Issue 41 Blue Crab Edition - Pushing the Profession and What Do You Think of Imaging

This week, did you hear that North Dakota just started allowing PTs to order diagnostic imaging? Oh yeah! That’s three states down, 47 (and one District) to go. For those marking your scratch-off wall maps, the three that allow it are Wisconsin, Utah, and North Dakota. On the back of that news, we’ve got papers discussing how to push PT forward through the next century, how PTs feel about X-rays, and more. Enjoy!

Push the Profession with Diagnostic Labels

The Gist - This piece, from an eminent physical therapist at Washington University of St. Louis, isn’t a research paper, but rather an argument. This former APTA Board member wants to push the profession forward and believes that new diagnostic labels are the way. She argues that the profession has emphasized treatment over diagnosis and what we do over what we know. She thinks it’s time to exert what we know and change the world’s perception of PT by diagnosing and treating out own, physical therapy-specific conditions. To do this, diagnostic labels are the key.

I know, I know, this all seems esoteric and not important to your daily practice, but it is. Diagnostic labels help the profession gain recognition “because they clearly indicate an understanding of the dysfunction causing the patient’s functional problem, whether it is a musculoskeletal dysfunction, the disordered motor control of a neurological pathology, or a cardiopulmonary pathology.” By giving patients PT-specific labels, we grab a foothold on the medical landscape and exert ourselves as profession in the eyes of patients and society.

Tell Me More - This is a very interesting piece that I know some people will vehemently debate. The author is calling for cultural change and that’s tough to do. She’s arguing that diagnostics are a primary role of the doctoring profession and that we need PT labels like the DSM has introduced for psychology and psychiatry. In her mind, “A diagnosis would focus on the collection of deficits systematically observed during the performance of tasks and measured during tests of body structure and function. A label for that condition would reflect a summation of the problem using known movement-related terms… The label also provides the direction for treatment by indicating the movement to be modified to reduce or eliminate the symptoms.”

Look, if you’ve made it this far, you should go read the piece. It’s longer, at 13 pages, but easy to read and well worth it. This is someone who’s trying to imagine a better future for PT and should be heard out, whether you agree or disagree with her methods. Give it 20 minutes of your time.

I’ll read it. Great! It’s available for APTA members here.

How do you feel about diagnostic imaging?

The Gist - This piece isn’t dissimilar to the last, discussing the future of physical therapy in diagnostic imaging. To do that, we need to know how PTs feel about their ability to order imaging. Well, we’ve got it, and they feel pretty good. Young PTs feel especially good about it. And this is good news, since PTs can order X-rays, CTs, and MRIs in North Dakota, Wisconsin, and Utah and recommend them in Colorado, Maryland, and Washington, DC. A recent study recently showed that PTs are better at suggesting imaging than physicians, ordering imaging in a way that’s approved by radiologic guidelines 91% of the time when physicians were only in the 80s. Go us! Over 90% of PTs feel comfortable ordering MRIs or X-rays which is also great news.

Tell Me More - Again, I know, why does this matter? This is how we gain more power to order imaging, by demonstrating that we can do it competently. Just last week, North Dakota law started allowing PTs to order imaging and studies like this can be really helpful in pushing that out to more states. It is legal to recommend that physicians order imaging in all states and legal to directly order it in three. Important info for any PT engaged in advocacy throughout the country. Lastly, military PTs have been able to order diagnostic imaging since 1972 and this has reduced costs and over treatment in that arena. Hopefully we’ll get this throughout the US soon.

I’ll read that paper. Sweet! Here ya go.

That’s our week! Hope you enjoyed this slightly off edition of PT Crab. It was a bit different than our regular content, but still full of elements important to the profession. As always, feel free to respond to let me know what you think, I’m all ears.

Cheers,

Luke