Our last post on TDN not being physical therapy has generated substantive discussion. In my many years as a PT, I have seldom seen so many PT’s rush for CE on TDN, fight for legislative rights to perform TDN, and use TDN as a way to differentiate their clinic or themselves in the marketplace. Whether you are an advocate or not, let’s at least admit to its acceleration as a seldom or mildly used intervention to its ubuquitous availability in the ortho world of PT.
Which reminds me of a marketing and business concept that we teach within EPPM-that is, the race for differentiation has really turned into the race for sameness (Moon, 2010). The fact of the matter is that the more PT’s try and differentiate ourselves through interventions or equipment, the more we are really just herding toward sameness and an inability for our customers (primarily our patients and those who recommend or refer to PT) to distinguish us in the healthcare marketplace. The net effect is that we in essence become even more of a commodity (like bottle water or for that matter protein bars) and an expensive one at that (just add up the CE dollars for all of these interventions and equipment that are added to the already over priced PT school tuition). Ironically, in an attempt to make us more competitive, we have spent so much time, energy, and money that we are really less competitive and subject to even more substitutes in the market (e.g. acupuncturist vs. a TDN PT, personal trainer vs. a PT in a medically-oriented gym or MOG). I also believe that we are constantly confusing consumers as to who we really are and what we really do. Said differently, we probably were a little bit easier to understand when we were just known as reconstruction aides (ok, that’s a little over the top but you get the point).
The real question then is in the evolving healthcare landscape, what really does differentiate a PT and physical therapy?
-Are we THE conservative alternative to surgery and medication?
-Are we THE experts in “aches and pains” and work with you to overcome them?
-Are we THE group that introduces new treatment interventions that decrease pain and improve function?
About a year ago, we had some extensive consumer research done by a specialty group that drilled down the question of what patients want from a physical therapy perspective (David Browder and I presented this at PPS). Phase I yielded 370 items (side note, none of the responses mentioned stretchy tape, needles, shoehorns, or cranial suture manipulation) which was narrowed to a top 9 and then put through extensive conjoint (trade off) analysis including the introduction of low and high copays to see if the results changed. Two of the top 5 were “clear instructions from the therapist” and “all staff are friendly”. Puzzled initially, it only takes a few minutes of research to understand this from the patient’s perspective-typically instructions given by healthcare professionals are horrific (see this prior post here). In addition, it is also very clear that most healthcare professionals counter-intuitively lack empathy (see this systematic review here and post on our secret sauce here as well as this blog post and survey on what makes a good doctor).
Which begs the question on what clearly differentiates physical therapy? Could it simply be empathy and giving clear instructions? While this might be common sense, it is clearly uncommon practice-at least that’s what our patients are telling us.
Genuinely interested in your thoughts on this important topic.
@physicaltherapy
