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This post was actually a response to a post by Phys Wiz in the thread DPT's calling themselves doctors and physicians...WHY?,
but I decided to delete my short response specifically addressing him/her and post it on its own.
My point is to provide some justification for our status as a doctoring profession. Please see his post prior to reading this for clarity, but I feel the content BELOW the dotted line sufficiently stands on it's own for a thread and feel free to skip to it:
Research IS required in my 3 semester long evidence based practice/medicine course, what do you call a case study and case series? a project? If we want to do an RCT I guess we could but that is unrealistic and unnecessary. I guess it is a project for a class in a loose way, but it is still descriptive research. You knew that right? Yea, we have to do a poster presentation our final year to the college.
If a med student had to do the extent of research you say, why are there MD/PhD degrees?
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As a profession, physical therapists have our own extensive body of research, as well as residencies and fellowships. If you're not a DPT student/DPT or faculty in one of these programs you have NO IDEA what you are talking about. I even had NO IDEA of the scope of knowledge, even during my first year in the program. Even after knowing what we had ahead of us:
http://pt.phhp.ufl.edu/dpt_curriculum.html
The health paradigm is changing, and surgery and pharmacology have their own serious drawbacks and in some cases just do not work, at least with excess pharm anyway. Of course, we need to work as a team to get the right combination of each intervention, and that can include physical therapy in most if not all cases.
Why do PTs have to know so much, even about diseases? I mean, we just exercise right? Here are a few reasons why -
On the topic of screening for disease and the need for medical intervention (this sounds much easier than it is):
1)Patients are getting released much sooner from the hospital inpatient/ICU and same day surgery is more common so we see them sooner and need to be able to detect things such as DVT, infection, heterotopic ossificans etc... that will be missed in the hospital.
2)Direct access is available in 48 states and patient's do not need to see their physician to see us. When medicare finally decides to reimburse for this following obvious evidence that it is a good idea, others will follow. We need to be able to screen these patients for systemic/visceral illness masking as a musculoskeletal problem and refer when medically indicated.
3)Systemic diseases take time to show up, and by the time we see a patient after medical referral for treatment, a disease could be showing more signs/symptoms that we need to know about to get them appropriate medical care.
4)Medical referral is sometimes from a specialist who did not thoroughly screen outside their area and missed red or yellow flags critical to getting the patient prompt and appropriate medical attention
Some other comments:
5)We make highly valued discharged recommendations for patients in acute care. I know this because physicians working with PTs have said so.
6)Just as physicians refer to a GI specialist for what they believe to be a GI problem outside their area of expertise, so are physical therapists referred patients with a (and I quote over and over again) "shoulder pain" diagnosis although the patient already said they have shoulder pain. Of course we are trained to recognize when the patient has more than shoulder pain as we have direct access that supports this.
QUESTION: do you think we would be sent patients if we weren't the trusted and respected profession we are?
7) Physical therapy is NOT modalities! I hardly EVER see ultrasound, hot packs, cold packs, electrical stimulation used in the clinic, let alone being used as a sole intervention. They are not even interventions, they are adjuncts to the real interventions. Like skilled joint mobilization, neuromuscular facilitation, etc...
8) We DIAGNOSE. Yes, I am going to this, we can diagnose musculoskeletal impairments better than family practitioners. No BS. Why? We study these in depth and this is our expertise. However, that is called a medical diagnosis, and we diagnose using a physical therapy diagnosis. FYI, the medical diagnosis often tells us NOTHING. What does "shoulder pain" tell me? NOTHING. Other diagnoses for LBP, hip pain are just as useless and often INCORRECT for physical therapy examination, evaluation, and intervention. Often hip pain or knee pain is from the back. ATTENTION: We can figure that out
10) A doctor can function autonomously, and we can do that. If it's not in our scope to do so, we will refer or consult as needed.
11) We conduct a thorough and skilled interview and physical examination. In my differential diagnosis class we practice (and practice) the SAME interviewing techniques and format taught to medical students. We consider the mechanism of injury and look for inconsistencies with the family history, previous medical history, medications, functional limitations, risk factors, associated signs/symptoms of other diseases, presence of constitutional s/s (e.g. nausea, fever, night sweats, dizziness, change in bowel/bladder function, fatigue, etc...), a review of systems putting everything together...
As a few very simplistic medical screening examples: On the exam, we know at least 1 test to determine whether there is a kidney problem and not back pain called costovertebral tenderness, AAA palpation and combination of signs and symptoms, McBurney's point/rebound tenderness for appendicitis, sign of the buttock, screening for DVT, knowing that significant relief of deep bone pain by aspirin is a sign of cancer, unexplained weight loss >20 pounds and night pain unrelieved by positional changes suggests cancer, and list goes on. We take all of the physical exam and combine it with the rest of the interview and make the judgement of appropriateness for physical therapy intervention.
I don't have all day to write this post, so my question to you is:
"Does what I typed sound like a doctoring profession?"
