felt a year long internship for PT's would be a good idea. Sort of like a graduated licsense. No direct access patients until said internship is done. I'm sure I am going to to grilled on that one but I truly believe it.

Don't get me wrong, some new graduate PT's are great and committed to learning day one( I've worked with them), but I think Bonez is correct....internship is the way to go.

(in reply to Sebastian Asselbergs)
Post #: 49
RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 26, 2009 6:24:43 PM   
bonez

 

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quote:

ORIGINAL: proud

I cannot say for sure I am fully understanding what the few last posts were about actually. Best to ask for clarification I think. Straight forward question format is best:

1. Bonez, are you suggesting that PT's diagnostic skills may not be that good based on the recent PMR post?

2. Bonez, are you suggesting that the inability to order labs or other varios diagnostic tests lessens ones diagnostic abilities?

3. Would you agree that diagnostic ability does vary between practitioners; regardless of profession? In other words, unless the clinicians is fuly engaged in life long learning....anyone at any time can miss something?

4. Perhaps I missed it in the PMR thread but....did you ever answer RWillcott's question?



Proud lets try to answer the questions.

#1 Some of the responses without naming names left me to think that maybe diagnostic skills for conditions that might walk in to a direct access clinic and not need therapy as the first option were lacking.

Part of that thought also comes from my initial involvement on the board. That was on the medical complexity part and in general many conditions presented took a long time to sort out for many of the respondants. This I feel was from the differential dx pathway chosen from the respondants and their experience in that area.

#2 The ability to order tests or not order tests really only speaks to finalizing the diagnosis. The important step for all, MD on down is to get to the thought process in place first. If one relied on tests only they would be costly to the system and not an effective thinker.

That having been said the ability to complete the dx "in house" is important in the direct acess arena.

#3 Absolutely bang on. The title you hang out has absolutely no bearing on dx skills. Graduation is viewed by me as aquiring the minimum skill set and a chance to get better. We all , self included, miss things and or head down the wrong path. How you recover is the real testement to your ability.

This was also the basis of the thought behind the PMR post. Many of us that do try to stay on top in all fields have unique skills and experience that can benefit the other different areas that frequent this board.

#4 I will have to review his question.

There is some hospital based intern work now going on at the Canadian DC school involving the last 2 graduating classes. I believe there is intern rotations to Saint Mikes and possibly one other. These however occur only after the base intern requirements are met.

The realitiy is that interns year of training can be easily surpassed in the real world with it equal to about three months of the cases seen in a busy practise

< Message edited by bonez -- April 26, 2009 6:41:57 PM >

(in reply to proud)
Post #: 50
RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 26, 2009 6:53:42 PM   
bonez

 

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I've gone back read the question asked and answered it.

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RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 26, 2009 11:58:02 PM   
Tom Reeves DPT ATC

 

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quote:

ORIGINAL: proud

Jumping in a little late here. But I have a question. What training does an ATC have with regards to differential diagnosis? Not of the athletic kind but rather the medical side?

People do tend to show up on our doorstsps with seemingly benign NMSK complaints which turn out to be much more sinister. PT's complete rotations within hospital settings where they will see such things as DVT's, Bone cancer that originally presented as trochanteric bursitis, CHF that originally presented as upper limb radiculopathy. For example.

My second question( I do not know) is...are ATC's regulated? Is there a college that protects the public? If so, what does the outlined scope of practice say about the term "diagnosis"?

Thanks.


The amount of regulation of ATCs does vary by state but generally, they are regulated nationally by the NATA.  To be an ATC you have to pass a (rather difficult, more so than the PT licensure exam was in 1991) national exam, then maintain 75 hours of continuing ed every three years.

To answer your first question, again, it probably varies from program to program.  The point, I think, is not that we want to become MDs.  We just want our PTs (and ATCs) to recognize "other" when they see it.  I don't want to or need to order labs for PMR because it wouldn't respond as expected with normal NMSK diagnosis.  I personally have no desire to differentiate between RA and PMR and lupus and psoriatic arthritis and  . . . .  I just want to see the patient, recognize that I cannot influence their function/pain/motion/strength and refer them to the appropriate provider who can.

