Increasing Autonomy for PT's

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   UWPT
9 Posts

Posted - 11/20/2006 :  23:01:22  Show Profile  Reply with Quote
Not too many postings lately. Just wanted to stimulate some discussion. I've had conversations with some PT's recently in regards to some very interesting points which included the necessity to promote the PT profession and to create greater autonomy. To market our profession as problem solvers and to encourage PT's, especailly new grads, to become better thinkers, and problem solvers. ie so that when they get a script from a MD they don't just follow it and don't incorporate their own knowledge and skill set to the treatment of that patient. Also to work more closer with MD's so that they better understand what we do and what we can bring to the table. I am looking forward to seeing what others have to say about this.
D.R.
USA
6 Posts

Posted - 11/23/2006 :  19:05:33  Show Profile  Reply with Quote
Like the worn phrase, "all politics is local", so too, ultimately all of our work in physical therapy is local, and in that, there are likely many different traditional practices that represent the therapeutic tradition in that local. Our tradition is strongly steeped in others (non-therapists)directing physical therapy. Changing this is going to continue to take some time, to reverse and change toward the autonomous practice we think of ourselves as practicing, AND having that be recognized as the practice pattern that is respected. (In fact the problem is thickening in some ways with the advent of physician extenders; now NP's and other nursing personnel and PA's on the scene over the last 10-30 years, and their directives toward physical therapy are sometimes ill-advised, and clearly coming to the whole issue of rehabilitation without the awareness of management beyond acute care). I still get directives from medical personnel, MD's and others, that try to sidestep the sense of physical therapist evaluation, so here is my point. EVERY referral, regardless of what is written, should be regarded by physical therapists as evaluation, then decision about treatment. Often, the projected or recommended treatment by the medical practitioner might be correct, but it is fundamental to our on-going process, that we take ownership for physical therapy. Of course we appreciate the referrals; each must be looked upon as asking for our thinking and our best practice at that point in that patients life, from the physical therapist philosophy of care and evidenced based process of intervention. Many professions in health care might want to use physical therapy from their professional background perspective; social service might want to involve physical therapy for the social aspect of activity, or because the individual has depression. Both are legitimate ideas, but can be more appropriately served through participation in activites other than physical therapy...or not, it is up to your evaluation. Physicians may order physical therpay because they want their patient to be more active; again, good idea, but is physical therapy the appropriate place for this to occur? It may be; it depends on your evaluation. ( I have been asked recently, why can't physical therapy be used for mental health purposes only? They did not fully agree with my answer). And, how often do physical therapists get repeat referrals for the same individual, same or near same diagnosis, and same failure of outcome? You and your evaluation have the opportunity to redirect the process toward something that works, perhaps a different service, perhaps writng how you believe the other over-riding factors in a patients life like depression, low motivation to change, frank disagreement with being referred to physical therapy, need to be addressed before physical therapy can be expected to be successful. And, of course the all important date of onset...this so often becomes blurred and given low importance, when in fact it is all important; the time factor has a huge influence on whether interventions and what interventions can realistically be expected to have a positve outcome. It is SO important not to treat non-acute situations as if they are acute. The whole pace and expectation for change is affected by the length of time one has had the disability influencing their life. To some degree, we should respect the adaptive response of the individual, even if we might see from our assessment, that they could have taken a different, possibly more successful path. But what we do as therapists should be consistent with the life stage or character of the disability in the individuals life, and adapt change interventions consistent with the time frame of the disability, and realistic potential for FUNCTIONAL change outlook.
It is all based on your ownership of physical therapy as a physical therapist; it cannot be defined by a non-therapist. We welcome all referrals and involvement from various co-professionals, people, and families, but demonstrate by your actions, that your community is getting your thinking and your planning, and your decision making process, before they are getting your pre-programmed, standard-issue "therapy" of the past, that unfortunately may have been influenced by non-therapists, and non-physical therapy purposes or concepts.

