Physiatry treatments?

[Healthinfo104]

I read that physiatrists treat disabling conditions (medical or physical diseases, disorders/ injuries etc) and that they aim to restore functionality to the person suffering with such conditions.

It stated that they also treat the psychosocial and emotional impacts of these conditions, or the functional impairment of psychiatric illness

What exactly can/ does a physiatrist do for psychosocial issues, or emotional/psychologic disorders?

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[jadedphysiotherapist]

I read that physiatrists treat disabling conditions (medical or physical diseases, disorders/ injuries etc) and that they aim to restore functionality to the person suffering with such conditions.

It stated that they also treat the psychosocial and emotional impacts of these conditions, or the functional impairment of psychiatric illness

What exactly can/ does a physiatrist do for psychosocial issues, or emotional/psychologic disorders?

Write referrals to neuropysch or a psychologist who then treat it with therapy, psychiatrist for med management, Sometimes coordinate and discuss care among the rehab disciplines to the family members putting it all together for psychosocial benefit

 

[Healthinfo104]

Write referrals to neuropysch or a psychologist who then treat it with therapy, psychiatrist for med management, Sometimes coordinate and discuss care among the rehab disciplines to the family members putting it all together for psychosocial benefit

Oh ok, can the physiatrist prescrow any psychiatric medications for a patient if like for instance they are having anxiety that's interfering with treatment?

Also. What kind of interventions do physiatrists do? Do they provide therapy like a physical therapist?

 

[j4pac]

Oh ok, can the physiatrist prescrow any psychiatric medications for a patient if like for instance they are having anxiety that's interfering with treatment?

Also. What kind of interventions do physiatrists do? Do they provide therapy like a physical therapist?

-Therapy (PT, OT, SLP, Chronic pain, pelvic therapy, neuropsych, sports psych, manual therapies such as OMT)
-Meds (pain meds, spasticity meds, bowel meds, bladder meds, psych meds, sleeping meds...lots of meds)
-injections and needling techniques (this includes steroid, MSC, PRP, synvisc, Botox, dry needling, prolo, acupuncture)
-non-surgical procedures (pain procedures)
-if you oversee an inpatient ward...you are essentially doing IM, which entails lots of different conditions and treatments.

Lots of options at your disposal and you really get a chance to tailor treatments based on goals and function.

 

[Healthinfo104]

-Therapy (PT, OT, SLP, Chronic pain, pelvic therapy, neuropsych, sports psych, manual therapies such as OMT)
-Meds (pain meds, spasticity meds, bowel meds, bladder meds, psych meds, sleeping meds...lots of meds)
-injections and needling techniques (this includes steroid, MSC, PRP, synvisc, Botox, dry needling, prolo, acupuncture)
-non-surgical procedures (pain procedures)
-if you oversee an inpatient ward...you are essentially doing IM, which entails lots of different conditions and treatments.

Lots of options at your disposal and you really get a chance to tailor treatments based on goals and function.

Can the Physiatrist do the PT, OT and SLP interventions? Or more so assesses what needs to be done?

 

[j4pac]

Can the Physiatrist do the PT, OT and SLP interventions? Or more so assesses what needs to be done?

The sessions are time consuming and PMR docs doing the treatments themselves isn't cost effective and isn't a very good use of resources. In the inpatient setting, PMR docs are typically responsible for overseeing the operation. In the outpatient setting, the role is primarily in prescriptions.

 

[Healthinfo104]

The sessions are time consuming and PMR docs doing the treatments themselves isn't cost effective and isn't a very good use of resources. In the inpatient setting, PMR docs are typically responsible for overseeing the operation. In the outpatient setting, the role is primarily in prescriptions.

Are they trained to do OT or PT interventions?

 

[j4pac]

Are they trained to do OT or PT interventions?

PMR docs are trained to have an understanding of what the therapists do, but they do not get much formal training in putting a patient through the variety of therapies. Physicians should not be spending their time doing the work of a therapists...it's a poor utilization of resources. BTW...you're beginning to sound like an dingus.

 

[Healthinfo104]

PMR docs are trained to have an understanding of what the therapists do, but they do not get much formal training in putting a patient through the variety of therapies. Physicians should not be spending their time doing the work of a therapists...it's a poor utilization of resources. BTW...you're beginning to sound like an dingus.