We have gone through this arguement a million times in different threads and with various spins and angles but PTs (forgive me for assuming I know what we all want) don't want to be the person that Mom brings Jr. in with an earache to.  We want the achy back, the hamstring injury, the ankle sprain.  MDs get a bit pissy when you tell them that your patient needs a cortisone shot, or needs an Xray or maybe should change their pain meds because they are stoned all day.  Imagine telling an FP that it is PMR, not Lupus.   

Our role is not to be primary care providers, but primary providers for NMSK problems.  our patients should learn to self select and we have to be disciplined enough to tell them when they should go somewhere else. 

I really have no idea where I am going with this but we have to clearly understand what our scope of practice is, mine is not to identify PMR, only to identify "other".  Treat and identify what I know and can influence directly and refer the rest.




(in reply to proud)
Post #: 52
RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 27, 2009 12:41:09 AM   
bonez

 

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quote:

ORIGINAL: Tom Reeves DPT ATC

]


.  MDs get a bit pissy when you tell them that your patient needs a cortisone shot, or needs an Xray or maybe should change their pain meds because they are stoned all day.  Imagine telling an FP that it is PMR, not Lupus.   

Our role is not to be primary care providers, but primary providers for NMSK problems.  our patients should learn to self select and we have to be disciplined enough to tell them when they should go somewhere else. 

I really have no idea where I am going with this but we have to clearly understand what our scope of practice is, mine is not to identify PMR, only to identify "other".  Treat and identify what I know and can influence directly and refer the rest.






Tom

My experience is that the MD is happy when you are right cause their MSK experience is quite limited.

When we are talking about the direct access arena it is my opinion that we need to do more than "other". Patients can't be expected to self diagnose and there by select their best option from a list of providers.

If the move is as suggested here, to be a one provider world then one has to do better than "other" cause there will not be any other choices.

Since some conditions PMR, have serious possible complications and others don't have the urgency it becomes necessary to know so you can direct the patient. The GP will get pissy if you send all the "other" back to them and clog their day with some non urgent issues.

(in reply to Tom Reeves DPT ATC)
Post #: 53
RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 27, 2009 2:06:23 AM   
chrisatc

 

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Well, as far as regulation goes, most states require licensure. But as in Tom's post, most of that comes back to passing the NATA and maintaining CEU's. However, little known that you do not have to maintain CEU's through the NATA once you have licensure, you only have to satisfy that state's requirements. That being said (any ATC's here) don't ask me how it works cause I don't work it that way. Most, if not all states should have a Practice Act. I think the only states that don't regulate are Alaska, WV and Maryland(which has I believe just passed licensure).
At least here in Florida, every ATC has to have a written protocol between them and the MD/DO. This will say basically what the ATC can do under the direction of the MD. This will usually expand a little on our domains of athletic training.

As far as differential diagnosis, I myself did not have a class, or rotation specifically dedicated to that area. But again, at least in my situation, I wasn't looking to work with anyone other than youth/high school age (and collegiate) athletes. So, while DVT and bone cancer is a possiblity in those populations, and I guess heart disease is always a chance too, I was trained specifically on acute and chronic orthopaedic issues. I do recall being taught to screen for a few other issues, but not an entire gammut of medical issues similar to those you listed.

Again, this is where we/the NATA has a sticking point in regards to billing. Would I like to see us able to bill, sure. But only because I see the amount of time we stick in, and the limited budgets we have (in the high school setting) that gets used by the atheltes, and we get nothing monetarily in return. The kids here, and especially the kids from the other schools that visit, treat us as a free clinic. We have one more event here at home, and have already had 245 contacts with kids from other schools, be it taping, evaluations/assessments and wound care. That is pretty close to the same number I have with my athletes in my guestimation, though I haven't tallied those as of yet.