Aurora
11 Posts

Posted - 11/28/2006 :  09:16:38  Show Profile  Reply with Quote
Those are some very valid points made and coincides with the APTA Vision 2020 "By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health." To achieve this I believe we need more members and greater involvement from members of our profession. The problem is how do we facilitate more involvement.

pam l
10 Posts

Posted - 12/03/2006 :  22:15:21  Show Profile  Reply with Quote
    quote:Originally posted by UWPT
    Not too many postings lately. Just wanted to stimulate some discussion. I've had conversations with some PT's recently in regards to some very interesting points which included the necessity to promote the PT profession and to create greater autonomy. To market our profession as problem solvers and to encourage PT's, especailly new grads, to become better thinkers, and problem solvers. ie so that when they get a script from a MD they don't just follow it and don't incorporate their own knowledge and skill set to the treatment of that patient. Also to work more closer with MD's so that they better understand what we do and what we can bring to the table. I am looking forward to seeing what others have to say about this.

pam l
10 Posts

Posted - 12/03/2006 :  22:23:21  Show Profile  Reply with Quote
I strongly believe that we as PTs are professionally obligated to further the profession and promote it to all audiences - other health care professionals, patients, the public. Other allied health care professionals try to compete with our services, and it is up to us, the PTs, to create and maintain our autonomy.
Also, I agree with "thinking out of the box" and really using the critical thinking skills of our profession. That is what our job is really about - Clinical Decision Making! Not just following a prescription and carrying out the steps of a protocol. This is putting in in simplest terms, but sometimes I do see colleague just going through the motions. It is then my obligation and dedication to this profession to help them think further about their treatments and care plans.

D.R.
USA
6 Posts

Posted - 12/20/2006 :  20:55:57  Show Profile  Reply with Quote
It is important to distinguish rehabilitation activities and philosophy of care/perspective from medicine. We can use information from medical personnel, but frame it wihtin our perspective, always keeping in mind that our fundamental consideration is to answer the question, what can we bring to patient managment that cannot be achieved in other ways. We address problems uniquely and comprehensively. We remember some basics about function and performance that are not evaluated or looked at by other health professions. We focus on human development and capacity to change, not just on intervention methods. Facilitate change. Be efective, not just rote repetition of therapeutic methods that are not achieving transition as you can define it, in your patients performance, recovery. Use what works with people, but be restricted by no method or approach if it does not fit the human situation you have before you. Think. Learn. Trust the observations of the problem you see before you. Find literature that correlates, or use it as a foil to recognize a unique combination of events, clinical picture...see that you have a unique situation here and must break the mold if that is what helps the individual. Decision making, problem solving from our philosophy of care, which may be distinct from the dominance of medicine and pathology identification thinking around you.

UWPT
9 Posts

Posted - 12/21/2006 :  08:00:05  Show Profile  Reply with Quote
Those are some great points that have been brought up. Too often I feel that some therapists are forgetting to look at the whole picture. Treat the patient as an individual and discover his or her own unique problems, and if these problems can be resolved help them resolve them. Don't just treat soley based on a diagnosis on the script. Often times there are additional factors involved that need to be corrected as well. Only by taking a look at the entire picture will you be able to achieve optimal outcomes. Given what has been said, It should be the goal for all physical therapists to strive to be considered diagnosticians and not simply be deemed just another outlet for patient care which is dictated by another professional.

MadCityPT
4 Posts

Posted - 07/09/2007 :  14:37:38  Show Profile  Reply with Quote
I agree that we should not be seen as "just another outlet for patient care which is dictated by another professional". I am curious to hear opinions on the credentialing of PTs. What are your thoughts on PT vs MSPT/MPT vs DPT? Should only the DPTs be granted direct access? Is the necessary education with the DPT (e.g. radiology and pharmacology classes)critical to have in order to see patients that have not been referred by a physician? These are classes that a Bachelors or Masters degree PT did not take, so is there more liability with direct access if you are not DPT trained? What states now grant direct access? And are insurance companines following suit and reimbursing for direct access?