I was asking because I wasn't sure... and whenever you ask something on here you never get a direct answer, you get this round about explanation that vaguely answers the question.

 

[DMBandFan86]

This would be about the same as asking radiologists if they are taking X-rays themselves or running the MRI machine. Or asking ENT if they do the audiology exam. Or a IM doctor if they are trained in nursing to start IV's, running lines, placing foley's etc.

 

[jadedphysiotherapist]

Oh ok, can the physiatrist prescrow any psychiatric medications for a patient if like for instance they are having anxiety that's interfering with treatment?

Also. What kind of interventions do physiatrists do? Do they provide therapy like a physical therapist?

Not positive on first question.

Second question, no. Different field applications.

Can the Physiatrist do the PT, OT and SLP interventions? Or more so assesses what needs to be done?

Depends. They don't perform therapies but many times check in for progress or determine when to consult.

It's too time consuming. When you have legalities for meds or pain injections, you're going to do that with your time.

 

[Healthinfo104]

This would be about the same as asking radiologists if they are taking X-rays themselves or running the MRI machine. Or asking ENT if they do the audiology exam. Or a IM doctor if they are trained in nursing to start IV's, running lines, placing foley's etc.

I was not sure, hence the reason I asked what sort of interventions do PM&R physicians provide?

 

[j4pac]

I was not sure, hence the reason I asked what sort of interventions do PM&R physicians provide?

Have we answered your questions?

 

[Healthinfo104]

Have we answered your questions?

Yes, thank you

 

[Fiveoboy11]

Physicians are not trained or qualified to practice any discipline but their own. And ordering/prescribing or supervising anything beyond their own discipline is nonsense. You can't understand something you have no training in. Just because you're handed a flawed scope of practice or job does't make you qualified or trained to do it.

 

[Healthinfo104]

Physicians are not trained or qualified to practice any discipline but their own. And ordering/prescribing or supervising anything beyond their own discipline is nonsense. You can't understand something you have no training in. Just because you're handed a flawed scope of practice or job does't make you qualified or trained to do it.

I was asking because I know PM&R doctors see patients with a range of issues that impair functioning... so i wasnt sure if that ment they are allowed to treat anything that comes through their door that impairs function including mental disorders.

 

[Kissmyabjj]

This would be about the same as asking radiologists if they are taking X-rays themselves or running the MRI machine. Or asking ENT if they do the audiology exam. Or a IM doctor if they are trained in nursing to start IV's, running lines, placing foley's etc.

This would be a decent analogy, except for the fact that in my (albeit limited) experience so far, very few physiatrists even check to see what the patients they referred even did in therapy. I have been very dissatisfied with our field's knowledge of SPECIFIC protocols and goal-setting in therapy. I get that we may not have the time or skill to provide these therapies ourselves, but we should at the very least be able to specify which exercises should be avoided, how aggressive the therapy should be, etc... It drives me crazy when a patient is asked if he or she has been to therapy for say non-radicular LBP, the patient says yes but that it didn't help, and the physician doesn't even ask what the patient did or bother to check the PT notes to see what approach was used.

 

[jadedphysiotherapist]

This would be a decent analogy, except for the fact that in my (albeit limited) experience so far, very few physiatrists even check to see what the patients they referred even did in therapy. I have been very dissatisfied with our field's knowledge of SPECIFIC protocols and goal-setting in therapy. I get that we may not have the time or skill to provide these therapies ourselves, but we should at the very least be able to specify which exercises should be avoided, how aggressive the therapy should be, etc... It drives me crazy when a patient is asked if he or she has been to therapy for say non-radicular LBP, the patient says yes but that it didn't help, and the physician doesn't even ask what the patient did or bother to check the PT notes to see what approach was used.

I've only seen surgical precautions personally.

Therapists determine exercises, aggressiveness, progression, POC, and protocols themselves now.

 

[j4pac]

I've only seen surgical precautions personally.

Therapists determine exercises, aggressiveness, progression, POC, and protocols themselves now.

I think that much of it is determines by resources. Obviously, if you have therapists highly trained in neuro rehab, then they are very capable of doing the job very well. But when your away from major medical facilities, that know how is much more scarce (especially when it comes to anything other than bread and butter Sports/spine rehab. I'd never assume the therapist knows what the patient needs more than you (though they usually will).