Thanks for reading ,
John, 2nd year SPT
but I decided to delete my short response specifically addressing him/her and post it on its own.
My point is to provide some justification for our status as a doctoring profession. Please see his post prior to reading this for clarity, but I feel the content BELOW the dotted line sufficiently stands on it's own for a thread and feel free to skip to it:
Research IS required in my 3 semester long evidence based practice/medicine course, what do you call a case study and case series? a project? If we want to do an RCT I guess we could but that is unrealistic and unnecessary. I guess it is a project for a class in a loose way, but it is still descriptive research. You knew that right? Yea, we have to do a poster presentation our final year to the college.
If a med student had to do the extent of research you say, why are there MD/PhD degrees?
-----------------------------------------------------------------------
As a profession, physical therapists have our own extensive body of research, as well as residencies and fellowships. If you're not a DPT student/DPT or faculty in one of these programs you have NO IDEA what you are talking about. I even had NO IDEA of the scope of knowledge, even during my first year in the program. Even after knowing what we had ahead of us:
http://pt.phhp.ufl.edu/dpt_curriculum.html
The health paradigm is changing, and surgery and pharmacology have their own serious drawbacks and in some cases just do not work, at least with excess pharm anyway. Of course, we need to work as a team to get the right combination of each intervention, and that can include physical therapy in most if not all cases.
Why do PTs have to know so much, even about diseases? I mean, we just exercise right? Here are a few reasons why -
On the topic of screening for disease and the need for medical intervention (this sounds much easier than it is):
1)Patients are getting released much sooner from the hospital inpatient/ICU and same day surgery is more common so we see them sooner and need to be able to detect things such as DVT, infection, heterotopic ossificans etc... that will be missed in the hospital.
2)Direct access is available in 48 states and patient's do not need to see their physician to see us. When medicare finally decides to reimburse for this following obvious evidence that it is a good idea, others will follow. We need to be able to screen these patients for systemic/visceral illness masking as a musculoskeletal problem and refer when medically indicated.
3)Systemic diseases take time to show up, and by the time we see a patient after medical referral for treatment, a disease could be showing more signs/symptoms that we need to know about to get them appropriate medical care.
4)Medical referral is sometimes from a specialist who did not thoroughly screen outside their area and missed red or yellow flags critical to getting the patient prompt and appropriate medical attention
Some other comments:
5)We make highly valued discharged recommendations for patients in acute care. I know this because physicians working with PTs have said so.
6)Just as physicians refer to a GI specialist for what they believe to be a GI problem outside their area of expertise, so are physical therapists referred patients with a (and I quote over and over again) "shoulder pain" diagnosis although the patient already said they have shoulder pain. Of course we are trained to recognize when the patient has more than shoulder pain as we have direct access that supports this.
QUESTION: do you think we would be sent patients if we weren't the trusted and respected profession we are?
7) Physical therapy is NOT modalities! I hardly EVER see ultrasound, hot packs, cold packs, electrical stimulation used in the clinic, let alone being used as a sole intervention. They are not even interventions, they are adjuncts to the real interventions. Like skilled joint mobilization, neuromuscular facilitation, etc...
8) We DIAGNOSE. Yes, I am going to this, we can diagnose musculoskeletal impairments better than family practitioners. No BS. Why? We study these in depth and this is our expertise. However, that is called a medical diagnosis, and we diagnose using a physical therapy diagnosis. FYI, the medical diagnosis often tells us NOTHING. What does "shoulder pain" tell me? NOTHING. Other diagnoses for LBP, hip pain are just as useless and often INCORRECT for physical therapy examination, evaluation, and intervention. Often hip pain or knee pain is from the back. ATTENTION: We can figure that out
10) A doctor can function autonomously, and we can do that. If it's not in our scope to do so, we will refer or consult as needed.
11) We conduct a thorough and skilled interview and physical examination. In my differential diagnosis class we practice (and practice) the SAME interviewing techniques and format taught to medical students. We consider the mechanism of injury and look for inconsistencies with the family history, previous medical history, medications, functional limitations, risk factors, associated signs/symptoms of other diseases, presence of constitutional s/s (e.g. nausea, fever, night sweats, dizziness, change in bowel/bladder function, fatigue, etc...), a review of systems putting everything together...
As a few very simplistic medical screening examples: On the exam, we know at least 1 test to determine whether there is a kidney problem and not back pain called costovertebral tenderness, AAA palpation and combination of signs and symptoms, McBurney's point/rebound tenderness for appendicitis, sign of the buttock, screening for DVT, knowing that significant relief of deep bone pain by aspirin is a sign of cancer, unexplained weight loss >20 pounds and night pain unrelieved by positional changes suggests cancer, and list goes on. We take all of the physical exam and combine it with the rest of the interview and make the judgement of appropriateness for physical therapy intervention.
I don't have all day to write this post, so my question to you is:
"Does what I typed sound like a doctoring profession?"
Thanks for reading ,
John, 2nd year SPT
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