Updated: May 10, 2022
Anyone who reads my blog posts knows I usually try to keep things light, fun, and informative, but I'm going to bring it down to a darker level today, so proceed at your own risk. This will start out a little negative, but I promise I'll turn it around at the end. According to the numbers, a little more than half of the patients who come in to our clinic enter in through "Direct Access," a law in NYS that says you can refer yourself directly to a Physical Therapist without a script from an MD, with some exceptions (No-Fault cases, Worker's Comp, Medicare follow-up visits). We are very proud of this, as patients are seeking us out on their own, often by friend or family referral or by their own online research.
But there is a darker reason that more and more patients are referring themselves to us directly. Their Physicians or surgeons are saying that they "don't need" Physical Therapy. Who doesn't need natural pain management, pain-free movement, and successful post-op recovery without pain pills, injections, or more surgery?? These patients have the common sense to realize that their Physicians or surgeons are incorrect, that they don't have to suffer in silence or live with a subpar outcome, and they seek us out on their own.
Here are some recent examples. We have HUNDREDS of these examples, but here are just a few:
A man who had a total hip replacement and was told by his surgeon that PT is a waste of time, and he shouldn't bother. This man is in terrible pain, can barely walk, and his ultimate goal is to return to downhill skiing. WHY this surgeon wouldn't refer his patient to PT? The world may never know. Maybe in the surgeon's eyes, they did an amazing job with the procedure, which means they "fixed" the patient, and the patient shouldn't need any more intervention, because their surgical skills are JUST. THAT. GOOD. Totally discounting the natural healing process, the effects of literally cutting through several layers of tissue and using carpentry tools to recreate a joint. No big deal. You may be thinking "why don't you call the surgeon and discuss the case?" Unfortunately, it is very common for us therapists to call a surgeon and leave a message trying to discuss a patient case, and more times than not, our calls fall on deaf ears and calls never get returned. I've been known to harass surgeons with 3-5 calls and voicemails, to no avail. And yes, there are cases of patients having an anterior total hip replacement and not having PT and getting back to their previous level of function. But most of these patients aren't hoping to return back to downhill skiing, running, or higher level activities.
Another example is an unfortunate woman who fell and broke her arm. Her surgeon did the surgery and put her in the sling, then discharged her home. No home instructions. No list of what to do/what not to do. This woman came in to therapy completely confused and terrified to use her arm at all. She even asked if she's allowed to use her hand, since no one ever told her if it was okay. She was given no information for her or her therapist to reach out for any questions or guidance. Again, the mindset seemed to be "I did a great job with the surgery, everything from here on out must be okay." Ego is an unfortunate thing sometimes.
I've had recent patients go in to their PCP with neck pain and back pain, asking for advice. They are offered a few pain pills, a prescription for an NSAID they can just get over the counter, some muscle relaxants, or maybe a referral to Pain Management. NO recommendation for Physical Therapy. Again, why the least costly and least invasive option wouldn't be recommended first, I will never know. Not to mention the many research articles proving the effectiveness and cost savings of Physical Therapy, plus the superior long-term outcomes. The only thing I can think of is a lack of education about PT or the MD being burned in the past by recommending PT and the patient ending up at a Mill PT clinic, making their problem worse and in turn being annoyed at their MD for the suggestion.
You might sense a little cynicism in my writing and you're right if you do, after 13+ years in the field, these stories get more frustrating by the day.
Don't get me wrong, there are MANY awesome Physicians and surgeons out there. We work very closely with several amazing local MDs and surgeons, and we value their expertise, desire to get the patient better, and collaborative spirit.
But know that if you have a conversation with your MD or surgeon and it doesn't sit right with you, you might want to listen to your intuition. If you're suffering with pain, stiffness, or immobility, or if you want to run again or ski again when your MD or surgeon just says, "you're fine," "you're old, what do you expect," or "just give it time" (when you already gave it enough time), trust that inner voice.
Don't be afraid to take advantage of Direct Access, and just send YOURSELF to a Physical Therapist. We will be the first to tell you if you made the wrong call, and if you need to be referred back to an MD or surgeon for more testing or further evaluation. We are Doctorate level educated Medical Professionals who are experts in human movement and recovery. (Again, WHY are we not consulted with or referred to more?!)
If you would like a totally free consultation with any of our therapists via phone call, video chat, or in-person, just register here https://www.thegreenroomptny.com/events-and-offers or if you have a local PT that you trust, hit them up! I find that most PTs by nature are very caring, helpful humans and you should take advantage of that. Do any of the above stories sound familiar? Do you have your own horror story (or success story) to share? Leave your thoughts or experiences in the comments below!
In good health,
Dr. Ashley Bertorelli, PT and Founder of The Green Room Physical Therapy
Clifton Park & Troy