June 6, 2013

How to Choose a Physical Therapist

By Tina Howell, PT, MPT, FFMY, CFMT, FAAOMPT
Performance Physical Therapy

There is some optimism regarding Obama-care in 2013 – that being increased consumer choice in healthcare. Most of us can now choose our own providers, specialist and yes, even physical therapists.

When you are referred to a physical therapist, you are able to choose any physical therapist clinic to guide you through the rehabilitation process. However, buyers beware – your physician may be a partial owner in the clinic where you are referred to and will have a vested interest in making sure you go to that clinic, even though it may not be a good fit for your condition.

So, how do you know the difference between a so-so physical therapist and a stand-out physical therapist that is not only knowledgeable and highly skilled, but gladly goes above and beyond the call of duty on your behalf?

Here are several specific and important questions that anyone can ask to help narrow down the choice of the best physical therapy fit for you.

1. How will I be matched to a specific physical therapist?

Skip the large clinic who tells you when you ask on the phone who your therapist will be, “All of our therapists are great and specialize in the type of care you need for your diagnosis.”

For a few cases, this may be true, but quite honestly, this is a line that really means you will be placed with the therapist with the most open schedule that matches yours, not the skills that match you therapy needs. If you settle for this, you’re rolling the dice on your care – it could be great, mediocre, or flat out inadequate.

Solution: Ask what type of skills your physical therapist has, and what diagnoses they see most often. Ask to be placed with the therapist who sees your diagnosis most frequently.

2. