Should You See A Physician Or A Physical Therapist?

Let me start out by making this clear. I have a Doctor of Physical Therapy (DPT) degree I do not have a Doctor of Medicine (MD).  If you have a rash and a fever I’m honestly useless to you. If you tweak your lower back picking something up, I’m your man! Much like our friend Stu from the Hangover, there can be a bit of confusion about what different medical professionals actually do. Yes a Dentist is a Doctor but not a Doctor of Medicine.

For the context of this post when I refer to a MD, I mean a General Practitioner or Family Practice Physician. This is typically who most insurance companies mandate you see before you can go see a specialist like an Orthopedic Surgeon. MD’s that function in the capacity fill a huge and vital role. They have to know a little bit about a ton of medical problems. They may see one patient with the flu and the next one could have a sprained ankle. They have to be able to decide what to do with that patient or if they would be better off to refer them to a different medical specialist. 

One of my duties in my last jobs in the Army was actually to serve as a clinical instructor for MDs going through a Family Practice residency. They would spend a few weeks with me learning about musculoskeletal evaluation and treatment. They were always so excited to actually learn how to treat people, not just diagnose them. They especially loved the mobility techniques and dry needling I would teach them because they would get results fast. The one thing they couldn’t change however is the amount of time they would get with their patients. On average an MD will get to spend 8-10 minutes with a patient. That’s not a lot of time to establish trust, listen to what the patient has to say, do a thorough exam and then actually treat that person if it’s needed. 

Many states and insurance companies want patients to see an MD first. One of the reasons for this is the very unlikely chance that your musculoskeletal pain could be caused by something internal. This could be pathology such as cancer, internal organ pain or a number of other systemic diseases. This is where red flag questions become an important part of evaluating someone. Red flag questions are asked to help rule out pain that is not coming from muscle, joint or bone problems. Also, any good medical professional, no matter what their degree should be able to tell when something just doesn’t seem right. I’ve caught cancer on two occasions, Lyme disease once, gallbladder disease once and muscular dystrophy once. That’s 5 people out of the thousands of people I have seen over the past few years. 

Here is an example list of red flag questions typically asked when someone has lower back pain. If you answer no to these questions you can feel pretty confident that your pain is coming from muscle, joint or bone related issues.

• Do you have constant pain that does not change with activity or rest?
• Do you have a previous history of cancer?
• Is the onset of the pain insidious(meaning there is no specific incident that caused the pain?
• Do you have a fever(>100 F)?
• Do you have tenderness in the gut(belly or lower abdomen)?
• Have you noticed difficulty with bowel or bladder activity?
• Do you have any recent unexplained weight loss or weight gain?
• Does the pain wake you up at night?

So, when you hurt your back you have two options. Option one, go and see your MD, have them spend 8-10 minutes with you and ask you the above set of red flag questions. Most likely they will give you some tylenol and a referral to see a physical therapist. Or you can pick option two and go see a physical therapist. Spend 60 minutes with that individual, answer the same set of red flag questions and then start working on fixing your back. 

-Dr. Danny, PT, DPT