 

[jadedphysiotherapist]

I think that much of it is determines by resources. Obviously, if you have therapists highly trained in neuro rehab, then they are very capable of doing the job very well. But when your away from major medical facilities, that know how is much more scarce (especially when it comes to anything other than bread and butter Sports/spine rehab. I'd never assume the therapist knows what the patient needs more than you (though they usually will).

Agreed. Depends on the sandbox everyone is in.

 

[Fiveoboy11]

This would be a decent analogy, except for the fact that in my (albeit limited) experience so far, very few physiatrists even check to see what the patients they referred even did in therapy. I have been very dissatisfied with our field's knowledge of SPECIFIC protocols and goal-setting in therapy. I get that we may not have the time or skill to provide these therapies ourselves, but we should at the very least be able to specifyd y which exercises should be avoided, how aggressive the therapy should be, etc... It drives me crazy when a patient is asked if he or she has been to therapy for say non-radicular LBP, the patient says yes but that it didn't help, and the physician doesn't even ask what the patient did or bother to check the PT notes to see what approach was used.

Physicians are not trained in physical therapy and therefore it's not within their scope to dictate what will and not be done, aggressiveness, frequency or duration, etc. That's based on the physical therapists evaluation. It's indeterminable by a physician exam. I also agree re the hilariousness of "failed" "PT" in the HPI of elective spine surgeries I constantly see. What failed and PT mean I have no idea. There's never any specifics and I highly doubt any investigating is done in the strong majority of cases. I'd love to see what outcome measures are used (or NOT used that should be) to gauge if improvement is actually occurring regardless of what the patient makes up in their head. In any case physicians are not trained or qualified to gauge the quality of care a patient received. If it's "working" that doesn't mean it's really working and the POC may actually be garbage. If it's "not working", it may actually be working with a perfect POC. And I really don't think the whole "if 'PT' doesn't work we'll do surgery" approach is very smart given patient incapability to know for sure if "it's kinda working 'n' whatnot" and the fact that this likely produces a very big hurdle to climb in a subset of patients.

 

[Jitter Bug]

You criticized physicians for both being too lazy to judge the quality of PT received, and that judging the quality of PT received is not within our "scope". You can't have it both ways.

If you want full autonomy, fine with me. Then you are accountable if it doesn't work. The patient decides if it works or not, cause if they aren't happy they won't come back to see you anymore.

And I will send them to someone else less antagonistic.

 

[jadedphysiotherapist]

Physicians are not trained in physical therapy and therefore it's not within their scope to dictate what will and not be done, aggressiveness, frequency or duration, etc. That's based on the physical therapists evaluation. It's indeterminable by a physician exam. I also agree re the hilariousness of "failed" "PT" in the HPI of elective spine surgeries I constantly see. What failed and PT mean I have no idea. There's never any specifics and I highly doubt any investigating is done in the strong majority of cases. I'd love to see what outcome measures are used (or NOT used that should be) to gauge if improvement is actually occurring regardless of what the patient makes up in their head. In any case physicians are not trained or qualified to gauge the quality of care a patient received. If it's "working" that doesn't mean it's really working and the POC may actually be garbage. If it's "not working", it may actually be working with a perfect POC. And I really don't think the whole "if 'PT' doesn't work we'll do surgery" approach is very smart given patient incapability to know for sure if "it's kinda working 'n' whatnot" and the fact that this likely produces a very big hurdle to climb in a subset of patients.

This isn't the private practice spine surgery forum.....this field is nonsurgical.

His post wasn't antagonistic either.
We don't need to get confrontational....and I've definitely been guilty of that in the past and make jabs here and there.

OP got their questions answered I believe. Probably good to cut it here

 

[Fiveoboy11]

[ d="Jitter e Bug, post: 19346333, member: 274816"]You criticized physicians for both being too lazy to judge the quality Dof PT received, and that judging the quality of PT received is not within our "scope". You can't have it both ways.

If you want full autonomy, fine with me. Then you are accountable if it doesn't work. The patient decides if it works or not, cause if they aren't happy they won't come back to see you anymore.

