Physician Script

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Wow that's bad. What do you do with a script like that (seriously)?
 
I am not quite sure how to handle that scenario. Notice how "eval and treat" isn't even checked. Physical Therapists HAVE to evaluate each and every patient. AND, we treat based on necessity and the evaluation. NOT the script. We don't get a script and bring patient's on back for their "E-stim, massage, US, HP." What a joke. If it were up to me this quack would permanently be stripped of physical therapy referral priveleges and be forced to write a 100 page literature review on the effectiveness of above mentioned treatments for neck pain.
 
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I am not quite sure how to handle that scenario. Notice how "eval and treat" isn't even checked. Physical Therapists HAVE to evaluate each and every patient. AND, we treat based on necessity and the evaluation. NOT the script. We don't get a script and bring patient's on back for their "E-stim, massage, US, HP." What a joke. If it were up to me this quack would permanently be stripped of physical therapy referral priveleges and be forced to write a 100 page literature review on the effectiveness of above mentioned treatments for neck pain.

But seriously what would you do if you got this script? Would you call up the physician to discuss the treatment goals?
 
But seriously what would you do if you got this script? Would you call up the physician to discuss the treatment goals?


Honestly I would probably refuse to see the patient. Doing an evaluation on that person would make me very uneasy. And calling that physician would probably be futile because it has already been demonstrated that he/she knows little to nothing about effectiveness of interventions.

Fozzy, do you have any recommendations about what to do in this case?
 
Working in a PT clinic as the person who did all the patient intake/received all the scripts from MDs, I've seen stuff like this before. Usually, when it says "no active exercise" there's a reason the MD says that (although a general "neck pain" dx isn't all that specific...generally it says "no active exercise" when there's a severe danger/risk/issue, like surgery, car accident injury, etc.) In those cases the PT would often call the MD to discuss treatment options, unless the MD faxed over the patient's visit notes that adequately describes the reasoning.

While it's possible that MD is stupid and ignorant about PT, it's also just as likely that he had a reason for it. Without knowing the full case history, it's hard to know. Maybe the patient had a history of neck problems/broke a cervical vertebrae in the past and now has symptoms again and the MD is worried about further injury - the MD may want to see if the symptoms will go away with basic modalities first and not risk further problems. It might be part of a protocol he has for something. He seems quite emphatic about the no manual therapy/exercise, so I'm sure there's some sort of reason behind it.
 
But seriously what would you do if you got this script? Would you call up the physician to discuss the treatment goals?


I'd call the doc. Refusing to see the patient doesn't help the patient at all. And, it's quite possible that the physician has had one, or a few, bad experiences when referring patients to PT. We have more than our fair share of clinicians in our profession who are of the "more is better" camp - if 10 hard reps are good, well, 20 will be better. If the patient is writhing around on the table when you're stretching them, well, just stretch harder.It doesn't take too many times of referring a patient to this type of provider to develop some hesitancy on the physician's part. But, I can't know that unless I call him/her. And, I have a much better foundation to educate this provider from if I know where they are coming from, so to speak.

And, based on this prescription, it seems like the physician wants to take a fairly conservative approach, and I'd like to know why. Is there considerable relevant pathology? If so, I need to know that. Hopefully, open communication leads to a better understanding of what physical therapy can and can't offer to this physician regarding this patient as well as future patients.
 
I'd call the doc. Refusing to see the patient doesn't help the patient at all. And, it's quite possible that the physician has had one, or a few, bad experiences when referring patients to PT. We have more than our fair share of clinicians in our profession who are of the "more is better" camp - if 10 hard reps are good, well, 20 will be better. If the patient is writhing around on the table when you're stretching them, well, just stretch harder.It doesn't take too many times of referring a patient to this type of provider to develop some hesitancy on the physician's part. But, I can't know that unless I call him/her. And, I have a much better foundation to educate this provider from if I know where they are coming from, so to speak.

And, based on this prescription, it seems like the physician wants to take a fairly conservative approach, and I'd like to know why. Is there considerable relevant pathology? If so, I need to know that. Hopefully, open communication leads to a better understanding of what physical therapy can and can't offer to this physician regarding this patient as well as future patients.

👍 that's what I was trying to get at, but my words were failing me. Too many presentations/papers this week I've lost my ability to be articulate haha.
 
I'd call the doc. Refusing to see the patient doesn't help the patient at all. And, it's quite possible that the physician has had one, or a few, bad experiences when referring patients to PT. We have more than our fair share of clinicians in our profession who are of the "more is better" camp - if 10 hard reps are good, well, 20 will be better. If the patient is writhing around on the table when you're stretching them, well, just stretch harder.It doesn't take too many times of referring a patient to this type of provider to develop some hesitancy on the physician's part. But, I can't know that unless I call him/her. And, I have a much better foundation to educate this provider from if I know where they are coming from, so to speak.

