truthseeker said:
How is a DPT going to decide? They listen to the history, are they any specific activities or positions that provoke the symptoms? Was there a specific onset that was related to movement? If not, that person goes back to their real doctor for metabolic/systemic diagnosis.
Regarding your final paragraph, I agree that it is safe and effective for physicians to see the patients first. There are, however many cases where the assessment skills of the PT is also safe and effective. So long as the practitioner, whatever the letters are behind their name, recognizes when they don't know confidently what is going on, the system works well for everybody.
truthseeker,
you seem like a very earnest and compassionate clinician but i'm sorry, you're suffering from a serious case of "you don't know what you don't know". this is a syndrome that many these days seem to be suffering from...
the geriatric patient with back pain is a PERFECT example of what i'm talking about. the point here is NOT whether you can make a musculoskeletal diagnosis. your skills here are firm, i have no doubt. the point is whether you can rule of EVERYTHING ELSE that can be causing and/or contributing to that back pain. so say this guy walks (rolls, crawls, whatever) into your office brand spanking new. now, do you really believe you will be able to correctly identify all of his problems? is ALS on your differential? what about meningioma? osteo from the gunshot wound he suffered in WWII? which cancers cause mets to the bone? is this even a bone problem? what other medical conditions present with LBP? even if it is musculoskeletal or orthopedic, or both, are you worred that the guy may be osteoporotic? are you going to read the bone scan? did you remember to check his testosterone? how do you feel about testosterone replacement in the osteoporotic male? what about pamidronate? or alendronate? which one should i use or should i forget about this altogether?
now, you might...might...get lucky and get the one 80 yo guy in this country who has zero comorbidities. if so, it's all you dude. all you. but for the rest, you're gonna having to do some figurin'.
now here's the thing. i'm god, right? so today i grant you full rights to do whatever you want. go ahead, order films, tests, start writing scripts like a mad man. plus, plus you can call yourself phil, tom, dr., super-pt man (woman)... i really don't care. this old geezer is waiting on you...what's your next move?
the point is, you simply have not been trained to think about all of the different things that may be causing this, let's alone which ones need to be ruled out first, which one's need to be treated acutely, which can wait, and such. mind you, i'm not saying you are not capable of being trained. but as of now, you haven't. and why should you be? that's not your job.
it's my job.
i'm willing to bet you'll agree with me on that. where are you on the geezer? you have to refer the patient to a doc. and your referral will say, "80 yo male with hx of blah pw 3 months of LBP - unlikely musculoskeletal. rule out neuro, cardio, pulm, GI, renal, endo, vascular, etc. etiology." ok, thanks for the help...i'll get him right in. right in three months. and in the meantime, the patient waits, the pathology brews and lord, you better hope i catch whatever it is in time to do something about it because if he's an ornery bugger, he'll be suing and you'll be first on the list. defensive medicine? you're god damned right. but it's also responsible medicine. (btw, if you intend to act as primary anything for anyone, you had better get used to the idea of defensive medicine.)
make no mistake, this drive for independence is ALL about billing. (truthseeker, i'm not directing that comment at you. as i said, you seem genuinely interested in delivering good care and i'm sure you do.) come on already! it's all about getting rid of the pesky referrals from the docs and being able to set up shop and start bringing in the bucks. it's just masked in clever, "the patients will be seen quicker...the patients will be seen cheaper...we're just as good," language to entice the insurers to start paying up.
a couple of predictions for the two fellow physicians who might be reading this. one, we'll lose this battle. because somehow we manage to lose all of these battles. two, eventually, the patients will lose too.
one day, the DPTs, DOTs, DNPs, DPAs, DRTs, OPPs and whoever else wants to play doctor will get to see patients all by their loansomes. they will do so complete with 2 or 3 years of post graduate training. i know..they'll have a couple of bio classes, a pharm class, some anatomy-by-computer, and a little outpatient sniffle and ****s treatment thrown in for good measure. okay, that's a little harsh...some of them will round with med students too (giggle)...because THEY get the tough cases. and then presto, sling that old scope over the shoulders, smooth down the coat and ta-dah they'll be "savin' lives".
except, they won't be. it's not that easy. and sadly, they won't even know they won't be until it's too late. trust me, as a doc, who's had this experience DESPITE all of the training, it's a sick feeling. but at least i can look in the mirror and say, yeah, i did my very best to train for this.
will they be able to do that?
healthydawg
