Biggest misconception about Pain?

[Nivens]

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Curious to hear yall's take on this.

Chatting with a cardiac anesthesia fellow in the nurses station yesterday and, as I'm currently doing a Heart Failure elective, he asked me if I am interested in cardiac anesthesia, to which I replied I enjoyed my cardiac time so far a great deal, but was thinking about pain fellowship. He shook his head and said "Pain seems great, right up to the point where you're stuck in clinic with an actual chronic pain patient." This struck me as odd, since my experience rotating through a PP pain clinic was pretty pleasant. I mean sure- there definitely was an occasional inconsolable fibro or opioid seeker, but most were just regular folks with headache/LBP.

What do you think- is this view a commonly held misconception about your day to day experience? What do you feel is commonly misunderstood or overblown about the field?

 

[SSdoc33]

"heart failure elective"?

im not sure its a misconception. there are a lot of inconsolable fibros and opioid seekers. there are also a lot of "regular" folks as well. depends on how you tailor your practice.

 

[deleted185747]

Chronic pain means you are treating the most miserable people that everyone else has given up on, at which point they are incurable. It would be your job to manage these people long term and see the misery for the rest of your career. You need to be exceptionally balanced, emotionally sound, ethical and objective to survive.

 

[Nivens]

"heart failure elective"?
.

Basically our service manages all end-stage heart failure patients in-house. Trust me- much more interesting and relevant to the rest of my residency than my other options.

 

[drusso]

Pain Medicine: 1/3 normal people with focal pain generators and/or treatable problems; 1/3 quasi-addicted, somatically-focused, needy/whiny people with an externally focused locus of control; 1/3 psychiatrically-disordered, malingering, secondary-gain seeking sociopaths.

Life is like a box of chocolates...

 

[Nivens]

At least you have a 33% chance of a nice interaction at work. If I generalize my experience from this year talking to surgical consultants on the phone, I can only imagine what the OR is like on a daily basis.

 

[freddydpt]

Pain Medicine: 1/3 normal people with focal pain generators and/or treatable problems; 1/3 quasi-addicted, somatically-focused, needy/whiny people with an externally focused locus of control; 1/3 psychiatrically-disordered, malingering, secondary-gain seeking sociopaths.

Life is like a box of chocolates...

Did you come up with this on your own? I nearly peed my pants.

 

[gdub25]

My experience is that this is a big misconception. I'm currently a fellow and was very nervous starting fellowship worried that I would find myself dealing with difficult patients and hate it. My experience during residency was VERY limited so I didn't have much experience to base things on. Now that I'm three months away from graduating I am very satisfied with my decision. My fellowship doesn't deal with a lot of drug seekers and I think we have a very favorable patient mix so my perception may be biased. As someone who is coming out and looking for a job I like the misconception however because it means less people going into pain and less competition.

 

[Dr. Ice]

My experience is that this is a big misconception. I'm currently a fellow and was very nervous starting fellowship worried that I would find myself dealing with difficult patients and hate it. My experience during residency was VERY limited so I didn't have much experience to base things on. Now that I'm three months away from graduating I am very satisfied with my decision. My fellowship doesn't deal with a lot of drug seekers and I think we have a very favorable patient mix so my perception may be biased. As someone who is coming out and looking for a job I like the misconception however because it means less people going into pain and less competition.

Ah youth..must be nice..life is very different as an attending my friend..when the patient is actually your responsibility for better or worse. A lot of it is about demographics. Don't work with the very rich...over privalaged a holes..don't work with the very poor...centrally sensitized, don't see a lot of comp/auto..secondary gain bs..oh wait what's left..

 

[powermd]

Curious to hear yall's take on this.

Chatting with a cardiac anesthesia fellow in the nurses station yesterday and, as I'm currently doing a Heart Failure elective, he asked me if I am interested in cardiac anesthesia, to which I replied I enjoyed my cardiac time so far a great deal, but was thinking about pain fellowship. He shook his head and said "Pain seems great, right up to the point where you're stuck in clinic with an actual chronic pain patient." This struck me as odd, since my experience rotating through a PP pain clinic was pretty pleasant. I mean sure- there definitely was an occasional inconsolable fibro or opioid seeker, but most were just regular folks with headache/LBP.