And, based on this prescription, it seems like the physician wants to take a fairly conservative approach, and I'd like to know why. Is there considerable relevant pathology? If so, I need to know that. Hopefully, open communication leads to a better understanding of what physical therapy can and can't offer to this physician regarding this patient as well as future patients.

I agree with what jesspt has said. Open line of communication is key. Plus, if you know the research, you should propose your plan and back it up. This is a great opportunity to be a patient advocate and help educate physicians!
 
I agree with what jesspt has said. Open line of communication is key. Plus, if you know the research, you should propose your plan and back it up. This is a great opportunity to be a patient advocate and help educate physicians!

A script like this should always be accompanied by a physician phone call, it is a matter of professional respect and courtesy. Too bad physician's think they can just make check marks and lines all over the place, and "order" what they want. Reasoning for pathology and intervention with medicine and reasoning for referral to PT and intervention are not one in the same.
 
A script like this should always be accompanied by a physician phone call, it is a matter of professional respect and courtesy. Too bad physician's think they can just make check marks and lines all over the place, and "order" what they want.

There you go over-generalizing again. The one prescription that you posted is not representative of every prescribing physician. If you claim to know what is best, then pick up the phone of educate the physician prescribing it.

Reasoning for pathology and intervention with medicine and reasoning for referral to PT and intervention are not one in the same.

You say this all the time in other posts. I'm not sure what this has to do with the post.
 
There you go over-generalizing again. The one prescription that you posted is not representative of every prescribing physician. If you claim to know what is best, then pick up the phone of educate the physician prescribing it.



You say this all the time in other posts. I'm not sure what this has to do with the post.


Overgeneralizing? Perhaps I have been imagining all the scripts that say specific interventions that are worthless, and "ROM and strengthening." My goodness residency programs sure hit the nail on the head when it comes to physical therapy. Physician's should respect that PT's know best in the first place and not suggest interventions they know nothing about.
 
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Perhaps I have been imagining all the scripts that say specific interventions that are worthless
Unless you have seen every script written by a physician in every region of the country and the world...generalizing.

My goodness residency programs sure hit the nail on the head when it comes to physical therapy.
I do not disagree that most physicians do not know how to write a good therapy prescription. However, when I brought up this same issue on a different thread it seems as though some of the posters on this thread prefer a more general "evaluate and treat." Interesting.

Physician's should respect that PT's know best in the first place and not suggest interventions they know nothing about.
When this thread first started I asked you what you were going to do with the prescription you said you were going to refuse to see the patient. Not helpful.

Instead of complaining about the way things are, why don't you do something about it? Educate your local providers about what it is that you do and when to refer. That seems more productive than going through the effort of scanning, uploading, and posting a bad referral to therapy to an internet forum where neither the patient or prescribing provider will benefit.
 
Unless you have seen every script written by a physician in every region of the country and the world...generalizing.


I do not disagree that most physicians do not know how to write a good therapy prescription. However, when I brought up this same issue on a different thread it seems as though some of the posters on this thread prefer a more general "evaluate and treat." Interesting.


When this thread first started I asked you what you were going to do with the prescription you said you were going to refuse to see the patient. Not helpful.

Instead of complaining about the way things are, why don't you do something about it? Educate your local providers about what it is that you do and when to refer. That seems more productive than going through the effort of scanning, uploading, and posting a bad referral to therapy to an internet forum where neither the patient or prescribing provider will benefit.


I didn't upload this script. I found it on a PT website, the clinic is in TX. I actually am a PT in AZ. I found the PT clinic website from the script. www.Texpts.com Looks to me like the staff is quite impressive.

Grassroots efforts are not what is needed here: See above clinic website. Obviously successful, with many clinician's going above and beyond required education. And still, a physician writes a bonehead PT referral. I've worked in other clinics with PT's with extensive post grad training leading to FAAOMPT, and still *****ic scripts. What is needed is a radical overhall of PT/Physician interaction in terms of insurance, law, and mutual professional respect. THEN, over time you would see much better outcomes, and I'm willing to bet better interaction and communication.
 
Grassroots efforts are not what is needed here: See above clinic website. Obviously successful, with many clinician's going above and beyond required education. And still, a physician writes a bonehead PT referral. I've worked in other clinics with PT's with extensive post grad training leading to FAAOMPT, and still *****ic scripts. What is needed is a radical overhall of PT/Physician interaction in terms of insurance, law, and mutual professional respect. THEN, over time you would see much better outcomes, and I'm willing to bet better interaction and communication.

