MD here... tips to get the most out of referrals

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Amazing how this never happens. Treatment actually is not for certain so IMO it should not be written in that way. Evaluate and treat if indicated makes more sense. Frequency, duration and specific treatments being "ordered" is not appropriate. Medical precautions are a good idea to include if there is any. Demand high quality thorough assessments and write ups. Demand quality POC's that are based on the physical therapy assessment. Demand high quality treatment that is established in the POC. Don't fall prey to a patient's own opinions re the quality of care they are getting as they do not have a clue. Don't be one of the majority of physicians who think they supervise and know physical therapy. The majority of physician and physical therapist collaboration/teamwork is garbage trust me, so don't copy what produces that.
 
Hi Doc,
Outpatient PT here
Eval and treat is perfect. Include any pre-cautions or contraindications if post surgical.
Include imaging findings if significant.
I don't like it when docs specified a modality
 
Thanks for asking. First, find a PT or PTs that you trust to let you know when something doesn't fit. Not someone who will just treat someone for the duration of the referral even if not much is changing. Unfortunately, there are some out there. Then, as DPTinFL said, let us know what you DON'T want us to do. Eval and Treat is the best way, assuming that you have a PT you trust. Also, if we call for clarification, please find a way to respond quickly. We aren't going to ask a question if we don't need to know the answer.

Good luck in residency.
 
Eval and treat saves you time and gives us maximum flexibility. Thanks for asking.
 
First of all you are awesome and a real team player for actually asking and caring about our input! Thank you!

Evaluate and treat as appropriate is perfect. If a patient won't benefit from skilled physical therapy but has been ordered to receive physical therapy, especially in an inpatient setting, it results in a whole lot of wasted time; We are fully capable of making that determination ourselves. We want to know why you have sent them to us for an evaluation and what you think because we value your input...just don't order specific exercises or modalities...leave that to us.

As mentioned, bring to our attention big and/or critical information such as weightbearing status or anything else that requires our immediate attention. Sending general post-surgical timetables regarding exercise progression isn't necessary but can be useful for new physical therapists to glance at if needed; they shouldn't, however, be sent with the expectation that it will be followed exactly.

Also, if we get in touch with you regarding a mutual patient and suggest an x-ray would be helpful please consider and order if you agree. Physical therapists are already able to order their own x-rays in Wisconsin and it's only a matter of time before the profession as a whole includes this in our scope of practice-we have spent three years learning everything about bones and muscles-we are absolutely qualified to order x-rays.

All doctors and therapists should make this kind of effort to build an excellent working relationship! It makes me want to start a thread like this in the MD section
 
truthseeker said:
Thanks for asking. First, find a PT or PTs that you trust to let you know when something doesn't fit. Not someone who will just treat someone for the duration of the referral even if not much is changing. Unfortunately, there are some out there. Then, as DPTinFL said, let us know what you DON'T want us to do. Eval and Treat is the best way, assuming that you have a PT you trust. Also, if we call for clarification, please find a way to respond quickly. We aren't going to ask a question if we don't need to know the answer.

Good luck in residency.
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Isn't the duration up to the PT? Why is it that there's some out there who just "do whatever" for 3x/wk for 4 weeks. How and why do you think that happens? Perhaps being treated like a technician has something to do with it. Isn't it up to the PT to decide what not to do? IMO, the PT needs to be empowered. All this the doc needs to supervise and be in the loop or something might happen is baloney to me. Something HAS happened along the lines of professional dementia and impaired development. The negative impact of this overwhelms the risk of PT autonomy. Yes we might miss something but that is better than missing all day long every day with hot packs and ultrasound. It is time to take the pampers off and take ownership for what is and is not done. People do not exactly flourish and master when they are unable to do the job the way it should be done.
 
Fiveoboy11 said:
Isn't the duration up to the PT? Why is it that there's some out there who just "do whatever" for 3x/wk for 4 weeks. How and why do you think that happens? Perhaps being treated like a technician has something to do with it. Isn't it up to the PT to decide what not to do? IMO, the PT needs to be empowered. All this the doc needs to supervise and be in the loop or something might happen is baloney to me. Something HAS happened along the lines of professional dementia and impaired development. The negative impact of this overwhelms the risk of PT autonomy. Yes we might miss something but that is better than missing all day long every day with hot packs and ultrasound. It is time to take the pampers off and take ownership for what is and is not done. People do not exactly flourish and master when they are unable to do the job the way it should be done.
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yes, the PT should be in charge of the duration. Read my post. I was giving an example of what not to do. PT's started as technicians. We are not now and the OP is onboard with that. relax and stop being so damn defensive.
 
truthseeker said:
yes, the PT should be in charge of the duration. Read my post. I was giving an example of what not to do. PT's started as technicians. We are not now and the OP is onboard with that. relax and stop being so damn defensive.
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But anger and indignation are always the way to resolve issues.
 