(in reply to proud)
Post #: 54
RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 27, 2009 1:28:57 PM   
Tom Reeves DPT ATC

 

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Bonez said:

"Tom

My experience is that the MD is happy when you are right cause their MSK experience is quite limited.

When we are talking about the direct access arena it is my opinion that we need to do more than "other". Patients can't be expected to self diagnose and there by select their best option from a list of providers.

If the move is as suggested here, to be a one provider world then one has to do better than "other" cause there will not be any other choices.

Since some conditions PMR, have serious possible complications and others don't have the urgency it becomes necessary to know so you can direct the patient. The GP will get pissy if you send all the "other" back to them and clog their day with some non urgent issues.
[/quote]

Bonez, I respectfully partially disagree with you here.  I don't think that either you or I are qualified to determine what the "other" is.  Sure, we can read the primer, I have one (its old but mostly accurate) but that does not a diagnostician make.  We can say that they have this list of symptoms, or that list of signs which suggests a rheumatological diagnosis but we simply don't see the numbers to confidently tell the patient that they have PMR or whatever.  They get that in their head and then tell the Rheumatologist that their Chiropractor or their Physical Therapist told that they had X and then we are looking bad if we are wrong, in court for practicing medicine without a license, or simply confusing the patient as to who they should believe.  And, the person they should believe 99/100 times is the rheumatologist, not me, not you.

We are obligated to send the "other" away, that is the definition of practicing within our scope of practice. 

I have a question, if you suspect bone cancer (which you mentioned) do you tell your patients that they probably have bone cancer and ask them to get their affairs in order? No, of course you don't.  If I am correct in my assumption, why do you feel comfortable telling them that they have PMR ("the diagnosis was first spoken here and confirmation/treatment was gotten elsewhere") ?? Both are "other" as are pancreatitis, gastric ulcers,  pyelonephritis, bowel obstruction, myeloma, etc . . .  Some are nasty nasty, some are moderate, and some "others" are self limiting.  I really have a hard time thinking that I/we can manage those things, or should be expected to differentiate and specifically name what we see.  I don't think that the depth and breadth of our education (yours or mine) lends itself to that type of diagnosis, that's what MD/DOs are for.  Heck, even their education doesn't really teach them many of those differentials, it takes IM or rheum, or ortho to make some of those calls.

You mentioned the term "pretender to the throne" in one of your posts on this topic but maybe not on this particular thread, and I am not a pretender to the throne.  Maybe my take and yours are different because of where we come from.  You come from the outside and have been forced to be more independent (I am not judging here, just the difference between tradional vs alternative if you agree with those terms) and I have "grown up" as a team player.  I have no problem dishing the "other", I don't want the throne, I don't think that there should be a throne.  But it is imperative that when we don't know something or are not sure about something we should send it to someone who is an expert on such matters.  If that is a family practice doc referring LBP to you or me it is the same thing.  How do you feel when your new patient has been treated by a massage therapist for months at the recommendation of their MD before seeing you? 

When I refer patients, I don't lose them forever, I suspect that sometimes when DC's patients get referred out, even though it is the right thing to do, they are told by the MD that they should Never, never, ever go to a chiropractor again for anything.  When the MD gets referrals from PT they praise the intuition of the PT.  Not right but often that is the way it is.

I am rambling again, It sounds like you have a much better relationship with the rest of the medical community in your neck of the woods but I think that maybe you are more the exception than the rule.  There is a very tenuous relationship between the medical clinic and the 7 DCs in our small town.

< Message edited by Tom Reeves DPT ATC -- April 27, 2009 1:46:49 PM >

(in reply to bonez)
Post #: 55
RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 27, 2009 5:40:02 PM   
Dnorwood

 

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quote:

ORIGINAL: chrisatc

Well, as far as regulation goes, most states require licensure. But as in Tom's post, most of that comes back to passing the NATA and maintaining CEU's. However, little known that you do not have to maintain CEU's through the NATA once you have licensure, you only have to satisfy that state's requirements. That being said (any ATC's here) don't ask me how it works cause I don't work it that way. Most, if not all states should have a Practice Act. I think the only states that don't regulate are Alaska, WV and Maryland(which has I believe just passed licensure).
At least here in Florida, every ATC has to have a written protocol between them and the MD/DO. This will say basically what the ATC can do under the direction of the MD. This will usually expand a little on our domains of athletic training.