Well, agree to disagree. I think education is a huge part of developing the relationship between physical therapy and physicians. I'm not surprised that physicians are writing good prescriptions. We aren't taught anything about physical therapy in school. So if you want good referrals, you need to educate those who aren't familiar with your full scope of practice. Education is key from my perspective.
 
I didn't upload this script. I found it on a PT website, the clinic is in TX. I actually am a PT in AZ. I found the PT clinic website from the script. www.Texpts.com Looks to me like the staff is quite impressive.

Yup, the staff is fairly impressive. In fact, the PT who posted this prescription is one of the authors of this study. And, unfortunately, you missed his whole point of the post. For those who don't frequent the Evidence In Motion blog, I'll quote his post below:

This patient really does exist. He’s a rancher down here in South Texas. 5am he’s already out digging fence posts, pulling wire, pitching hay, or rebuilding cattle guards…and he stays at it until dusk, occasionally stopping for a glass of ice tea or a taco.
We’ve all seen this type of referral at one point or another. The question is how to handle it when it comes. Do we take responsibility for this patient’s outcome and simply ignore the referral requests? Do we follow the requests and then blame the shoddy outcomes on the referring provider? Or maybe we allow that gnawing feeling in our viscera loose to argue the valor of current EBP or just the sheer stupidity of the logic in “no active exercise” to the referring provider.
How do you coach your residents or fellows to handle these?
I think that a good approach with this type of encounter is to be very direct. Pick up the phone or get over there and visit the doc.
Seek to understand first.
Why is he so specific in his requests? You'd like to understand... He may have had a bad experience with a PT or he may be looking simply for pain relief and not wanting to "stimulate" the irritated nerve region too much... etc. Get his perspective (don't start off trying to change it), and then gently and humbly answer his concerns and offer why the EBP approach can perhaps better reach his aim/intent which is hopefully yours as well.

Bottom line: Look to build a relationship and collaborate with this referring provider vs. compete for "best knowledge" on managing these patients. His student loans are larger than yours. His perspective is that he's got the edge on "best knowledge".
ab

And, to respond to the last part of your previous post, quoted here (my emphasis added):
I've worked in other clinics with PT's with extensive post grad training leading to FAAOMPT, and still *****ic scripts. What is needed is a radical overhall of PT/Physician interaction in terms of insurance, law, and mutual professional respect. THEN, over time you would see much better outcomes, and I'm willing to bet better interaction and communication

You discuss mutual respect, but offer none in your posts about physicians and their "*****ic" scripts. It has been my experience that respect needs to be earned, whereas you appear to want it awarded to you on minimal to no merit. Solely ranting and raving about the what is wrong with the current system won't make referral sources, other health care providers, or your peers respect you. Acting as a knowledgeable physical therapist, and a professional who is able to discuss conservative care of musculoskeletal injuries in a rational way, might be a good start. I know that an internet forum isn't always the best way to convey one's opinion as some significant non-verbal communication gets lost, but I don't think that I'm alone in sensing some venom and vitriol coming from your posts.
 
Yup, the staff is fairly impressive. In fact, the PT who posted this prescription is one of the authors of this study. And, unfortunately, you missed his whole point of the post. For those who don't frequent the Evidence In Motion blog, I'll quote his post below:



And, to respond to the last part of your previous post, quoted here (my emphasis added):


You discuss mutual respect, but offer none in your posts about physicians and their "*****ic" scripts. It has been my experience that respect needs to be earned, whereas you appear to want it awarded to you on minimal to no merit. Solely ranting and raving about the what is wrong with the current system won't make referral sources, other health care providers, or your peers respect you. Acting as a knowledgeable physical therapist, and a professional who is able to discuss conservative care of musculoskeletal injuries in a rational way, might be a good start. I know that an internet forum isn't always the best way to convey one's opinion as some significant non-verbal communication gets lost, but I don't think that I'm alone in sensing some venom and vitriol coming from your posts.

Thanks for finding the context🙂 👍
 
I reserve my "acting" as a knowledgeable physical therapist for when I am actually practicing physical therapy. I'm utilizing this board as a way to express and vent my frustrations and be a proponent to the profession and advocate for change to an antiquated and baseless system. You are using it as a way to have friendly conversations with others about issues relating to PT, and debate/discuss evidence. What is wrong with your way versus mine? You do not dictate the discussions that take place here. In practice, I have always shown professional respect toward physician's over the phone, in person and with patient's. Physician's (on average) have not done the same IMO with regard to written referrals or the profession of physical therapy in general.