What do you think- is this view a commonly held misconception about your day to day experience? What do you feel is commonly misunderstood or overblown about the field?

I saw a young guy in his 30s today with back and leg pain for 3 years. Had a lumbar MRI that showed a little syrinx, then subsequent thoracic and cervical MRIs to follow it up the spine. He works as a plumber/handyman and the pain has been causing him to miss lots of work. I reviewed the MRI findings with him and explained the syrinx was likely entirely incidental and unrelated to his symptoms. The small disc bulge at L5-S1 also was unlikely to account for his symptoms. I suspected piriformis and sure enough his exams were consistent with this diagnosis. Next I held his leg in deep flexion and internal rotation for about 40 seconds then had him get up and walk around. The pain was gone. I sent him home with a self-guided PT program, and plans for a piriformis tendon injection under ultrasound (which he may not need if the PT goes well enough). I'll do a formal PT referral if he needs the injection.

He told me I did more for him in 20 minutes than all his other doctors in the past 3 years.

I hear this kind of thing from patients all the time.

Tell me how bad you think it sucked to be "stuck in clinic" with this "actual chronic pain patient".

Share this story with your misinformed heart failure preceptor.

 

[Dr. Ice]

I saw a young guy in his 30s today with back and leg pain for 3 years. Had a lumbar MRI that showed a little syrinx, then subsequent thoracic and cervical MRIs to follow it up the spine. He works as a plumber/handyman and the pain has been causing him to miss lots of work. I reviewed the MRI findings with him and explained the syrinx was likely entirely incidental and unrelated to his symptoms. The small disc bulge at L5-S1 also was unlikely to account for his symptoms. I suspected piriformis and sure enough his exams were consistent with this diagnosis. Next I held his leg in deep flexion and internal rotation for about 40 seconds then had him get up and walk around. The pain was gone. I sent him home with a self-guided PT program, and plans for a piriformis tendon injection under ultrasound (which he may not need if the PT goes well enough). I'll do a formal PT referral if he needs the injection.

He told me I did more for him in 20 minutes than all his other doctors in the past 3 years.

I hear this kind of thing from patients all the time.

Tell me how bad you think it sucked to be "stuck in clinic" with this "actual chronic pain patient".

Share this story with your misinformed heart failure preceptor.

Are you sure this isn't chronic discogenic pain with a component of chemical radiculitis aside from temporary pain relief from FADIR

 

[lobelsteve]

Are you sure this isn't chronic discogenic pain with a component of chemical radiculitis aside from temporary pain relief from FADIR

Yes, we all are sure it is a treatable condition and not the normal imaging you want to treat. Rabbit hole: what would you do for disc bulge? Esi, please no. Disco, hell no. Intradiscal PR or stemcell voodoo, call your attorney hell no.

 

[101N]

Biggest misconception about pain in the US: that it's nociceptive🙂

 

[powermd]

Are you sure this isn't chronic discogenic pain with a component of chemical radiculitis aside from temporary pain relief from FADIR

Or maybe God did it?

Please, chemical radiculitis lasting 3 years?

I had chemical radiculitis once after doing a bridge over a rubber PT ball. It lasted a few weeks. The chemicals must have diffused away.

This patient had a positive sitting SLR despite no nerve root impingement combined with a lot of pain in the buttock with sitting. This is a duck, not Archaeopteryx.

 

[Fiveoboy11]

I saw a young guy in his 30s today with back and leg pain for 3 years. Had a lumbar MRI that showed a little syrinx, then subsequent thoracic and cervical MRIs to follow it up the spine. He works as a plumber/handyman and the pain has been causing him to miss lots of work. I reviewed the MRI findings with him and explained the syrinx was likely entirely incidental and unrelated to his symptoms. The small disc bulge at L5-S1 also was unlikely to account for his symptoms. I suspected piriformis and sure enough his exams were consistent with this diagnosis. Next I held his leg in deep flexion and internal rotation for about 40 seconds then had him get up and walk around. The pain was gone. I sent him home with a self-guided PT program, and plans for a piriformis tendon injection under ultrasound (which he may not need if the PT goes well enough). I'll do a formal PT referral if he needs the injection.