As far as differential diagnosis, I myself did not have a class, or rotation specifically dedicated to that area. But again, at least in my situation, I wasn't looking to work with anyone other than youth/high school age (and collegiate) athletes. So, while DVT and bone cancer is a possiblity in those populations, and I guess heart disease is always a chance too, I was trained specifically on acute and chronic orthopaedic issues. I do recall being taught to screen for a few other issues, but not an entire gammut of medical issues similar to those you listed.

Again, this is where we/the NATA has a sticking point in regards to billing. Would I like to see us able to bill, sure. But only because I see the amount of time we stick in, and the limited budgets we have (in the high school setting) that gets used by the atheltes, and we get nothing monetarily in return. The kids here, and especially the kids from the other schools that visit, treat us as a free clinic. We have one more event here at home, and have already had 245 contacts with kids from other schools, be it taping, evaluations/assessments and wound care. That is pretty close to the same number I have with my athletes in my guestimation, though I haven't tallied those as of yet.


To clarify a little on what Chris and Tom have said.  The NATA does not regulate athletic trainers, the Board of Certification does.  The NATA is the equivalent of the APTA, a professional organization.  The Board of Certification tracks CEU's and violations to the Code of Ethics and all disciplinary actions agains ATs for violation of Ethics are through the BOC.  However, this regulation is for the national certification only.  In those states that have no regulation what so ever, any individual could, in theory present themselves as an AT and there would be no legal grounds to do anything about it.  The BOC has no authority over someone calling themselves an AT, as long as they are not representing themselves with the ATC credential.  So this regulation is left up to the state level whether through registration, state certification, or state license.  Here in WA we are just finishing up our first year of licensure after and 20+ year battle to gain regulation in our state.  As with many new licensing processes, there are loop hools that need to be closed to ensure the public's safety.

To answer Proud's question on diff Dx, the short answer is no it is typically not a part of our diadactic training.  At my alma mater, we took a current topics in general medicine class that covered many general conditions, mainly for recognition and referral.  I would say that I am pretty comfortable with the typical "Red Flags" used in NMSK evaluation.  Furthermore, I work very closely with my supervising physician, so if I have something that just doesn't feel right, I discuss the case with him.

I hope this clarifies some things.

_____________________________

Denton Norwood, MS, ATC

(in reply to chrisatc)
Post #: 56
RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 27, 2009 7:50:28 PM   
bonez

 

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quote:

ORIGINAL: Tom Reeves DPT ATC


I have a question, if you suspect bone cancer (which you mentioned) do you tell your patients that they probably have bone cancer and ask them to get their affairs in order? No, of course you don't.  If I am correct in my assumption, why do you feel comfortable telling them that they have PMR ("the diagnosis was first spoken here and confirmation/treatment was gotten elsewhere") ?? Both are "other" as are pancreatitis, gastric ulcers,  pyelonephritis, bowel obstruction, myeloma, etc . . .  Some are nasty nasty, some are moderate, and some "others" are self limiting.  I really have a hard time thinking that I/we can manage those things, or should be expected to differentiate and specifically name what we see.  I don't think that the depth and breadth of our education (yours or mine) lends itself to that type of diagnosis, that's what MD/DOs are for.  Heck, even their education doesn't really teach them many of those differentials, it takes IM or rheum, or ortho to make some of those calls.