I just don't see the maximum potential of the PT profession and maximum benefit for the patient being reached with phone calls to educate physician's and "earning" respect over time as Jesspt says. The above methods are already being utilized as they've always been. How's that working?
 
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I reserve my "acting" as a knowledgeable physical therapist for when I am actually practicing physical therapy.

See, there's part of the problem (as I perceive it). I haven't been around you when you've actually practiced. I can only base my perception of your characteristics as a physical therapist on our interactions here, and based on that, my perception (and it may be only mine, but I doubt it) is that you're bitter and angry. I understand that you're using this forum to vent, but frankly, given the lack of licensed clinicians on these boards, I think you might find more satisfaction on RehabEdge or the Evidence in Motion blog.

I'm utilizing this board as a way to express and vent my frustrations and be a proponent to the profession and advocate for change to an antiquated and baseless system

My approach to being an advocate and yours are quite different. I can't see how being rude, calling other health care providers "*****s", etc. is going to advance our profession.

You do not dictate the discussions that take place here.

Nor do I ever intend to. I am usually glad to see that you have posted or started another thread.

I just don't see the maximum potential of the PT profession and maximum benefit for the patient being reached with phone calls to educate physician's and "earning" respect over time as Jesspt says.

Now, where did I ever say that was how we should reach the maximum potential for our profession? You are taking my words out of context as an attempt to argue your position. I was citing an example of how I would respond if a patient of mine came into my clinic with the prescription that you posted when you started this thread. And, speaking of the maximum benefit for the patient, how exactly does this achieve the maximum benefit:
Honestly I would probably refuse to see the patient.

The above methods are already being utilized as they've always been. How's that working?

I've got to say, that for me, they seem to work fairly well in regards to my daily practice. I just don't get prescriptions from referral sources who know me that look like the example you posted. I agree with you that our profession remains poorly understood by those outside of it, physicians and patients alike. But "raging against the machine, without taking pause to offer sound reasoning, will get us nowhere. And I rarely hear or see your reasoning process in your posts. Additionally, part of our problem is internal. We've got a lot of PTs who look at themselves like glorified personal trainers, and when they make that phone call to a referral source, they can't talk to them as a peer or even a well educated resource for the physician. That certainly won't help us make the changes that we both want to see for our profession.
 
See, there's part of the problem (as I perceive it). I haven't been around you when you've actually practiced. I can only base my perception of your characteristics as a physical therapist on our interactions here, and based on that, my perception (and it may be only mine, but I doubt it) is that you're bitter and angry. I understand that you're using this forum to vent, but frankly, given the lack of licensed clinicians on these boards, I think you might find more satisfaction on RehabEdge or the Evidence in Motion blog.



My approach to being an advocate and yours are quite different. I can't see how being rude, calling other health care providers "*****s", etc. is going to advance our profession.



Nor do I ever intend to. I am usually glad to see that you have posted or started another thread.



Now, where did I ever say that was how we should reach the maximum potential for our profession? You are taking my words out of context as an attempt to argue your position. I was citing an example of how I would respond if a patient of mine came into my clinic with the prescription that you posted when you started this thread. And, speaking of the maximum benefit for the patient, how exactly does this achieve the maximum benefit:




I've got to say, that for me, they seem to work fairly well in regards to my daily practice. I just don't get prescriptions from referral sources who know me that look like the example you posted. I agree with you that our profession remains poorly understood by those outside of it, physicians and patients alike. But "raging against the machine, without taking pause to offer sound reasoning, will get us nowhere. And I rarely hear or see your reasoning process in your posts. Additionally, part of our problem is internal. We've got a lot of PTs who look at themselves like glorified personal trainers, and when they make that phone call to a referral source, they can't talk to them as a peer or even a well educated resource for the physician. That certainly won't help us make the changes that we both want to see for our profession.

There have been plenty of posts I've made that have been civil. You are just easy to jump on my back when I don't post in the way you think I should. At least I have enough guts to say what I actually think and discuss the real issues. Instead of prancing around and sugar coating everything (and I'm not saying you do).

Yes, I am angry. We are part of a profession that has so much potential, and I would argue just as much if not more than any healthcare profession. But, we are held down in an inappropriate manner, limiting the capacity to reach the potential.

I concede there are PT's who are bonehead "old school" practitioners. But I also contend that this does not change or isn't affected in a positive way by how PT's are forced to practice today. If PT's are allotted (or even forced) to practice as actual professionals, they will be need to learn and know at a much higher level, and there will be more incentive to do so. Currently, it is more of a learn on your own if you feel like it type of deal. The profession will NEVER advance as a whole this way. The potential will never be reached, and patient's will never get the best care possible for conservative management of NMSK issues.
 
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