He told me I did more for him in 20 minutes than all his other doctors in the past 3 years.

I hear this kind of thing from patients all the time.

Tell me how bad you think it sucked to be "stuck in clinic" with this "actual chronic pain patient".

Share this story with your misinformed heart failure preceptor.

You sent him home with a self guided PT program? Did you go to physical therapy school? Are you a PT? Do you have a license to practice physical therapy? What exactly is "formal" PT? How is what you did not a simple HEP? What's your justification for calling it PT? What's your name and state you practice in so I can report you for misrepresenting what you know to patients?

Lots and lots of misguided doctors out there...

 

[Dr. Ice]

Or maybe God did it?

Please, chemical radiculitis lasting 3 years?

I had chemical radiculitis once after doing a bridge over a rubber PT ball. It lasted a few weeks. The chemicals must have diffused away.

This patient had a positive sitting SLR despite no nerve root impingement combined with a lot of pain in the buttock with sitting. This is a duck, not Archaeopteryx.

Sorry missed the 3 years part

 

[willabeast]

You sent him home with a self guided PT program? Did you go to physical therapy school? Are you a PT? Do you have a license to practice physical therapy? What exactly is "formal" PT? How is what you did not a simple HEP? What's your justification for calling it PT? What's your name and state you practice in so I can report you for misrepresenting what you know to patients?

Lots and lots of misguided doctors out there...

this is interesting...a PT with an attitude! i like that. if i take your comment at face value, are you saying that doctors do not have the skills or knowledge to direct patient's MS rehab, and if they try, they need to be punished by the state medical boards? or...is this sort of like chiropractic, where the term chiropractic manipulation is patented, and although you can perform it, you cannot use the term? because as far as i know (and i fully admit there is a lot i do not know) the term "physical therapy" is not patented, and anyone can perform it. maybe not as well as you, but that is a let the buyer beware sort of thing.
Caveat emptor/ˌkævɛɑːt ˈɛmptɔːr/ is Latin for "Let the buyer beware"[1] (from caveat, "may he beware", a subjunctive form of cavere, "to beware" + emptor, "buyer").

 

[powermd]

You sent him home with a self guided PT program? Did you go to physical therapy school? Are you a PT? Do you have a license to practice physical therapy? What exactly is "formal" PT? How is what you did not a simple HEP? What's your justification for calling it PT? What's your name and state you practice in so I can report you for misrepresenting what you know to patients?

Lots and lots of misguided doctors out there...

A real bridge builder we have here.

Maybe this patient and his insurance company don't need to spend $2000 to learn something you can find on Youtube.

Have you ever heard of a physician directed exercise program? It's a thing. Might want to check that out before issuing open threats on a public message board.

 

[Fiveoboy11]

No, PT's do not do quackropractic manipulation. They do manipulation when it's indicated, not whenenever. Yes, physical therapy is a protected term in all 50 states and if a non PT is pretending to practice physical therapy they're breaking the law. There's lots non PT's don't know about physical therapy, that's why they shouldn't masquerade as if they know everything a PT knows "and then some."

 

[Fiveoboy11]

A real bridge builder we have here.

Maybe this patient and his insurance company don't need to spend $2000 to learn something you can find on Youtube.

Have you ever heard of a physician directed exercise program? It's a thing. Might want to check that out before issuing open threats on a public message board.

There's a difference between a physical therapy HEP (a real one) and a physician directed HEP, that's why the latter shouldn't be called the former (also because it's misleading, and illegal). What training do physicians have in designing a HEP anyway?

 

[willabeast]

No, PT's do not do quackropractic manipulation. They do manipulation when it's indicated, not whenenever. Yes, physical therapy is a protected term in all 50 states and if a non PT is pretending to practice physical therapy they're breaking the law. There's lots non PT's don't know about physical therapy, that's why they shouldn't masquerade as if they know everything a PT knows "and then some."

well... apparently in California the term is "implied" not legally binding "expressed". so i think i am safe from the California Medical Board using the term Physical Therapy if i give instructions to a patient. of course, no one is really safe if they want to get you, right? only the paranoid survive...
http://www.apta.org/TermProtection/StateLaws/

 

[VA Hopeful Dr]

There's a difference between a physical therapy HEP (a real one) and a physician directed HEP, that's why the latter shouldn't be called the former (also because it's misleading, and illegal). What training do physicians have in designing a HEP anyway?