And I will send them to someone else less antagonistic.[/QUOTE]
Are you telling me there's effort put forth by physicians to judge the quality of physical therapy service on a case by case basis and that it's within their scope to do so? Yet they never do in a legitimate, competent and objective fashion?

I like accountability for my own work. I don't believe in make believe supervision or someone else thinking they are "ultimately responsible" for my work.

 

[jadedphysiotherapist]

There's a percentage that do and a percentage that dont...just like there's a percentage of therapists practicing EBP and CPGs with our field's growing literature and some that dont.

Stop. This isnt a DA or large turf post, its educational. Continue PM or you'll be violating TOS.....and I'm not a saint myself.

Goodnight.

 

[Kissmyabjj]

I've only seen surgical precautions personally.

Therapists determine exercises, aggressiveness, progression, POC, and protocols themselves now.

I get that for the most part and I would never attempt to weigh in on therapy for a super complex case, like severe TBI with hemiparesis. However, it is not uncommon for me to have a productive conversation with a therapist who saw one of my MSK referrals and for us to come away from the conversation with a different opinion than what we entered with. Have any of these conversations changed a PT''s management of the patient? I don't know. But I do know that I have pointed out things that a therapist didn't identify on his or her initial eval and vice versa. I just think that we as physiatrists need to make a conscious effort to UNDERSTAND, not have complete mastery of, the therapy that we are prescribing for our patients. This is especially important in large academic centers in underserved areas, where patients often have to wait months to see PT or OT and the best we have to offer them are cookie cutter HEP's.

 

[jadedphysiotherapist]

I get that for the most part and I would never attempt to weigh in on therapy for a super complex case, like severe TBI with hemiparesis. However, it is not uncommon for me to have a productive conversation with a therapist who saw one of my MSK referrals and for us to come away from the conversation with a different opinion than what we entered with. Have any of these conversations changed a PT''s management of the patient? I don't know. But I do know that I have pointed out things that a therapist didn't identify on his or her initial eval and vice versa. I just think that we as physiatrists need to make a conscious effort to UNDERSTAND, not have complete mastery of, the therapy that we are prescribing for our patients. This is especially important in large academic centers in underserved areas, where patients often have to wait months to see PT or OT and the best we have to offer them are cookie cutter HEP's.

Yes, and that's interdisciplinary teamwork.

 

[cbest]

Physicians are not trained in physical therapy and therefore it's not within their scope to dictate what will and not be done, aggressiveness, frequency or duration, etc. That's based on the physical therapists evaluation. It's indeterminable by a physician exam. I also agree re the hilariousness of "failed" "PT" in the HPI of elective spine surgeries I constantly see. What failed and PT mean I have no idea. There's never any specifics and I highly doubt any investigating is done in the strong majority of cases. I'd love to see what outcome measures are used (or NOT used that should be) to gauge if improvement is actually occurring regardless of what the patient makes up in their head. In any case physicians are not trained or qualified to gauge the quality of care a patient received. If it's "working" that doesn't mean it's really working and the POC may actually be garbage. If it's "not working", it may actually be working with a perfect POC. And I really don't think the whole "if 'PT' doesn't work we'll do surgery" approach is very smart given patient incapability to know for sure if "it's kinda working 'n' whatnot" and the fact that this likely produces a very big hurdle to climb in a subset of patients.

I review the notes PTs send me all the time. I revise plans relatively frequently. I don't think the majority of PTs in my area are very good. I explicitly state in my PT Rx the directional preference of an MDT program or what exercises I want someone to have when trying to get a shoulder rehabbed. I don't want my patients to have their time wasted with US, TENS units, or spending 20 minutes riding a bike. I have discontinued PT if I think my patient is getting suboptimal care and will send the patient to a different therapist. There's good and not-so-good physiatrists, spine surgeons, PTs, etc and I'll do my best to find the best health care providers for my patients.

 

[Fiveoboy11]

Enough

I review the notes PTs send me all the time. I revise plans relatively frequently. I don't think the majority of PTs in my area are very good. I explicitly state in my PT Rx the directional preference of an MDT program or what exercises I want someone to have when trying to get a shoulder rehabbed. I don't want my patients to have their time wasted with US, TENS units, or spending 20 minutes riding a bike. I have discontinued PT if I think my patient is getting suboptimal care and will send the patient to a different therapist. There's good and not-so-good physiatrists, spine surgeons, PTs, etc and I'll do my best to find the best health care providers for my patients.

