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What You Don't Know Can Hurt Your Patients

Too many clinical questions, not enough time, and overwhelming data smog.  Sound familiar?  It should, because these problems are now universal and affect all health care professionals in modern societies.  This piece from Medscape Today addresses how these problems affect the physician community and data-based information about selected solutions and outcomes.

The more important issue is not the problems, those are here to stay.  The real issue is how to manage these problems on a corporate and personal level.   How are you handling the issue of keeping up?

Have a great Memorial Day Weekend!

 

Rob

Wellness Visit With a PT???...Our Worsening Identity Crisis

Not a single PT from this previous post regarding our profession's identity crisis responded that they make their living at health and wellness PT. Now we exacerbate the problem by having our professisonal organization recommend that consumers get an annual health and wellness check-up? Initiatives like this discredit what we do well and make our identity even more ambiguous. What's next? See a PT for bed wetting or depression? This is very painful for me to publicly admit here, but we are now no different than chiros who advocate that consumers get annual spine health check-ups to correct vertebral subluxations.

For the life of me, who is driving all of the health and wellness initiatives at APTA? Mr. Barnes, please save us from ourselves before we self-destruct. We need focus on our core identity.

John

Congratulations, Ben Massey!

Just about everyone will recognize the name Ben Massey Jr., PT, MA.  He hails from Anderson, NC and currently is the president of the North Carolina Board of Physical Therapy Examiners in Durham, NC.  Ben has also served as past APTA president. Yesterday the APTA presented him with the  2007 Federal Legislative Leadership Award during APTA's Advocacy Academy and Physical Therapy Day on Capitol Hill. 

This award is presented annually to an individual who demonstrates outstanding leadership in federal legislative issues and promotes initiatives that preserve, protect, and advance the practice of physical therapy.

Ben, thank you for all your past and present service to our profession!

The EIM Working Group

Primal Reflex Release Therapy (PRRT)- Making the News

The link to this story came across my desk this morning (courtesy of EIM's Evidence Express) and thought you ought to see this "little used, unusual form of physical therapy" guaranteed to relieve chronic pain.  Yes, thats right: a silver bullet that immediately relieves chronic pain.  The reason is because it actually treats the cause of pain......tension (of course everyone should know that by now).

I have seen PTs in exhibit halls at various professional meetings literally flock to see this "break-through" treatment.  But, as we see and hear in the video, the only way you know it works is to try it yourself.

Now, there may be something to this.  However, at this point I still don't know what conditions or syndromes it is indicated for, who is said to benefit, and whether or not it is effective (I haven't tried it yet).  A nice  start would be to at least be able to read a case study in a reputable journal describing the intervention and associated outcomes (seriously, let me know if one is available).  Right now all I can tell is that there is a "whole lot of shaking going on".  Despite that, I bet you will still see some PTs flocking to demonstrations,  jumping on the PRRT bandwagon and patients paying out of pocket for it.  However, I wonder if insurers are really paying for this (as stated).

We have a long way to go.

 

Rob

Generation Y floods the workplace

Many are familiar with Lynne Lancaster and David Stillman's book When Generations Collide.  While you will always miss the mark if you stereotype, recognizing generational differences with regard to perspective can help us foster relationships much better.  In fact, I was discussing this very topic earlier today with 3 other colleagues.

This article discuss the characteristics of Generation Y (Gen Y): 1977 - 1994 (sorry X'ers, your no longer the current hot-topic :)).  Described as purpose driven, well educated, technically savy, and perpetually curious, they also have a number of other interesting characteristics you might want to be aware of.  Especially if you are a soft-ware design or physical therapy employer, according to this article.

Gen Y will be looking for a portable skill-set, opportunity and will not settle for "thats-the-way-we-do-it here" explanations for practice.  PT students of this generation will be very comfortable with EBP, so much so that I don't think they will stay very long (if at all) with employers who haven't deployed EBP practice patterns and processes in a tangible manner. Are you ready for them? We are.

Welcome, Gen Y!

Rob

Check Out the Upcoming EIM Courses!!!

Check out upcoming Evidence in Motion courses currently open for registration! Learn more about MyEIM and our new Articulate course format!

Download WhatIsMyEIM.pdf

Download ArticulateFormat.pdf

***Indicates course open for internal registration only. Contact facility POC listed on website.

Evidence-based Examination and Selected Interventions for Patients with Lumbopelvic Spine and Hip Disorders

Sep 15, 2007
Medford, NJ (USA)

Nov 3-4, 2007***
Hawthorne, NY (USA)

Evidence-based Examination and Selected Interventions for Patients with Cervical Spine Disorders

Aug 17-18, 2007***
Davenport, IA (USA)

Aug 18, 2007***
Russellville, KY (USA)

Sep 15-16, 2007
Burlington, NC (USA)

Sep 29, 2007***
Everett, WA (USA)

Evidence-based Examination and Selected Interventions for Patients with Upper Extremity Disorders

