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I was thinking about fields with mid-levels who have a pretty large scope, like CRNAs or optometrists. Is PT similar, or is it just that the two fields work together but have different capabilities?
I was thinking about fields with mid-levels who have a pretty large scope, like CRNAs or optometrists. Is PT similar, or is it just that the two fields work together but have different capabilities?
The question is there overlap? Sure there is. I spend quite a bit of time discussing and demonstrating an exercise program that is specific to the patient. Certain modalities are better than others and can be helpful in hastening the patient's recovery.
In the real world you will see P.T.s who think they know more than they actually do providing more "treatment" than they actually should. Take the obvious reply above as an example.
This was directed at my input?
Sorry, not at all. You were right on the money. More toward a certain late December poster.
Let me be more specific to the student O.P. In the inpatient world there is daily collaboration, as there should be. I believe the therapists play an invaluable role and help people tremendously. I have nothing bad to say about that aspect.
Its the outpatient world is where we see the trend I mentioned.
Does every patient with a pain need dry needling? Because they get it, even with obvious exam findings of radiculopathy.
Does every patient with a pain need hot packs and cold packs on the same visit? Because they get it.
Does every patient need electrical stimulation as a part of their regimen? Because they get it.
Does every patient need neuromuscular retraining exercises? Because they get it. And since the whole premise behind this and result of this are debatable, let's leave that for another time.
Does every patient need core strengthening? Because they get it, even though there is no way to accurately and precisely measure baseline levels and gains.
Traction is still a great modality. Rarely do people get it. Because it doesn't work? No. Because its time intensive and requires a 1:1 therapist to patient ratio rather than the passive modalities that seem to allow a better income stream.
Do I really need to send my patient for three months of the above bull**** when there is an obvious facet pain by history, examination, and imaging? Yes, because the P.T. lobby has done well with the government bureaucrats it seems. Is the above treatment regimen more expensive than a facet block x 2 and RF? Absolutely.
There are quite a few basic questions that seem to be unanswered and overlooked every day.
Sorry, not at all. You were right on the money. More toward a certain late December poster.
Let me be more specific to the student O.P. In the inpatient world there is daily collaboration, as there should be. I believe the therapists play an invaluable role and help people tremendously. I have nothing bad to say about that aspect.
Its the outpatient world is where we see the trend I mentioned.
Does every patient with a pain need dry needling? Because they get it, even with obvious exam findings of radiculopathy.
Does every patient with a pain need hot packs and cold packs on the same visit? Because they get it.
Does every patient need electrical stimulation as a part of their regimen? Because they get it.
Does every patient need neuromuscular retraining exercises? Because they get it. And since the whole premise behind this and result of this are debatable, let's leave that for another time.
Does every patient need core strengthening? Because they get it, even though there is no way to accurately and precisely measure baseline levels and gains.
Traction is still a great modality. Rarely do people get it. Because it doesn't work? No. Because its time intensive and requires a 1:1 therapist to patient ratio rather than the passive modalities that seem to allow a better income stream.
Do I really need to send my patient for three months of the above bull**** when there is an obvious facet pain by history, examination, and imaging? Yes, because the P.T. lobby has done well with the government bureaucrats it seems. Is the above treatment regimen more expensive than a facet block x 2 and RF? Absolutely.
There are quite a few basic questions that seem to be unanswered and overlooked every day.
I'm not sure our lobbying body has anything to do with this. They aren't exactly known to have a lot of influence.
Sorry, not at all. You were right on the money. More toward a certain late December poster.
Let me be more specific to the student O.P. In the inpatient world there is daily collaboration, as there should be. I believe the therapists play an invaluable role and help people tremendously. I have nothing bad to say about that aspect.
Its the outpatient world is where we see the trend I mentioned.
Does every patient with a pain need dry needling? Because they get it, even with obvious exam findings of radiculopathy.
Does every patient with a pain need hot packs and cold packs on the same visit? Because they get it.
Does every patient need electrical stimulation as a part of their regimen? Because they get it.
Does every patient need neuromuscular retraining exercises? Because they get it. And since the whole premise behind this and result of this are debatable, let's leave that for another time.
Does every patient need core strengthening? Because they get it, even though there is no way to accurately and precisely measure baseline levels and gains.
Traction is still a great modality. Rarely do people get it. Because it doesn't work? No. Because its time intensive and requires a 1:1 therapist to patient ratio rather than the passive modalities that seem to allow a better income stream.
