I’ve recently had a ton of new patients come my way. I'm not saying this to brag, I say this because they all seem to be coming my way through the same pattern. First, they get injured and wait a few weeks hoping the injury will go away. This is kinda like when my son hides behind behind my nightstand when he doesn’t want to take a bath. Bath time isn’t going away anytime soon and neither is your injury.
Next, after a few weeks of dealing with pain, most people go and see their physician. They usually are given some medicine and are sent to a specialist, like an Orthopedic Surgeon. Once at the specialist, they are re-evaluated and diagnosed. This also typically includes unnecessary advanced imaging such as MRIs. Usually at this point you will be given a referral to a physical therapy clinic. The problem with this, is that now it’s been a few weeks at best and you’ve gotten some very expensive and most likely unnecessary images of the injured body part. To make it worse, no one has even addressed any mobility, stability or movement dysfunctions that most likely caused the injury to begin with.
Our current medical model is often enraging to think about. I like to think that most medical providers are very ethical people. We get into medical careers to help people and it makes us feel great when we get someone better. The majority of the problem is based off of two factors: 1) Providers are having to see more and more patients with declining insurance reimbursement and 2) Decisions are often times dictated by money.
I spent the last 4 years practicing as a Physical Therapist in the Army. Conditions are not ideal, by any means. Our budgets are too small, we have too many patients and our patient base is constantly doing extremely physically demanding activities (i.e jumping out of airplanes with 60 lb. of gear on). We also have a much different model of treatment.
If you hurt yourself in the Army you typically go straight to the physical therapy clinic. From there, if you do not get better you are sent to see your family practice physician or a specialist. Images, like MRI, are only ordered when absolutely necessary. Surgeries are only performed after physical therapy has been performed for at least 2-6 months unsuccessfully.
So, why is the model so much different in the civilian world versus the military? It’s simple: money. Surgeons and physical therapists do not get paid based on how many surgeries they perform or visits they see a person. Surgeons are busy enough in the military. They prefer for patients to go straight to the physical therapy clinic. This way they only see the patients that are truly surgical candidates if they do not get better with physical therapy. It's more efficient and cost effective.
Don’t get me wrong, I like money as much as anyone. I want to make as much as I can to support my family. I will, however, never let money dictate how I will treat a patient. I currently average just under 3 visits with clients before symptom resolution and discharge. I’ve even had business mentors tell me to stop getting people better so quickly. They want me to hold back and try to draw out my average number of visits to 5-7. I tell them I can’t do that, it’s unethical in my mind and I wouldn’t want someone doing that to my family members.
Here’s my point with this blog post. Go see someone that will actually put their hands on you, spend time with you and address the physical limitations that are causing your injury. Surgery is a last resort and there’s no guarantee you will be any better after a surgery. I’m obviously biased because I’m a Physical Therapist. If you’re injured you should get to a competent Physical Therapist as quickly as possible. This is how we keep the military fit to fight and it’s even being adopted by private companies. Intel used early physical therapy access and saved $2 million dollars in a year! Also, Aetna and Starbucks used early access to physical therapy and cut the cost of back injuries in half!
It you're having difficulty figuring out what to look for in a physical therapist, take a quick look at this blog post. It should help steer you in the right direction.
Good luck and thanks for reading.
-Dr. Danny, PT, DPT
Dr. Danny and staff's views on performance improvement, injury prevention, and sometimes other random thoughts.