Lev0phed said:
Hello, Im a resident looking to get your advice/tips on referrals. Do you like it when we write "evalute and treat"? What info do you need or what common things do we do that shouldnt be done, etc.
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It's completely dependent on your setting and field

If surgical, all of your precautions and contraindications are really important, particularly weightbearing.

If this is IM/FM then medications or heavy side effects that have just been started are important know as the side effects can produce headaches or dizziness that may be misinterpreted as a vestibular or proprioceptive issue in our initial evaluation.

For neuro and EM, if there is imaging necessary, then please let the imaging be viewable on EHR. It helps seeing the injury for sensorimotor issues or hand placement when moving someone.

If you don't specify modalities or exercise progressions and keep it broad, then Evaluation is more than fine.

If you're pressed for time and it's a low level injury, and you refer to an outpatient clinic, the therapist should have plenty of time to do the differential during the initial evaluation.

Hope that helped. Take care of yourself in residency and stay healthy.
 
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"Evaluate and treat" is great. I would say that most PT's don't even follow what it says anyways unless it's a post-op with specific protocol/precautions. When you do see the patients for follow-up, it would be good to ask how PT is going though and how much % they are better. If patients are not really seeing any significant benefits after 4 weeks, chances area there needs to be a change. Unfortunately a lot of PT's won't make that call and just milk patients for their insurance money.
 
nuptstudent2017 said:
"Evaluate and treat" is great. I would say that most PT's don't even follow what it says anyways unless it's a post-op with specific protocol/precautions. When you do see the patients for follow-up, it would be good to ask how PT is going though and how much % they are better. If patients are not really seeing any significant benefits after 4 weeks, chances area there needs to be a change. Unfortunately a lot of PT's won't make that call and just milk patients for their insurance money.
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It's scary how little insight you have. And if you really are a student and you come on here and write that you should be kicked out of school.
 
Fiveoboy11 said:
Maybe if you just tell me what not to do that would fix me right up
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maybe think about what kind of representative of the profession you are. You might be a good clinician but your attitude is definitely off-putting. OK, that's an understatement. I don't think I'm the first to say something like that. You are an embarrassment.
 
truthseeker said:
maybe think about what kind of representative of the profession you are. You might be a good clinician but your attitude is definitely off-putting. OK, that's an understatement. I don't think I'm the first to say something like that. You are an embarrassment.
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I'm not really concerned about playing the roll of a 8th tier healthcare professional or a change nothing teamlover and if that embarrasses you then that's too bad. Go find a politician or some fake gutless person to talk to if you don't like it.
 
Fiveoboy11 said:
I'm not really concerned about playing the roll of a 8th tier healthcare professional or a change nothing teamlover and if that embarrasses you then that's too bad. Go find a politician or some fake gutless person to talk to if you don't like it.
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the sad thing is, it should embarrass you the way you present yourself and MY profession.
 
truthseeker said:
the sad thing is, it should embarrass you the way you present yourself and MY profession.
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I feel the same way about you. Promoting poor principles such as PT's with a doctorate aren't "real" doctors. Good call, it's far superior overall for the general public to think we're uneducated idiots like they do now. As if PT's with a doctorate want to behave like chiropractors and naturopaths as pretending to be physicians. Nothing like students spending 7 years and > 100k on a degree and then having people in their own profession illegitimizing it. I don't remember anything in PT school about the "doc" telling the PT "what not to do" as part of the referral. Where does that garbage come from? Harmful if you ask me and downright shameful to promote it.
 
Example of a similar end product is in an episode of hard knocks from last year (rams) in the last or second to last episode where Goff goes to a guy (? An athletic trainer) and says something like "I need manual, on the whole thing." The athletic trainer proceeds to do just that. I would've loved it if the ATC went off on him, did a real exam, then did what he thought was best. I don't know that pretty boy 20 year olds should be telling athletic trainers what to do. I wonder what produces that?
 
to the OP,
I apologize for my "colleague." there is one in every crowd. My point about tell us what NOT to do pertains to weightbearing status, mobilization of a fracture, active vs passive motion based upon the structural integrity of the tissue with insight that you might have because you were involved with their surgery and have much more intimate knowledge of the character of the tissue.

fiveoboy11 is I think on probation on other threads on SDN and is generally not representative of most PTs. And not in a good way.
 
I apologize for mine too. Supposedly he thinks all physicians are surgeons and all patients are post surgical. Regardless "what not to do" = (in his mind) precautions/contraindications (real recognized terms everyone else uses).
 
Thank you to the OP for a thoughtful question that many physicians have never thought to ask, and sorry for the derailed thread and unproductive conversation. I suspect the majority of PTs would concur that an order to "evaluate and treat" with any important precautions highlighted works great. Making your self available for/responsive to interdisciplinary communication when a therapist tries to get in touch with you will go further towards helping the patient get better than anything you could write on the referral.
 
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