Uhh, if the MD in question is PMR trained (which many pain management docs are) then I'm going to have to go with "a lot".

 

[Nivens]

Derailing my thread here guys...

 

[SSdoc33]

Derailing my thread here guys...

no, this is pretty much what pain medicine is all about.

 

[deleted185747]

No, PT's do not do quackropractic manipulation. They do manipulation when it's indicated, not whenenever. Yes, physical therapy is a protected term in all 50 states and if a non PT is pretending to practice physical therapy they're breaking the law. There's lots non PT's don't know about physical therapy, that's why they shouldn't masquerade as if they know everything a PT knows "and then some."

Hey do you have a brother named Steve Lobel by chance?

 

[powermd]

There's a difference between a physical therapy HEP (a real one) and a physician directed HEP, that's why the latter shouldn't be called the former (also because it's misleading, and illegal). What training do physicians have in designing a HEP anyway?

Chill the F out. What an insecure little troll you are. If I were BILLING for PT services I can see someone in the PT community raising an eyebrow. But simply advising someone to do some stretches with the caveat that if it doesn't work out I will refer them for formal PT eval? I think you would benefit from some medical MJ.

 

[cbest]

There's a difference between a physical therapy HEP (a real one) and a physician directed HEP, that's why the latter shouldn't be called the former (also because it's misleading, and illegal). What training do physicians have in designing a HEP anyway?

So as a physiatrist, I wouldn't have the appropriate training to design and prescribe a home exercise program? Would it make a difference if I had a kinesiology background and worked as a strength and conditioning coach? You don't own exercise. Strength and conditioning coaches/personal trainers don't own exercise. We, as physicians, don't own exercise. Would I trust the HEP of a hematologist? Probably not. But many on this forum have a solid understanding of MSK medicine and exercise prescription.


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[smq123]

Hi everyone! As a reminder, please keep your posts civil and on topic. Furthermore, as a reminder, this is the Pain Medicine forum, not the physical therapy forum, so the focus is on issues of interest to practitioners of that specialty.

Thanks! Now back to your previously scheduled program....

 

[willabeast]

Hi everyone! As a reminder, please keep your posts civil and on topic. Furthermore, as a reminder, this is the Pain Medicine forum, not the physical therapy forum, so the focus is on issues of interest to practitioners of that specialty.

Thanks! Now back to your previously scheduled program....

i wonder if we should copyright the term "pain" before some group claims it.

 

[smq123]

I saw a young guy in his 30s today with back and leg pain for 3 years. Had a lumbar MRI that showed a little syrinx, then subsequent thoracic and cervical MRIs to follow it up the spine. He works as a plumber/handyman and the pain has been causing him to miss lots of work. I reviewed the MRI findings with him and explained the syrinx was likely entirely incidental and unrelated to his symptoms. The small disc bulge at L5-S1 also was unlikely to account for his symptoms. I suspected piriformis and sure enough his exams were consistent with this diagnosis. Next I held his leg in deep flexion and internal rotation for about 40 seconds then had him get up and walk around. The pain was gone. I sent him home with a self-guided PT program, and plans for a piriformis tendon injection under ultrasound (which he may not need if the PT goes well enough). I'll do a formal PT referral if he needs the injection.

He told me I did more for him in 20 minutes than all his other doctors in the past 3 years.

I hear this kind of thing from patients all the time.

Tell me how bad you think it sucked to be "stuck in clinic" with this "actual chronic pain patient".

Share this story with your misinformed heart failure preceptor.

This story actually gives me a little hope for humanity. I had lost a big chunk of what little I had left after reading an article about the new CDC opiate guidelines in the NY Times. Well, not the article so much as the comments. Jeebus - "Great. Now what will I do if I ever develop chronic pain?!" "My sister's ex-boyfriend has chronic headaches and Vicodin is the ONLY thing that helps him function. What is he supposed to do now?!" "Everyone knows that narcotics are the most effective option for pain." "Anyone who says that narcotics are not the answer obviously knows nothing about what it's like to live with chronic pain." OMG.

