Abolishing the Template Letter
Reinforcing Credibility as Musculoskeletal Experts.
By Darrin Schober, PT, MS
Inevitably, we have all done it. In a pinch for time, we scratch out a letter to a doctor to update him or her on a patient’s plan of care. How many of us are guilty of writing a letter like this?
Dear Dr. Jones,
Mrs X’s treatment plan for her back pain will include core strengthening, progressive resistive exercise, manual therapy, and education in correct movement and a home program. Please sign the attached plan of care. Thank you for the referral.
Chances are, we have all written unimpressive notes like this. If the private practice physical therapist’s goal is to be recognized as a direct access musculoskeletal primary care provider, the days of the template letter are over. Aside from conveying important information about patient care, a letter to a referring practitioner can also serve as a opportunity for marketing your expertise. Many of us have read letters addressed to either a referring doctor or primary care provider, and by the end we have forgotten why or what we are reading. It is important to not only know the audience but also know their language. Given the time constraints of the average medical practitioner, most providers tend to gloss over long template documents describing your plan of care, and the real communication of your concern is lost in a word maze.
When communicating with a referring medical colleague, ask yourself the following four questions:
- What is relevant regarding the plan of care?
- What information is important to convey regarding the patient’s presentation?
- What medical jargon does this specialty understand?
- How can I highlight the benefits of this patient receiving care at our clinic?
Communicating with a neurosurgeon and pain clinic specialist can be far different from your general family practice physician. What interests the orthopedic physician will not apply to the physical medicine and rehab physician. Therefore it is naive to assume the same formal template can convey the concise concerns of a patient to all practitioners. Furthermore, utilizing the referral letter solely to get a signature on a plan of care undermines our expertise as musculoskeletal specialists. This opportunity for direct communication with a referring provider enhances the role of the physical therapist in the medical management of all patients, and as a result, further strengthens the brand of physical therapy.
A well-written referral letter should include the following information:
- Patient name, date of birth, and diagnosis
- Pertinent evaluation findings and their correlation to patient function. Be sure to utilize language specific to the practitioner.
- Interventions that will address the stated deficits. Be specific in order to highlight your clinic’s skills and specialty areas.
- Recommendations for further imaging or intervention
- Request for plan of care signature
- Information on how the practitioner can contact your clinic for questions
- Progress that has occurred from therapy and any successful outcomes in patient performance (progress note or discharge note)
Although slightly more time consuming than the cut-and-paste of a traditional form-letter, the benefits of personalization and conciseness of a well-written referral letter are intangible. Engaging with referring providers on a regular basis will strengthen your position in your community as a musculoskeletal expert while concurrently offering an opportunity to display your brand in a positive manner. In addition, continuing to strengthen relationships with referring providers will reinforce the position that the private practice physical therapist occupies in today’s medical landscape. Finally, as we move toward attainment of the American Physical Therapy Association’s Vision 20/20, the ability to educate practitioners on our assessment and intervention skills will solidify the position for our profession as the movement specialists.
Sample Initial Eval Letter:
Dr. Clark Griswold
National Lampoon Clinic Health System
733 West Happy Avenue
Orlando, FL 55555
Re: Eddie Wu
Diagnosis: Low back pain, M54.5; Abnormal Posture, R29.3; Osteoporosis, M81.0
Dear Dr. Griswold:
Thank you for the opportunity to evaluate and treat Eddie at Optimum Therapies, LLC, with regard to his low back pain. As you are aware, these are chronic symptoms that increased in the last year following an increase in lifting and bending involved in a move to a new home.
Upon initial evaluation today, Eddie presents with local low back pain and a negative straight leg raise and denies radicular symptoms. Eddie shows hypomobility throughout the thoracolumbar junction and lumbar spine and significantly decreased strength through the hip abductors and gluteals. Soft tissue restrictions are present, and a dynamic lower extremity valgus pattern is notable with functional mobility, particularly squatting and stair climbing.
We plan to treat Eddie two times per week, decreasing to one time per week over the next eight weeks, and we do anticipate that he will do very well. Interventions include core strengthening with emphasis on rotational stability, utilization of Graston technique for soft tissue mobilization, functional neuromuscular reeducation for gluteal activation for proper femoral alignment in squat, and manual spine mobilization to improve spinal flexibility. Particular concern will be taken to monitor his posture during all tasks given his history of osteoporosis. We will utilize the Functional Movement Screen to quantify his risk for injury.
If you are in agreement with this plan, please sign and return the attached Medicare Plan of Care Certification for our records. If you have any questions or concerns regarding his management in physical therapy, please do not hesitate to contact me at 444-444-4444.
We look forward to sending you an update with a positive outcome.
Evaluating Therapist, PT, DPT, GCS
Optimum Therapies, LLC
Darrin Schober is the owner of Optimum Therapies located in Wisconsin and North Dakota. He can be reached at Darrin@OptimumTherapies.com.