You're not qualified to start, stop, prescribe or modify a physical therapy POC. The quality of physical therapy and therapists is directly related to you and your colleagues overbearing ways. Learn a different way. Support physical therapist empowerment and it will change in time. Keep on doing what you and your colleagues have been doing forever and you get what you ask for.

 

[j4pac]

Enough

You're not qualified to start, stop, prescribe or modify a physical therapy POC. The quality of physical therapy and therapists is directly related to you and your colleagues overbearing ways. Learn a different way. Support physical therapist empowerment and it will change in time. Keep on doing what you and your colleagues have been doing forever and you get what you ask for.

So...you continue with a failing PT regimen? Isn’t that the definition of insanity? Clearly, the mass majority of therapists have much more knowledge about PT goals than a physiatrist...but if something isn’t working there has to be someone to intervene, and why not it be the physician who’s medical license is on the line? If you seriously think that all PTs are created equal (and that all PT failures are due to overbearing physicians), you are a bit naive and out of touch.

 

[Fiveoboy11]

So...you continue with a failing PT regimen? Isn’t that the definition of insanity? Clearly, the mass majority of therapists have much more knowledge about PT goals than a physiatrist...but if something isn’t working there has to be someone to intervene, and why not it be the physician who’s medical license is on the line? If you seriously think that all PTs are created equal (and that all PT failures are due to overbearing physicians), you are a bit naive and out of touch.

No

Someone to intervene? THE PHYSICAL THERAPIST

It's the PT's license on the line. Get over yourself

There is variance in terms of quality of PT's, but that's no difference from any profession, and yes physician dictatorcare has no doubt had a huge negative impact on my profession

 

[68PGunner]

So...you continue with a failing PT regimen? Isn’t that the definition of insanity? Clearly, the mass majority of therapists have much more knowledge about PT goals than a physiatrist...but if something isn’t working there has to be someone to intervene, and why not it be the physician who’s medical license is on the line? If you seriously think that all PTs are created equal (and that all PT failures are due to overbearing physicians), you are a bit naive and out of touch.

Curious question... Don't you think your OMM education is more than adequate to assess the effectiveness of a PT prescribed regimen?

 

[Fiveoboy11]

Curious question... Don't you think your OMM education is more than adequate to assess the effectiveness of a PT prescribed regimen?

You clearly know little to nothing about the practice of physical therapy, physical therapy education or assessing the effectiveness of physical therapy. OMM education in DO school is ? 1% of physical therapy education all PT's go thru? How do you being OMT trained and all assess "the prescribed PT regimen" anyway?

Scary how ignorant and delusional you are

 

[Kissmyabjj]

No

Someone to intervene? THE PHYSICAL THERAPIST

It's the PT's license on the line. Get over yourself

There is variance in terms of quality of PT's, but that's no difference from any profession, and yes physician dictatorcare has no doubt had a huge negative impact on my profession

So in your opinion, should all PT referrals from physiatrists just state the injury and "evaluate and treat"?

 

[j4pac]

Curious question... Don't you think your OMM education is more than adequate to assess the effectiveness of a PT prescribed regimen?

I don’t think so. A DO straight out of medical school would probably suck at determining effectiveness of PT. I’m a PGY-3 at perhaps the best residency at outpatient MSK in the world (along with having years of experience in practice before residency), and I still have lots to learn about PT prescriptions and determining effectiveness. PTs have a doctorate at focusing on therapy regimens. I know physicians who are probably better than the majority of PTs at therapy management but they are a rare exception. Maybe I’ll get there someday but I’m not there yet.

OMT provides an excellent background on spine anatomy, mechanics, and a guide to palpation. That’s where it’s most useful. I also see it as a very valuable tool to have in your toolbox, and PMR is a specialty that rewards physicians for having tools in their tool bag. Some of it is hocus pocus...but I cannot tell you how many people have thanked me for OMT. For chronic pain patients it a tool when few other tools work...patients appreciate it, even if it may not have long-term efficacy. If you can have a patient leave your office happy and optimistic...that’s an enormous win.