Thanks for sharing. 🙂

 

[VA Hopeful Dr]

i wonder if we should copyright the term "pain" before some group claims it.

If it takes all chronic pain from my family practice office, I will support this wholeheartedly...

 

[freddydpt]

There's a difference between a physical therapy HEP (a real one) and a physician directed HEP, that's why the latter shouldn't be called the former (also because it's misleading, and illegal). What training do physicians have in designing a HEP anyway?

1. As a PT, these comments do not reflect the field's opinion.
2. "There's a difference... and that's why..." isn't an actual argument. Calling a PT HEP "a real one" sounds infantile even to me. Make a better argument why your HEP is better than his.
3. Please feel free to contact any residency program director of a PM&R program for their curriculum/powerpoints regarding exercise programs. Therex is included as a key portion of treatment for nearly all diagnoses treated by a PM&R physician. It is included in nearly all didactics throughout a 3 year residency. PM&R physicians do not have nearly the same amount of time supervising and performing tactile correction of these exercise programs as a PT does, but the biomechanical/functional anatomy theories and therex prescribing patterns are all the same (within reason and style of course).
4. There is a better way to approach trying to make change in the language of a fellow clinical practitioner than "where do you get off...? or... who do you think you are...?" Behavioral change curricula in PT school and maybe a few professionalism courses taught you that. Clearly you are addressing someone who has the same treatment philosophy as you do, so why be so confrontational?

 

[clubdeac]

I saw a young guy in his 30s today with back and leg pain for 3 years. Had a lumbar MRI that showed a little syrinx, then subsequent thoracic and cervical MRIs to follow it up the spine. He works as a plumber/handyman and the pain has been causing him to miss lots of work. I reviewed the MRI findings with him and explained the syrinx was likely entirely incidental and unrelated to his symptoms. The small disc bulge at L5-S1 also was unlikely to account for his symptoms. I suspected piriformis and sure enough his exams were consistent with this diagnosis. Next I held his leg in deep flexion and internal rotation for about 40 seconds then had him get up and walk around. The pain was gone.

So If I read this correctly, you performed a FAIR maneuver and his pain was gone? I think that would r/o piriformis syndrome as Pace, FAIR and Freiberg are three of the most common piriformis provocative maneuvers. Also I hoped you billed a 97110 for your self-guided PT program 😉

 

[powermd]

So If I read this correctly, you performed a FAIR maneuver and his pain was gone? I think that would r/o piriformis syndrome as Pace, FAIR and Freiberg are three of the most common piriformis provocative maneuvers. Also I hoped you billed a 97110 for your self-guided PT program 😉

No. Pace, Lesegue, and Freiburg were all positive.

What I did next was this:

http://www.webmd.com/back-pain/piriformis-stretch

Except I helped him do the stretch by leaning in and holding the flexed leg pushed toward the contralateral shoulder to the point where he could feel deep buttock strain.

I personally experienced piriformis syndrome after a session of hard rowing about 8 weeks ago. In retrospect I had been experiencing very mild symptoms of this for years, but never like this. At first I thought I might have a herniated disc- and so did the PT who examined me. To be fair, it was just a quick exam, not a full eval. But he never even mentioned piriformis as a possibility. So I read about rowing injuries and piriformis was mentioned. Since I had never read what it is PTs do to treat piriformis syndrome, and my patient's experiences with PT for piriformis were generally very positive, I read about it. After only 20 seconds of stretch the excruciating radiating leg pain was gone, as was most of the buttock pain. I made it a regular part of my running/rowing workouts, and have added hip stabilization exercises too. The problem is under excellent control now, although it starts to creep back if I don't do the exercises.

 

[SSdoc33]

No. Pace, Lesegue, and Freiburg were all positive.

What I did next was this:

http://www.webmd.com/back-pain/piriformis-stretch

Except I helped him do the stretch by leaning in and holding the flexed leg pushed toward the contralateral shoulder to the point where he could feel deep buttock strain.

