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How to work with the referring physician for a good outcome for the patient.

By David E. Bright, PT, MPT

For those of us in Physical Therapy private practice, we recognize there is a lack of understanding for patients and other medical professionals as to the services we provide. By better understanding some of the medical professionals who refer patients to our clinics, there is a hope we can better educate the community, both patients and referral sources, on our services and the benefits of physical therapy.

This questionnaire was filled out by a local family physician. Though the questionnaire identifies only one type of referral source, the hope is there will be some generalizability to the responses to allow us to begin to bridge the gap for a better understanding of who we are and what we do as physical therapists.

It will also hopefully help us to be intentional in developing our understanding of how we are perceived by our local communities and referral sources. Knowing where we stand will give us the opportunity to improve and advance these perceptions.

Questionnaire

What type of medical training do you have and when did you complete your training?
Family Practice Residency completed in 2004

In what type of settings/practices have you worked?
1. Traditional family medicine practice with 3 providers. Transitioned to hospital-owned practice. Total of 7 years.
2. Concierge family medicine practice with a focus on lifestyle medicine, 3 years as solo doc, last 2 years with partner.

Do you hold any specialized board certifications?
No

What are the primary types of patients you see that you refer for physical therapy?
Many of my patients have early dysfunctional issues, most with pain. I appreciate the value of early intervention in correcting dysfunctional movement patterns through physical therapy to treat pain and particularly reduce risk of further injury. What I want my patients to “graduate” from physical therapy with is an understanding of their individual problem and what it will take from them going forward to maintain the improvements and prevent future issues. Often that could include a more global assessment, particularly for vulnerable areas such as old injuries or non-painful issues identified on a functional movement assessment. As my patients’ primary care physician, I encourage them to be as active and fit as possible. Optimizing mobility and function is vital to creating opportunities for patients to engage in fitness opportunities and simply enjoy an active lifestyle. The active lifestyle is often the keystone to long-term health and independence. A handful of local physical therapists have proven themselves to be fantastic at helping achieve this goal, and their commitment to improving the lives of our patients have made them truly vital members of our community. They have shown me through their successes the value of early intervention. My patients are very fond of the personal interest given to them by their therapist and the resulting meaningful relationship that develops between patient and therapist. In my observations these therapists are fulfilled in their work empowering people to thrive as they see the fruits of their labor.

What is your standard course of action when someone comes into your office with subacute (2-4 weeks) of shoulder or low back pain?
History and Physical. Trial of antiinflammatory medications with home exercises referral, Image, or refer to specialist MD depending on response. On average, physical therapy is first line before images and other referrals.

Do you prefer one physical therapy provider over another, and if so, why?
Yes. I appreciate the personal relationships I have developed with specific PTs. I have a level of confidence in them that I can impart to my patients to help them buy in to the process of physical therapy. The relationship also aids in communication because frankly I view talented physical therapists as diagnostic aides given their expertise and experience. Having them feeling comfortable reaching out to me to add their opinion is important to me. Electronic medical records do a very poor job of telling the story, and a quick text or phone call gives me the feedback to be confident in helping my patients. I truly appreciate the therapists that are willing to exchange cell phone numbers with me.

Have you had any red flags, or negatives, in working with physical therapists?
I have had negative experiences with physical therapy at several different clinics and in the end it all comes down to outcomes. Patients usually can tell when therapists are just going through the motions and maximizing visits. The teaching that occurs is limited to none. The personal touch is limited. And the communication with the referring doctor is limited. There is a difference when a therapist commits to a patient’s success. It’s not just about making a profit to keep the business thriving, but also about relationships: with other healers, with the patient, with the community.

David E. Bright, PT, MPT, is a PPS member and owner of Excel Rehab and Sports in Clemson, South Carolina. He can be reached at dbright@excelrehabsports.com.

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