Patient Education | Fearon Physical Therapy

Patient Education

Educated editorial

_{-Tim Fearon}

Over the years of listening to patients who have had poor treatment elsewhere I have grown disgusted with what commonly passes to the unwitting public as "physical therapy". Hopefully your life has been healthy enough that you have had minimal, if any, need for therapy. If you have needed therapy, I sincerely hope that you have had the experience of meeting one of the growing numbers of dedicated and competent therapists who are building the profession in an appropriate way. These people I am proud to call colleagues. There is, unfortunately, a mass of substandard treatment in the market place.

I recently spent some time with a colleague who was going through the necessary planning stages of opening her own practice. When it came to the name of the practice she told me that she was so disillusioned with the practice level of her peers that she wanted to avoid using the phrase "physical therapy" in the name. She lamented that she is commonly told by potential patients that they have already tried PT only to learn that it was some internet driven "therapy" advice, an iPhone application or, even worse, some unethical, intellectually lethargic PT watching as they rode the bike. This was disturbing but very understandable. I agreed that, based on what we see the public subjected to, I should have named the practice Fearon Orthopaedic Manual Therapy.

In this current market place there is a great deal of driving economic force dictating what is offered as care. Don't be fooled by unscrupulous arrangements or haphazard care. Most insurance companies develop a list of preferred providers based on how little they can pay them, not on how effectively they treat patients. In other words preferred price structure for the insurance company, not preferred care for the patient. This, of course, pushes down to the clinic who tries to have the cost of delivering the care be as low as possible. Often the solution is that the therapist schedules more patients per hour, gives them less of their time and has ancillary personnel deliver the "care".

Many physician offices hide behind the veil of trust of their patients and have them see "their therapist" which they, in fact, employ and are profiting from the referral for your "care". The fact that they profit from the treatment delivered by "their therapist" is all too often the motive for the recommendation, not the effectiveness of their care. Remember that you have the right to choose your PT provider, no one can tell you that "you must go here."

Many corporate owned therapy facilities put high pressure on their clinics to have production numbers. In short, these practices focus on the business side of being in the rehabilitation business, not the clinical effectiveness. To be fair, some do so and deliver good care. You, the patient, should hold us all to the same standards.

How do you know if you are getting good care? The first answer is obvious: are you objectively improving? I tell patients that they have the right to expect improvement with EVERY treatment. There should be some subjective change ( your opinion ), some objective change (our observation), and some functional gain. In addition, there should be some progression of treatment. The same thing done repeatedly is only effective at keeping you where you are.

Red flags to watch for:

-no improvement and no change in treatment

-no ongoing assessment and reassessment process of the status of your problem by the therapist

-as a consequence of treatment a new problem is emerging

-your care is predominantly delegated to some ancillary personel

-excessive use of modalities (ultrasound, heat, electric stim; they may feel nice but there is minimal evidence behind them)

-you are predominantly doing your own treatment, performing the same exercises you are competently and compliantly performing at home while someone else watches you (or even worse, you are not watched at all!)

-you spend minimal time with your therapist

-the office appears to be a turnstile business more than a clinic focused on outcomes

-you ask questions of your therapist and get vague, philisophical, or theoretical answers without objectivity directly about your present case

-your therapist holds court in a bullpen of multiple patients (check your statement, this should be "group therapy")

-the therapist is treating the X-ray or MRI and paying no attention to how treatment affects you, the patient

-everyone seems to be getting the same treatment, with no apparent rationale

-immersion in an environment of sensory overload with big screen TV's, music, and scores of people exercisng around you as a subsitute for the energy that should be directed to resolving your problem

-a lack of enthusiasm on the part of your therapist for identifying your goals and progressing you towards them

I am the strongest of supporters of good therapy. That means good care for you, the patient. Those who are delivering substandard care are undermining the foundation of the profession and destroying the trust necessary for patients to place their physical health needs in the hands of another. This is totally unprofessional, unethical and should be illegal. There are many good therapists in this state. If you feel that you are not getting good care, speak up. If you are right, then either you, your insurance company or both are being unprofessionally deprived of your time and money. If you need help finding a good therapist feel free to call us. I have been practicing and teaching in the same place for decades now and know quite a few capable therapists. If I don't know one near you, at least I will know someone close to where you live who can guide you from there.

Below are some very interesting articles and graphs, and I try to update them periodically. Nothing requires a medical education; these are purposefully chosen for you, the medical consumer to educate yourself easily.

Remember that the surest way to get good care is to be in charge of it yourself. Stay fit, eat right, good posture and by all means fight gravity!

- Tim

Considering surgery? Read this first: "A Knife in the Back" by Jerome Groopman"

How do lumbar fusion, artificial disk implants, and non operative treatment compare?

Graph from Mirza; Folly of FDA-approval studies for BMP

What's causing your back pain? Can we make the diagnosis with imaging?:

Disc Findings in Normal Subjects

Findings of Normal Subjects on MRI

Comparing X-ray & MRI Findings of Symptomatic and Asymptomatic

MRI findings in Cervical & Thoracic Spine in Normal Subjects

A look at imaging economics:

http://www.stonehearthnewsletters.com/medical-ethics-self-referrals-imaging-medicare/health-care/