I personally experienced piriformis syndrome after a session of hard rowing about 8 weeks ago. In retrospect I had been experiencing very mild symptoms of this for years, but never like this. At first I thought I might have a herniated disc- and so did the PT who examined me. To be fair, it was just a quick exam, not a full eval. But he never even mentioned piriformis as a possibility. So I read about rowing injuries and piriformis was mentioned. Since I had never read what it is PTs do to treat piriformis syndrome, and my patient's experiences with PT for piriformis were generally very positive, I read about it. After only 20 seconds of stretch the excruciating radiating leg pain was gone, as was most of the buttock pain. I made it a regular part of my running/rowing workouts, and have added hip stabilization exercises too. The problem is under excellent control now, although it starts to creep back if I don't do the exercises.

glad you had relief, but piriformis syndrome, IMHO is relatively rare and way over-diagnosed. anytime a patient has butt and leg pain and there is no MRI, i am always hearing that it is "piriformis syndrome" from the therapists. it is usually not the case

 

[powermd]

glad you had relief, but piriformis syndrome, IMHO is relatively rare and way over-diagnosed. anytime a patient has butt and leg pain and there is no MRI, i am always hearing that it is "piriformis syndrome" from the therapists. it is usually not the case

I would agree with you there. It's like how nearly every UE EMG/NCS is positive for carpal tunnel syndrome. Send a patient to PT with butt pain and you're almost certain to get a diagnosis of leg length discrepancy, SI joint dysfunction, piriformis.... Doesn't help their credibility. I sent my brother in law to a PT I respect for eval of butt pain. He got all these diagnoses. I sent him to the PT because I wasn't quite convinced any of these were true based on my own exam. He had no radiating leg pain at that point, so no one had ordered an MRI. Turns out (a year later) he had a big L4-5 HNP. Got better with a single epidural. Still doing well now two years later. He runs and works his core aggressively, no problem.

 

[drusso]

So as a physiatrist, I wouldn't have the appropriate training to design and prescribe a home exercise program? Would it make a difference if I had a kinesiology background and worked as a strength and conditioning coach? You don't own exercise. Strength and conditioning coaches/personal trainers don't own exercise. We, as physicians, don't own exercise. Would I trust the HEP of a hematologist? Probably not. But many on this forum have a solid understanding of MSK medicine and exercise prescription.


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Home exercise instruction is just a component of you E/M visit. You can "up charge" by documenting the time you spent reviewing, demonstrating, and critiquing exercise program.

 

[Fiveoboy11]

1. As a PT, these comments do not reflect the field's opinion. There's opinions and there's facts. A person or a fields opinions aren't necessarily true are they?
2. "There's a difference... and that's why..." isn't an actual argument. Calling a PT HEP "a real one" sounds infantile even to me. Make a better argument why your HEP is better than his.

A physician directed HEP is real but a physician directed PT HEP is not, that's what I meant. A PT HEP is designed by a PT, a physician HEP by a physician. That's the difference.
3. Please feel free to contact any residency program director of a PM&R program for their curriculum/powerpoints regarding exercise programs. Therex is included as a key portion of treatment for nearly all diagnoses treated by a PM&R physician. It is included in nearly all didactics throughout a 3 year residency. PM&R physicians do not have nearly the same amount of time supervising and performing tactile correction of these exercise programs as a PT does, but the biomechanical/functional anatomy theories and therex prescribing patterns are all the same (within reason and style of course).
Sure pm&r physicians get lots of training and have experience in rehab, that doesn't make them a PT. I see all the time on here you guys bashing this and that (non pain fellow prescribing pain intervention/meds, non physician playing doctor/doing pain interventions). Where's the consistency? PT's have far more training/experience in designing HEP's yet it's ok for physicians to and even call it "PT." It's ok if you do it I guess.
4. There is a better way to approach trying to make change in the language of a fellow clinical practitioner than "where do you get off...? or... who do you think you are...?" Behavioral change curricula in PT school and maybe a few professionalism courses taught you that. Clearly you are addressing someone who has the same treatment philosophy as you do, so why be so confrontational?