 

[j4pac]

No

Someone to intervene? THE PHYSICAL THERAPIST

It's the PT's license on the line. Get over yourself

There is variance in terms of quality of PT's, but that's no difference from any profession, and yes physician dictatorcare has no doubt had a huge negative impact on my profession

I think your a bit insecure. I send a patient to you with the wrong working diagnosis...it’s your responsibility to make the right decision for the sake of the patient. It is also my responsibility to do what’s in the best interest of the patient. People DO make mistakes...even PT’s...in spite of having more specific training in the field.

Your mindset is a bit dangerous.

 

[jadedphysiotherapist]

Mods, trying to remain professional here and ease things a bit.

Curious question... Don't you think your OMM education is more than adequate to assess the effectiveness of a PT prescribed regimen?

Don't take this as antagonistic.

No, because there is a large difference between seeing the content on powerpoint and having boards questions on it, compared to implementing interventions daily for 30-60 minutes a session. OMM is only a subset of practice as well, and good therapists are changing their plans while referencing physical therapy research which have their own journals....and the literature has grown extensively.

I use this as a comparison quite a bit:
A psychologist using psychotherapy at week 3 shouldn't require psychiatric consultation and input into their treatment effectiveness, unless it's discourse over pharmaceuticals, managing the same condition. Psychiatrists and psychologists have some pretty solid interprofessional respect and work well even with conservative competition between them. Therapists aren't there yet....but we can get there.

So in your opinion, should all PT referrals from physiatrists just state the injury and "evaluate and treat"?

It depends.

The physiatrists I've seen at some places do that, as they have mutual respect among the disciplines' decisionmaking, although I don't think new grads (PTs) have that directly upon graduation, as you don't have enough cases under your belt, which is why there is a desire for a residency year and to change the training pathway....the problem is making it financially viable.

If you have precautions you're concerned about, I would like to see that personally in notes, which is where emr works well. I try to reference everything before the pt. walks in.

I've also seen places where a simple, generic icd pain diagnosis is given, and the therapist is doing all differential, explaining imaging to patients via emr after it has been ordered and billed in a different room, and tx themself while the referrer is a steady referral source stream, making marketing unnecessary.

Again each setup is different.

I think your a bit insecure. I send a patient to you with the wrong working diagnosis...it’s your responsibility to make the right decision for the sake of the patient. It is also my responsibility to do what’s in the best interest of the patient. People DO make mistakes...even PT’s...in spite of having more specific training in the field.

Your mindset is a bit dangerous.

To comment on one thing mentioned, it is the therapist license on the line, is it not? I'm not sure on your setup, maybe yours is too, I'm not sure.

This is different than the NP and CRNA dynamic though, in which they are actually under supervision using the same legalities, and errors will cost the attending their license, as they cosign.

You seem very approachable for discussion by the way.

 

[j4pac]

Mods, trying to remain professional here and ease things a bit.



Don't take this as antagonistic.

No, because there is a large difference between seeing the content on powerpoint and having boards questions on it, compared to implementing interventions daily for 30-60 minutes a session. OMM is only a subset of practice as well, and good therapists are changing their plans while referencing physical therapy research which have their own journals....and the literature has grown extensively.

I use this as a comparison quite a bit:
A psychologist using psychotherapy at week 3 shouldn't require psychiatric consultation and input into their treatment effectiveness, unless it's discourse over pharmaceuticals, managing the same condition. Psychiatrists and psychologists have some pretty solid interprofessional respect and work well even with conservative competition between them. Therapists aren't there yet....but we can get there.



It depends.

The physiatrists I've seen at some places do that, as they have mutual respect among the disciplines' decisionmaking, although I don't think new grads (PTs) have that directly upon graduation, as you don't have enough cases under your belt, which is why there is a desire for a residency year and to change the training pathway....the problem is making it financially viable.

If you have precautions you're concerned about, I would like to see that personally in notes, which is where emr works well. I try to reference everything before the pt. walks in.

I've also seen places where a simple, generic icd pain diagnosis is given, and the therapist is doing all differential, explaining imaging to patients via emr after it has been ordered and billed in a different room, and tx themself while the referrer is a steady referral source stream, making marketing unnecessary.