Tom my training and licence in my area actually addresses the right to use and interpret xray. In doing so that includes dealing with the bone pathology associated as seen on those films.
Primary bone cancer is not as common in all of our cliics as is secondary forms. Have I seen  bone mets on film ordered by myself based on a clinic exam and hx? You bet. Does that let me tell them they probably have it ? You bet. Has it happened? Once again you bet. Do you do it with every patient well here you have to use your clinical skills and personal skills.
I have had that discussion not a lot but it has happened. Is it hard to do yep.
My father inlaw to be was in that very situation and to live in a small community and know all the relatives and find it and keep it between him and I only until he wanted it out there was another.
As a practitioner you do have to protect your self first but you also serve your patient. They have come to you first with a problem and if you can help it great but they have all expected you to answer "the question" too.

That does not mean I am dxing internal med conditions but those with a msk involvement better be looked out for.

The pretender to the throne issue was directed at comments here that PT's will become the experts in the msk field. Team work is important for the patient but if you are to be the expert you need to be the expert in finding out what you should not treat as well.
I felt that included naming the condition not just sending the"other" away if it had an msk root.  

(in reply to Tom Reeves DPT ATC)
Post #: 57
RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 28, 2009 12:21:24 AM   
chrisatc

 

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quote:

ORIGINAL: Dnorwood

quote:

ORIGINAL: chrisatc

Well, as far as regulation goes, most states require licensure. But as in Tom's post, most of that comes back to passing the NATA and maintaining CEU's. However, little known that you do not have to maintain CEU's through the NATA once you have licensure, you only have to satisfy that state's requirements. That being said (any ATC's here) don't ask me how it works cause I don't work it that way. Most, if not all states should have a Practice Act. I think the only states that don't regulate are Alaska, WV and Maryland(which has I believe just passed licensure).
At least here in Florida, every ATC has to have a written protocol between them and the MD/DO. This will say basically what the ATC can do under the direction of the MD. This will usually expand a little on our domains of athletic training.

As far as differential diagnosis, I myself did not have a class, or rotation specifically dedicated to that area. But again, at least in my situation, I wasn't looking to work with anyone other than youth/high school age (and collegiate) athletes. So, while DVT and bone cancer is a possiblity in those populations, and I guess heart disease is always a chance too, I was trained specifically on acute and chronic orthopaedic issues. I do recall being taught to screen for a few other issues, but not an entire gammut of medical issues similar to those you listed.

Again, this is where we/the NATA has a sticking point in regards to billing. Would I like to see us able to bill, sure. But only because I see the amount of time we stick in, and the limited budgets we have (in the high school setting) that gets used by the atheltes, and we get nothing monetarily in return. The kids here, and especially the kids from the other schools that visit, treat us as a free clinic. We have one more event here at home, and have already had 245 contacts with kids from other schools, be it taping, evaluations/assessments and wound care. That is pretty close to the same number I have with my athletes in my guestimation, though I haven't tallied those as of yet.


To clarify a little on what Chris and Tom have said.  The NATA does not regulate athletic trainers, the Board of Certification does.  The NATA is the equivalent of the APTA, a professional organization.  The Board of Certification tracks CEU's and violations to the Code of Ethics and all disciplinary actions agains ATs for violation of Ethics are through the BOC.  However, this regulation is for the national certification only.  In those states that have no regulation what so ever, any individual could, in theory present themselves as an AT and there would be no legal grounds to do anything about it.  The BOC has no authority over someone calling themselves an AT, as long as they are not representing themselves with the ATC credential.  So this regulation is left up to the state level whether through registration, state certification, or state license.  Here in WA we are just finishing up our first year of licensure after and 20+ year battle to gain regulation in our state.  As with many new licensing processes, there are loop hools that need to be closed to ensure the public's safety.

To answer Proud's question on diff Dx, the short answer is no it is typically not a part of our diadactic training.  At my alma mater, we took a current topics in general medicine class that covered many general conditions, mainly for recognition and referral.  I would say that I am pretty comfortable with the typical "Red Flags" used in NMSK evaluation.  Furthermore, I work very closely with my supervising physician, so if I have something that just doesn't feel right, I discuss the case with him.

I hope this clarifies some things.



Yes, thanks for adding the info Denton.

(in reply to Dnorwood)
Post #: 58
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