Any Physicians and PT's don't have the same treatment philosophy, not even pm&r and PT, not even PT & PT.

Call it what it is, a physician HEP. Don't play a PT, then complain about wannabee doctors, noctors, non pain physicians, etc. It's the same thing.

 

[powermd]

Any Physicians and PT's don't have the same treatment philosophy, not even pm&r and PT, not even PT & PT.

Call it what it is, a physician HEP. Don't play a PT, then complain about wannabee doctors, noctors, non pain physicians, etc. It's the same thing.

I reviewed your posting history and it seems that not only do you have a problem expressing yourself in a way that doesn't piss people off, you have a real hang up with semantics.

When you announce in our forum that "physical therapy" is a legally protected term (in all 50 states!) and start making direct threats to enforce that, you sound insecure, childish, weak, and petty. Do you get that? You have effectively LOWERED my opinion of your entire field. Prior to your outburst I truly felt that PTs were part of the "good guy" group - secure in what they have to offer patients - and above petty turf battles with MDs. Now I am left wondering if all the PTs I know secretly harbor the same feelings you do. And that makes me less likely to refer patients their way. Well done.

 

[Fiveoboy11]

I reviewed your posting history and it seems that not only do you have a problem expressing yourself in a way that doesn't piss people off, you have a real hang up with semantics.

I think semantics and the way people on here respond to what I say reveal a lot.
When you announce in our forum that "physical therapy" is a legally protected term (in all 50 states!) and start making direct threats to enforce that, you sound insecure, childish, weak, and petty.

What physical therapist is secure and strong? You cannot exactly be openly honest and critical at work as a PT. If you do then look out for retaliation if you don't lose your job. Physical therapists are literally weak and insecure in the job security sense and having ownership and control of their own profession. Maybe you've felt that way about all PT's all along. Maybe physical therapists remind you of children and you a parent, so doesn't take much for you to think of me as childish.
Do you get that? You have effectively LOWERED my opinion of your entire field. Prior to your outburst I truly felt that PTs were part of the "good guy" group - secure in what they have to offer patients - and above petty turf battles with MDs. Now I am left wondering if all the PTs I know secretly harbor the same feelings you do. And that makes me less likely to refer patients their way. Well done.

I would bet your real view of physical therapy and physical therapists was not high before my posts. Too bad your views are artificial and sci fi given the absolute joke system PT's are forced to work in.

Physician and PT relationships are 99% fake and superficial IMO. They're not a team and there's not mutual bonafide respect. I come on here and say what I say and get reported plus I'd extrapolate your comments to mean if I said it to you with a relationship between us you'd terminate it.

 

[lobelsteve]

I would bet your real view of physical therapy and physical therapists was not high before my posts. Too bad your views are artificial and sci fi given the absolute joke system PT's are forced to work in.

Physician and PT relationships are 99% fake and superficial IMO. They're not a team and there's not mutual bonafide respect. I come on here and say what I say and get reported plus I'd extrapolate your comments to mean if I said it to you with a relationship between us you'd terminate it.

You do seam a bit hot headed and frankly unreasonable. But hey, no need to shout.

 

[freddydpt]

I would bet your real view of physical therapy and physical therapists was not high before my posts. Too bad your views are artificial and sci fi given the absolute joke system PT's are forced to work in.

Physician and PT relationships are 99% fake and superficial IMO. They're not a team and there's not mutual bonafide respect. I come on here and say what I say and get reported plus I'd extrapolate your comments to mean if I said it to you with a relationship between us you'd terminate it.

No more feeding the troll

 

[Leo Aquarius]

I would bet your real view of physical therapy and physical therapists was not high before my posts. Too bad your views are artificial and sci fi given the absolute joke system PT's are forced to work in.

Physician and PT relationships are 99% fake and superficial IMO. They're not a team and there's not mutual bonafide respect. I come on here and say what I say and get reported plus I'd extrapolate your comments to mean if I said it to you with a relationship between us you'd terminate it.

There are narcissistic vs. borderline traits here. Emotional instability due to mis-perceived insults. Inappropriate, intense anger or difficulty controlling anger. Nobody would opt to work with someone like this.

Ok, no more feeding the troll.