Again each setup is different.



To comment on one thing mentioned, it is the therapist license on the line, is it not? I'm not sure on your setup, maybe yours is too, I'm not sure.

This is different than the NP and CRNA dynamic though, in which they are actually under supervision using the same legalities, and errors will cost the attending their license, as they cosign.

You seem very approachable for discussion by the way.

Mods, trying to remain professional here and ease things a bit.



Don't take this as antagonistic.

No, because there is a large difference between seeing the content on powerpoint and having boards questions on it, compared to implementing interventions daily for 30-60 minutes a session. OMM is only a subset of practice as well, and good therapists are changing their plans while referencing physical therapy research which have their own journals....and the literature has grown extensively.

I use this as a comparison quite a bit:
A psychologist using psychotherapy at week 3 shouldn't require psychiatric consultation and input into their treatment effectiveness, unless it's discourse over pharmaceuticals, managing the same condition. Psychiatrists and psychologists have some pretty solid interprofessional respect and work well even with conservative competition between them. Therapists aren't there yet....but we can get there.



It depends.

The physiatrists I've seen at some places do that, as they have mutual respect among the disciplines' decisionmaking, although I don't think new grads (PTs) have that directly upon graduation, as you don't have enough cases under your belt, which is why there is a desire for a residency year and to change the training pathway....the problem is making it financially viable.

If you have precautions you're concerned about, I would like to see that personally in notes, which is where emr works well. I try to reference everything before the pt. walks in.

I've also seen places where a simple, generic icd pain diagnosis is given, and the therapist is doing all differential, explaining imaging to patients via emr after it has been ordered and billed in a different room, and tx themself while the referrer is a steady referral source stream, making marketing unnecessary.

Again each setup is different.



To comment on one thing mentioned, it is the therapist license on the line, is it not? I'm not sure on your setup, maybe yours is too, I'm not sure.

This is different than the NP and CRNA dynamic though, in which they are actually under supervision using the same legalities, and errors will cost the attending their license, as they cosign.

You seem very approachable for discussion by the way.

I didn’t mean to imply that PTs don’t have licenses to maintain. I meant to say that my license and my patients well-being will not be tied to what I believe to be the wrong management by a PT. Granted...the PT is going to be making the right decisions more often than not, but nobody’s perfect. I spent 5 years performing primary care in the military before my residency, with very little resources in regards to PT. We had one military PT for thousands of service members, and I’d say that the PT was just so-so at their job, which was made significantly worse by the impossible demand. So...I did way more therapy prescriptions than I should have out of necessity. Now...I’m in a resource rich environment with much more trained therapists. Believe me, I understand the value of PT. Physiatrists are not a replacement, not even close. But I think we can complement each other well.

 

[jadedphysiotherapist]

I didn’t mean to imply that PTs don’t have licenses to maintain. I meant to say that my license and my patients well-being will not be tied to what I believe to be the wrong management by a PT. Granted...the PT is going to be making the right decisions more often than not, but nobody’s perfect. I spent 5 years performing primary care in the military before my residency, with very little resources in regards to PT. We had one military PT for thousands of service members, and I’d say that the PT was just so-so at their job, which was made significantly worse by the impossible demand. So...I did way more therapy prescriptions than I should have out of necessity. Now...I’m in a resource rich environment with much more trained therapists. Believe me, I understand the value of PT. Physiatrists are not a replacement, not even close. But I think we can complement each other well.

That's perfectly fine and it sounds like you have a lot of experiential knowledge.

I misinterpreted your comment, in that I thought you meant you would be losing your license, instead of the therapist, for the therapist practicing poorly.

I know this is a problem for many attendings that work with crna and np under their license.

Thank you for your service in the military.

 

[nvrsumr]

PT is not much better than general aerobic activity and mild resistance rom for msk. There is a personal trainer accountability aspect that is helpful

 

[jesspt]

PT is not much better than general aerobic activity and mild resistance rom for msk. There is a personal trainer accountability aspect that is helpful

You're going to kill @Fiveoboy11. Like, literally give him a stroke.

 

[jesspt]

A DO straight out of medical school would probably suck at determining effectiveness of PT.

I think they would be fine. determining efficacy isn't that hard.

