2020 Essay Contest - Honorable Mention: Miscommunication: Physical Therapy’s Least Talked About Epidemic by Aaron Bowe

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2020 Essay Contest - Honorable Mention: Miscommunication: Physical Therapy’s Least Talked About Epidemic by Aaron Bowe

Miscommunication is likely the biggest detriment in modern healthcare, and it creates divides between professions, prevents timely referrals, and slows the diagnosis process. Time and time again, we hear of friends and family who are stuck in a loop; they see many different medical professionals, each of whom isn’t able to connect every piece of the puzzle. With more inclusive interprofessional communication, patients wouldn’t have to start over with each medical appointment.

For physical therapy practice, an issue that is begging for a resolution is untimely referrals. Chronic injuries are far more difficult to treat over time, and preventative measures are the most cost-effective way to keep patients healthy in the long run. Physical therapists are able to spend a substantial amount of time with patients in order to educate and train them in methods to decrease pain, but also improve things like strength and stability to prevent future musculoskeletal complications. Physical therapists are also able to improve balance and implement fall prevention programs. The CDC states that falls are the leading cause of death due to injury in the geriatric population. The issue, however, is that PTs rarely work with clients and patients to prevent falls until after one occurs.  Dr. Castleberry, who founded the Falls Prevention Clinic at Emory & Henry College stated, “I have never received a referral on time for a Parkinson’s patient. I typically see them when movement is almost completely limited.” Furthermore, 50-70% of people with Parkinson’s Disorder experience at least 1 fall per year (Morris, Martin, and Schenkman). Yet, these patients do not typically get referred for physical therapy in the early stages of the disorder. 

The current medical model, which focuses on acute conditions, would likely result in medical treatment of a Parkinson’s patient after a serious fall, or after disability results in major disruption of activities of daily living. Eventually, the patient may see a PT to work on alleviating these limitations, but the progression of disability may have been greatly reduced if the patient would have been seen earlier. 

All of this is not to say that other professions are responsible for this deficit in the field of physical therapy. The issue is prevalent in other healthcare professions, and it begins with a culture of disinterest in other professions, starting at the graduate level. Our school prides itself greatly on our integration of coursework and lab activities with the occupational therapy students. However, our cohort is almost done with our second year of didactic work, and we have only had 1 hour of coursework combined with our PA students. Our school provides us with interprofessional shadowing opportunities in our community, which allow us to see how different medical professionals work. Yet, in my experience, it became clear that many of the professionals didn’t understand why a SPT was shadowing them. Furthermore, in my discussion with PA and occupational therapy students, it has become evident that there is a general lack of comprehension of what our neighboring professions actually do. If we don’t fully understand responsibilities of our fellow professions, we certainly cannot expect to fully utilize them as resources for providing more holistic care to our patients. Furthermore, if other healthcare professionals don’t fully understand how physical therapists can be utilized, it may be unrealistic to assume that the general public understands the preventative care that PTs can provide. Direct access is becoming increasingly more available across the United States, and patients can circumvent the referral process altogether by being evaluated by a PT as a source of primary care.  In order for this to be an effective strategy, patients would need to have a generalized understanding of what physical therapists do. In order for the public to understand physical therapy, it is imperative that we advocate for the value of our profession. It is equally important that other fields do the same; with better public understanding of healthcare, people can avoid being stuck in the loop of unnecessary initial evals and extra referrals. One way to advocate in the field of physical therapy is through the American Physical Therapy Association (APTA). The APTA action center on apta.org provides an outlet for contacting legislators which can help improve current policies. For example, we can fight to make telehealth more widespread, which would improve interdisciplinary communication and allow experts in our professions to work with patients from afar.  

Overall, the Accountable Care Organizations (ACOs) seem to be a viable solution for addressing the communication disconnect that leads to uncoordinated care across professions. Accountable Care Organizations are patient centered and focused on preventative care. Composed of a team of healthcare professionals, these organizations make it easier to perform co-evaluations.  For example, if a patient is seeing a primary care physician, then a cardiologist, physical therapist, occupational therapist, etc. can join the appointment via video as needed. This allows for experts in their practice to educate patients and make evidence-based decisions. Furthermore, when therapists are involved in the decision-making process, we can encourage physiological and lifestyle changes to prevent future impairments, as opposed to the current medical model of applying a bandage to cover up the pain. 

Co-evaluations allow for different professionals to communicate in real time and collaborate when making clinical decisions. If it isn’t feasible to perform co-evaluations in person, telehealth and ACOs make it feasible for professionals to do so with the click of a button. However, technology and ACOs alone are not enough to solve the complex issue of miscommunication in healthcare. Education is a critical tool that every therapist should be using. We can educate patients in the clinic, but we can also work to educate the public, and push for legislation that does the same. Current healthcare culture normalizes conditions that result in excess spending and possible complications and disability. I feel, as a future physical therapist, that it is my responsibility to educate the public on the benefits of exercise, including prevention of heart disease and diabetes. If the public becomes informed on options for prevention of serious conditions, then people will have the ability to help close the communication gap. This is by no means an easy task to resolve, but coordination and education are the first two steps in the right direction.

Citations

  • Morris ME, Martin CL, Schenkman ML. Striding out with Parkinson disease: evidence-based physical therapy for gait disorders. Phys Ther. 2010;90(2):280–288.