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	UWPT 9 Posts Posted - 11/20/2006 : 23:01:22 Show Profile Reply with Quote Not too many postings lately. Just wanted to stimulate some discussion. I've had conversations with some PT's recently in regards to some very interesting points which included the necessity to promote the PT profession and to create greater autonomy. To market our profession as problem solvers and to encourage PT's, especailly new grads, to become better thinkers, and problem solvers. ie so that when they get a script from a MD they don't just follow it and don't incorporate their own knowledge and skill set to the treatment of that patient. Also to work more closer with MD's so that they better understand what we do and what we can bring to the table. I am looking forward to seeing what others have to say about this. D.R. USA 6 Posts Posted - 11/23/2006 : 19:05:33 Show Profile Reply with Quote Like the worn phrase, "all politics is local", so too, ultimately all of our work in physical therapy is local, and in that, there are likely many different traditional practices that represent the therapeutic tradition in that local. Our tradition is strongly steeped in others (non-therapists)directing physical therapy. Changing this is going to continue to take some time, to reverse and change toward the autonomous practice we think of ourselves as practicing, AND having that be recognized as the practice pattern that is respected. (In fact the problem is thickening in some ways with the advent of physician extenders; now NP's and other nursing personnel and PA's on the scene over the last 10-30 years, and their directives toward physical therapy are sometimes ill-advised, and clearly coming to the whole issue of rehabilitation without the awareness of management beyond acute care). I still get directives from medical personnel, MD's and others, that try to sidestep the sense of physical therapist evaluation, so here is my point. EVERY referral, regardless of what is written, should be regarded by physical therapists as evaluation, then decision about treatment. Often, the projected or recommended treatment by the medical practitioner might be correct, but it is fundamental to our on-going process, that we take ownership for physical therapy. Of course we appreciate the referrals; each must be looked upon as asking for our thinking and our best practice at that point in that patients life, from the physical therapist philosophy of care and evidenced based process of intervention. Many professions in health care might want to use physical therapy from their professional background perspective; social service might want to involve physical therapy for the social aspect of activity, or because the individual has depression. Both are legitimate ideas, but can be more appropriately served through participation in activites other than physical therapy...or not, it is up to your evaluation. Physicians may order physical therpay because they want their patient to be more active; again, good idea, but is physical therapy the appropriate place for this to occur? It may be; it depends on your evaluation. ( I have been asked recently, why can't physical therapy be used for mental health purposes only? They did not fully agree with my answer). And, how often do physical therapists get repeat referrals for the same individual, same or near same diagnosis, and same failure of outcome? You and your evaluation have the opportunity to redirect the process toward something that works, perhaps a different service, perhaps writng how you believe the other over-riding factors in a patients life like depression, low motivation to change, frank disagreement with being referred to physical therapy, need to be addressed before physical therapy can be expected to be successful. And, of course the all important date of onset...this so often becomes blurred and given low importance, when in fact it is all important; the time factor has a huge influence on whether interventions and what interventions can realistically be expected to have a positve outcome. It is SO important not to treat non-acute situations as if they are acute. The whole pace and expectation for change is affected by the length of time one has had the disability influencing their life. To some degree, we should respect the adaptive response of the individual, even if we might see from our assessment, that they could have taken a different, possibly more successful path. But what we do as therapists should be consistent with the life stage or character of the disability in the individuals life, and adapt change interventions consistent with the time frame of the disability, and realistic potential for FUNCTIONAL change outlook. It is all based on your ownership of physical therapy as a physical therapist; it cannot be defined by a non-therapist. We welcome all referrals and involvement from various co-professionals, people, and families, but demonstrate by your actions, that your community is getting your thinking and your planning, and your decision making process, before they are getting your pre-programmed, standard-issue "therapy" of the past, that unfortunately may have been influenced by