Clinician: "Are your symptoms improving?
Patient: "Yes."
Clinician: "When you do the exercises that your physical therapist provided, do your symptoms get better?"
Patient: "Yes."

PT interventions/plan of care for that patient = efficacious.

 

[j4pac]

I think they would be fine. determining efficacy isn't that hard.

Clinician: "Are your symptoms improving?
Patient: "Yes."
Clinician: "When you do the exercises that your physical therapist provided, do your symptoms get better?"
Patient: "Yes."

PT interventions/plan of care for that patient = efficacious.

When the answer is yes...then I agree, it’s easy. When the answer is no...definitely more difficult. Send the patient back to PT for re-eval...but at some point our have to think about what your missing or question the PT strategy. That doesn’t happen very often, but it does happen. In those cases, it’s nice to have a specialist to refer.

 

[jesspt]

When the answer is yes...then I agree, it’s easy. When the answer is no...definitely more difficult. Send the patient back to PT for re-eval...but at some point our have to think about what your missing or question the PT strategy. That doesn’t happen very often, but it does happen. In those cases, it’s nice to have a specialist to refer.

Agreed. It is more difficult when the patient has not improved. Hopefully you receive some communication from the PT that expands on the treatment the patient received (as well as possible barriers to improvement).

 

[jadedphysiotherapist]

When the answer is yes...then I agree, it’s easy. When the answer is no...definitely more difficult. Send the patient back to PT for re-eval...but at some point our have to think about what your missing or question the PT strategy. That doesn’t happen very often, but it does happen. In those cases, it’s nice to have a specialist to refer.

What is your opinion on emr for communication?

 

[j4pac]

What is your opinion on emr for communication?

I like it quite a bit if it’s something straight forward. A question like “what do you think about Baclofen for patient so and so” is a great EMR convo. But if it’s a complicate conversation or one that can be misinterpreted as being critical I’d rather do it in person or over the phone.

 

[Fiveoboy11]

PT is not much better than general aerobic activity and mild resistance rom for msk. There is a personal trainer accountability aspect that is helpful

Not a doubt in my mind when you're involved as part of the "team." Take a dufus like you out of the equation and the quality/outcome improves

 

[pmrmd]

PT is not much better than general aerobic activity and mild resistance rom for msk. There is a personal trainer accountability aspect that is helpful

Very true. Most DPT/PTs utilize completely unrelated and useless forms of exercise as their "treatment"program as well as over-utilization of dry needling.

Not a doubt in my mind when you're involved as part of the "team." Take a dufus like you out of the equation and the quality/outcome improves

This is a PM&R forum sport. No one is asking for your deranged opinion on anything. BTW: I give out therapeutic exercise and incorporate modalities like traction as a part of my practice because A. I'm educated on it. B. I know how to provide it. C. P.T.s don't do it anymore because they would rather dry needle everything because they have no concept of pathophysiol0gy. D. It works and provides a benefit. and E. kcuF you, you insecure troll.

 

[SSdoc33]

i get tired of trying to convince my patients of the benefit of therapy. most just dont give a sh$t about themselves to care enough. if they put in their time and work, it probably helps some patients. stenosis, intra-articular stuff, run of the mill OA? nope.

 

[DMBandFan86]

But my question is, are physiatrists trained in forming treatment plans specific to the kind of movements and activities that rehab patients are supposed to do?

not as well as therapists are.

or do PT's come up with the regimen alone and physiatrist just prescribe PT?

You can write a therapy prescription for generic PT, or write the prescription for a specific treatment. Whether or not the therapist does the said treatment depends on the therapist and their own assessment.

And this may be kind of a stupid question, but just like someone who suffers from HFpEF needs different treatments from a pt who suffers from a COPD exacerbation, the regimen for cardio rehab for a heart failure pt should differ from pulmonary rehab for a COPD pt right?

Pulmonary and cardiac rehab are relatively similar. Exercise, increase endurance, time ==> get better.

And will we as future physiatrists be part of designing the regimen for a cardio rehab patient like a cardiologist would design a treatment plan for a heart failure pt?

There are specific cardiac and pulmonary rehab centers and pretty standard treatments. Start slow and increase endurance until they can do the rehab themselves at home or fail.