May 12-13, 2007
Jacksonville, FL (USA)

Oct 26-27, 2007***
W. Palm Beach, FL (USA)

Evidence-based Examination and Selected Interventions for Patients with Lower Extremity Disorders

Aug 25-26, 2007
Jacksonville, FL (USA)

Sep 8-9, 2007
Concord, NH (USA)

Evidence-based Exercise for the Management of Musculoskeletal Disorders

Jul 28-29, 2007***
Charlotte, NC (USA)

Evidence-based Examination and Selected Interventions for Patients with Knee Disorders

Aug 25-26, 2007***
Bronx, NY (USA)

We encourage early registration to insure a seat. Extensive hands-on lab sessions are included.  Visit us on the web at www.evidenceinmotion.com to get more details, learn about other 2007 course dates and locations. Register online today!

Feel free to email us at courses@evidenceinmotion.com if you have any questions or need additional information. Consider passing this post on as an email to your colleagues who might benefit from this information. Hope to see you at an Evidence in Motion course in 2007! We sincerely thank you for joining with us to translate evidence into practice.

The Evidence in Motion Team

I Can't Sleep I am Outraged!

My current bed time reading is Maggie Mahar's Money Driven Medicine- The Real Reason Health Care Cost So Much.   Where has the culture of ethical responsibility gone in health care?   As John has pointed out the lack of ethical responsibility in the device manufacturing industry and in the surgeons that are accepting kickbacks is rampant.  If that doesn't wake our profession up I don't know what will.  However, if you still are on the sidelines please read the recent WSJ article on the drug Oxycontin and Big Pharmas role in pushing it.    The Purdue Frederick pharmaceutical company and three of its executives pleaded guilty to misbranding the drug with the intent to defraud and mislead the public about its addictive qualities. Unfortunately they are only paying $635 million in fines and will avoid jail time, that is not justice.  A huge number of people are prescribed this drug for musculoskeletal pain.  The article highlights an individual who started taking the drug in 2002 for back pain and became dependent on the drug within a month.  We owe it to society to promote our profession.  You got drugs, you got surgery, you got us. Each of us as physical therapists and collectively as a profession need to find our voice and make some noise.  We need to aggressively market who we are without worrying about offending surgeons and big pharma.  If we are truly serious about our role as professionals then society expects nothing less. 

Tim

Wake Up Physical Therapists If You Are Sleeping!

Carleen sent me a copy of this article from the Wall Street Journal that was coincidentally perfectly timed with my post earlier today on the disaster of spine surgery in the US. Thanks Carleen for passing along!

Ladies and gentleman who are physical therpaists around the world, please take note. Evidence-based minded physical therapists hold the answer to the back pain disaster in our world. I recognize this may sound like a grandiose and self-serving comment, but it's simply the truth. The question is whether we are willing to acknowedge and accept the responsibility to serve the public's greater good, market ourselves as the premiere evidence-based practitioners for musculoskeletal conditions, and provide high quality evidence-based non-surgical management approaches that are far more effective, dramtically less risky, and with substantially lower costs than traditional medical alternatives of drugs and surgery. We should be taking over the health care system when it comes to managing back pain.

John

Evidence-based spine surgery?

Isn't this article an oxymoron? You have to love the typical disclaimers about the absence of proof not being equated with the proof of absence. Although this is true in principle, lumbar fusion has been studied extensively and shown to be of little benefit. Now we have total disc replacement procedures (here is the latest 'evidence' propaganda) that report earth shattering 'success rates' of 92%. Until you read the small print, you might actually think these procedures are effective. The catch is that they use dismally low (and easy to achieve) thresholds to define success, in this case achieving greater than 15% of improvement on the Oswestry over a 2-year period. If you do the math, this equates to a miserly .63% change per month! Only spine surgeons would equate this to success (certainly not the average consumer). There are also no data to suggest that these very invasive and costly procedures provide more benefit than non-surgical treatments that are far less expensive, have more evidence for their use, and are accompanied by exponentially lower risks. The passage of time and some solid biopsychosocial education are likely to achieve at least comparable improvements.

Science is not immune from 'spin'. Only spine surgeons and device manufacturers benefit from the spin that is so pervasive in device supported spine surgery research. The consumer and health care system will continue to be major losers until the health care system regains a moral compass whose true north is represented by the consumer's best interest and not that of spine surgeons and device manufacturers.

John

Can Physician-Industry Relationships Can Be Ethically Established?

I am not optimistic, but the "Standards of Professionalism" document currently being developed by the American Academy of Orthopedic Surgery is at least a step in the right direction. If it does not mandate disclosure of all conflicts of interest, it will have been a failure. Shouldn't consumers be able to expect at a minimum to be informed when their spine surgeon gets a nice check from the device manufacturer for electing to put hardward in their back? I will remain a pessimist until proven otherwise. Until such time, consumers should be very leery of anything close to spine surgery and recognize that decisions made about their back may have little to do with their spine.

John