We started a series entitled Physical Therapist Pet Peeves a few weeks ago with #1 being the term “skilled physical therapy”.
Pet Peeve #2 is the the referral for a “trial of physical therapy”. The scenario usually unfolds like this. A patient with low back pain who has been seen by their primary care doctor is now referred to a spine doc. The first level of treatment was a “trial of anti-inflammatories” and in all likelihood pain medication. Since the patient didn’t respond entirely to the meds and complaints include some radiation to the leg, the patient was referred to a “specialist” who ordered an MRI (and if the doc owned the MRI, evidence shows it was self-referred). There was undoubtedly seen some “bulging disk(s)”. The specialist believes that surgery would relieve the symptoms. However, the patients insurance will not approve the surgery unless a “trial of physical therapy” did not result in improvement. The conversation: “Mrs. Jones, you need surgery. Unfortunately, your $%X@^ insurance company won’t let me help you and they say you have to have a “trial physical therapy” which of course can’t possibly help a surgical condition. Perhaps it was a little softer conversation, “Mrs. Jones, you need surgery but let’s do a “trial of physical therapy””. In all likelihood, this “trial” was done in the physician’s own PT clinic. Regardless of where treatment was sought, there is no basis or assurance that the physical therapist upholds the best current evidence in the treatment of LBP (another post for another time). I refer to this scenario which occurs every day (and several times a day if you live in Greeley, CO), as being “set up by the knife”.
Today, the so called “Iowa study” was published which shows not surprisingly that directly accessing a PT results in lower overall cost associated with the initiating complaint and less visits then when referred by a physician to a physical therapist. Imagine if patient consumers really weren’t brainwashed by language such as “trial of physical therapy”. Just imagine the savings in unnecessary tests and medications (or just read this post about a recent published paper of the impact of direct access for LBP). With 2 legs of the stool now in the public domain (direct access and savings in downstream costs for LBP done by a PT), we now only need a referral for profit study published to propel independent PT’s to the upper echelon of the food chain.
We don’t tell patients, “you appear to have an ear infection, let’s do a “trial of primary care””. We don’t tell patients, “you have torn ACL, let’s do a “trial of orthopedic surgery””. So, it is time to represent physical therapists as what we are, a solution and the preferred specialist referral option based on evidence, not a modality with the same poor odds of success as an anti-inflammatory medication.
Thoughts?
@physicaltherapy