Do I really need to send my patient for three months of the above bull**** when there is an obvious facet pain by history, examination, and imaging? Yes, because the P.T. lobby has done well with the government bureaucrats it seems. Is the above treatment regimen more expensive than a facet block x 2 and RF? Absolutely.
There are quite a few basic questions that seem to be unanswered and overlooked every day.
Sorry, not at all. You were right on the money. More toward a certain late December poster.
Let me be more specific to the student O.P. In the inpatient world there is daily collaboration, as there should be. I believe the therapists play an invaluable role and help people tremendously. I have nothing bad to say about that aspect.
Its the outpatient world is where we see the trend I mentioned.
Does every patient with a pain need dry needling? Because they get it, even with obvious exam findings of radiculopathy.
Does every patient with a pain need hot packs and cold packs on the same visit? Because they get it.
Does every patient need electrical stimulation as a part of their regimen? Because they get it.
Does every patient need neuromuscular retraining exercises? Because they get it. And since the whole premise behind this and result of this are debatable, let's leave that for another time.
Does every patient need core strengthening? Because they get it, even though there is no way to accurately and precisely measure baseline levels and gains.
Traction is still a great modality. Rarely do people get it. Because it doesn't work? No. Because its time intensive and requires a 1:1 therapist to patient ratio rather than the passive modalities that seem to allow a better income stream.
Do I really need to send my patient for three months of the above bull**** when there is an obvious facet pain by history, examination, and imaging? Yes, because the P.T. lobby has done well with the government bureaucrats it seems. Is the above treatment regimen more expensive than a facet block x 2 and RF? Absolutely.
There are quite a few basic questions that seem to be unanswered and overlooked every day.
Where to start...
"May see physical therapy"....
No. They may see a PT, a PTA, a OT, a COTA or a SLP. You individualize your own group but deindividualize the others. And this is done multiple times in your response. That is like someone calling you "PM&R" (literally, not a physiatrist, and not by your name), and anyone who does a job remotely similar to yours (PM&R PA or NP) being called PM&R.
"Or a combination depending on needs"...
No. It's not determined by need at all. It's determined by everyone but those qualified to make the determination (insurance, physician, administration).
"And addresses any barriers"...
I'd bet the vast majority of barriers that a physiatrist can and should "deal with" are not, and too many that a physiatrist can't or shouldn't are. Example of the former that I've seen relentlessly would be poor communication with rehab professionals re managing the patient medically and addressing the concerns of the patient and therapy staff re the medical concerns (in a timely manner). Example of the latter would be "PT to work on strengthening" (or any similar
worthless variation) which I've seen a sickening amount (thousands of times). Re communication, "Talked with the nurse about it" doesn't count and writing a quickie note doesn't either. Consider how much is lost in translation with this nurse or "rehab director" (often not a physical therapist and not anyone seeing or who knows the patient) middle man method.
I doubt there is much overlap between what a physical therapist REALLY does and what a physiatrist does. The biggest similarity is they most often "work together" in the inpatient acute setting, they often see similar patients (functionally limited, disabled, impaired, in pain) and there is some overlap between entry level training for a PT and some parts of PM&R residency. A PM&R physician by far comes out of residency with the best "understaning" (they really don't) of physical therapy than any other physician specialty but still lame and pitiful.
Sorry, not at all.
Traction is still a great modality. Rarely do people get it. Because it doesn't work? No. Because its time intensive and requires a 1:1 therapist to patient ratio rather than the passive modalities that seem to allow a better income stream.
it feels good when its done to some people but it really doesn't have much if any long term effect. A good therapist would address WHY unloading feels good and address those factors that are causing the symptoms, not necessarily only the symptoms themselves. When you get off of the traction machine/device, unless you are on the space station or a professional scuba diver, gravity is still loading you.
yes, water exercise will reduce the gravity component but again, when you get out of the pool there it is again. I find that most people that have back problems either don't move enough in their hips, or move too much in their spine or both. we need to move where we are built to move. lack of hip movement can cause facets to slap together to often and too vigorously. Over time that results in degenerative changes. also can cause too much sagittal plane movement in the spine which is one thing that can cause disk herniations as well as facet problems. Modalities of any kind are rarely of long term benefit. Kind of like taking a Tylenol. They have some utility in very acute stages of mechanical pain, but rarely get done in my clinic.
The difference between PMR and PT is big but I think of it as areas of expertise. Good PM&R docs realize that the good PTs know more about PT stuff than they do. Good PTs don't try to practice medicine. Unfortunately, not all PM&R docs are good ones and not all PTs are good ones. Too many cookbook followers I fear.
Duh