non-therapists, and non-physical therapy purposes or concepts. Aurora 11 Posts Posted - 11/28/2006 : 09:16:38 Show Profile Reply with Quote Those are some very valid points made and coincides with the APTA Vision 2020 "By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health." To achieve this I believe we need more members and greater involvement from members of our profession. The problem is how do we facilitate more involvement. pam l 10 Posts Posted - 12/03/2006 : 22:15:21 Show Profile Reply with Quote quote:Originally posted by UWPT Not too many postings lately. Just wanted to stimulate some discussion. I've had conversations with some PT's recently in regards to some very interesting points which included the necessity to promote the PT profession and to create greater autonomy. To market our profession as problem solvers and to encourage PT's, especailly new grads, to become better thinkers, and problem solvers. ie so that when they get a script from a MD they don't just follow it and don't incorporate their own knowledge and skill set to the treatment of that patient. Also to work more closer with MD's so that they better understand what we do and what we can bring to the table. I am looking forward to seeing what others have to say about this. pam l 10 Posts Posted - 12/03/2006 : 22:23:21 Show Profile Reply with Quote I strongly believe that we as PTs are professionally obligated to further the profession and promote it to all audiences - other health care professionals, patients, the public. Other allied health care professionals try to compete with our services, and it is up to us, the PTs, to create and maintain our autonomy. Also, I agree with "thinking out of the box" and really using the critical thinking skills of our profession. That is what our job is really about - Clinical Decision Making! Not just following a prescription and carrying out the steps of a protocol. This is putting in in simplest terms, but sometimes I do see colleague just going through the motions. It is then my obligation and dedication to this profession to help them think further about their treatments and care plans. D.R. USA 6 Posts Posted - 12/20/2006 : 20:55:57 Show Profile Reply with Quote It is important to distinguish rehabilitation activities and philosophy of care/perspective from medicine. We can use information from medical personnel, but frame it wihtin our perspective, always keeping in mind that our fundamental consideration is to answer the question, what can we bring to patient managment that cannot be achieved in other ways. We address problems uniquely and comprehensively. We remember some basics about function and performance that are not evaluated or looked at by other health professions. We focus on human development and capacity to change, not just on intervention methods. Facilitate change. Be efective, not just rote repetition of therapeutic methods that are not achieving transition as you can define it, in your patients performance, recovery. Use what works with people, but be restricted by no method or approach if it does not fit the human situation you have before you. Think. Learn. Trust the observations of the problem you see before you. Find literature that correlates, or use it as a foil to recognize a unique combination of events, clinical picture...see that you have a unique situation here and must break the mold if that is what helps the individual. Decision making, problem solving from our philosophy of care, which may be distinct from the dominance of medicine and pathology identification thinking around you. UWPT 9 Posts Posted - 12/21/2006 : 08:00:05 Show Profile Reply with Quote Those are some great points that have been brought up. Too often I feel that some therapists are forgetting to look at the whole picture. Treat the patient as an individual and discover his or her own unique problems, and if these problems can be resolved help them resolve them. Don't just treat soley based on a diagnosis on the script. Often times there are additional factors involved that need to be corrected as well. Only by taking a look at the entire picture will you be able to achieve optimal outcomes. Given what has been said, It should be the goal for all physical therapists to strive to be considered diagnosticians and not simply be deemed just another outlet for patient care which is dictated by another professional. MadCityPT 4 Posts Posted - 07/09/2007 : 14:37:38 Show Profile Reply with Quote I agree that we should not be seen as "just another outlet for patient care which is dictated by another professional". I am curious to hear opinions on the credentialing of PTs. What are your thoughts on PT vs MSPT/MPT vs DPT? Should only the DPTs be granted direct access? Is the necessary education with the DPT (e.g. radiology and pharmacology classes)critical to have in order to see patients that have not been referred by a physician? These are classes that a Bachelors or Masters degree PT did not take, so is there more liability with direct access if you are not DPT trained? What states now grant direct access? And are insurance companines following suit and reimbursing for direct access?

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