How do I navigate this doctor versus physical therapist situation?
July 28, 2014 7:09 PM   Subscribe

My MD prescribed a kind of leg bracing, anticipating relatively quick results. My physical therapist is like no way. How do I get to the bottom of this without causing awkwardness?

My MD and physical therapist work in the same large hospital (in the same building, but different wings). My physical therapist hinted that we might need to pause physical therapy last week. Also last week, my MD prescribed additional therapy in terms of a) strength training and b) a particular kind of bracing.

My therapist is saying that nobody will do the bracing on an outpatient basis because of liability concerns. She is making strong claims about how only X will provide the results that I am trying to obtain through physical therapy. But I am having insurance problems covering X. So my physical therapy is ending, albeit temporarily.

This is not the result that I want, although I may have to accept it until I get my secondary insurance in order. If my therapist and MD didn't work with the same patients in the same facility, I'd go straight to my MD and be what's up with this, I'm getting conflicting information. I'm hesitant to do this because of the professional relationship the two have.

How to navigate. THANK YOU
posted by anonymous to Health & Fitness (9 answers total)
If your therapist has a concern about what the prescribing MD wants the therapist should take it up with the MD without putting you in the middle.

Also, without knowing what "X" is I'm having a hard time following your question. I'm also having a hard time figuring out what "X" could be... I'm guessing "X" is a medical intervention because, really, it's not like one physical therapy modality (heat, ice, estim, paraffin, laser, ultrasound, etc.) typically makes or breaks a treatment.

Good luck!
posted by ticketmaster10 at 7:17 PM on July 28, 2014 [2 favorites]

I recommend just asking your MD. MDs working for a large hospital are typically paid on salary and what other doctors or healthcare providers in the hospital do doesn't affect them much (although other factors, like your insurance, can). They might not want to "throw them under the bus" as we often say by straight up telling you the PT is an idiot, but I usually extend that professional courtesy to most other healthcare providers whether they are employed by my institution or not. The polite and professional thing to do is to say "PT So-and-so may feel that X because they have seen good results with it, but what they don't realize from the physician's perspective is that Y is best because blah blah blah." And then maybe to call and discuss it with them (or drop an email or EMR inbox message which is usually super easy in a system like that) to explain the reasoning.

(agreed with ticket master that without knowing what X is it's a little hard to say whether your doctor is likely to be polite in disagreeing with the opinion or not, but I'm assuming that your PT isn't recommending homeopathy or something)
posted by treehorn+bunny at 7:27 PM on July 28, 2014 [2 favorites]

I am biased. I had a bad experience with hospital PT, with my opinion being that these are some of the laziest PTs you will find with experience from the stone age.

"liability" might just mean that hospital rules make the treatment plan a pain to implement.

I would recommend you go back to your MD to clarify the order then get a referral to the best private PT in your city to get the order carried out.
posted by crazycanuck at 7:46 PM on July 28, 2014

Just to weigh in and agree that you don't need to navigate the MD/PT relationship; that's their business and their problem. I, too, would go back to the MD, tell her what the PT advised, and ask for clarification at the least. I'd probably start with "Doctor, I'm confused ...".
posted by worldswalker at 8:57 PM on July 28, 2014 [1 favorite]

I don' t want to say it is "unprofessional" putting you in the middle like that, but it is close to it.

I have had two different body parts fractured at different times over the years and another broken bone injury. In all the time I spent in PT, the therapist never put me in a situation like that, and there were times when clarification of doctor's scripts were needed and other times the therapist wanted additional things addeded to the script.

All of it was handled by the doctor and therapist as it should be in your case.
posted by mlis at 9:23 PM on July 28, 2014

Also, you can follow up with the mods via the contact form (link is located at lower right section of the page) to explain what "X" is and they can post it for you preserving your anonynimity.
posted by mlis at 9:27 PM on July 28, 2014

Mod note: From the OP:
X refers to a standing frame (it's machinery they want me to get for home so that I can use it every day -- it costs thousands and getting insurance to cover it is very difficult). I couldn't get a satisfactory explanation from PT as to why splints/bracing (as prescribed by the doctor) wouldn't bring about at least some benefits that the standing frame would.
posted by taz (staff) at 1:26 AM on July 29, 2014

Go back to your MD or ask for a different PT person because that's bullshit. Your doctor ordered a specific therapy and he's being second-guessed by the PT person...that's not for YOU to sort out, it's for THEM to sort out. You being off of PT is unacceptable.

The way you tell it, your PT person is be super-unprofessional and rather difficult. Call your doc first thing this AM and find out what's going on.

A good doctor will speak with the physical therapist and discuss the issue. A good physical therapist will call a doctor to clarify any questionable orders. So we know right off that your physical therapist is not following professional protocol. What else might he/she be wrong about?
posted by Ruthless Bunny at 5:09 AM on July 29, 2014

Changing your PT might actually be more simple than that.

See if you can find out Mr. Bat Hang's schedule. If he is ever absent at times when the PT clinic is open, schedule your appointments for those times. Voila, new therapist.

Usually hospital PT has open gym so simply reassigning PT is awkward unless Mr. Bat Hang is not in the facility. You can get the MD to get Mr. Bat Hang to implement doctor's order, stealth reassign outside Mr. Bat Hang's hours, or go private.
posted by crazycanuck at 9:41 AM on July 29, 2014

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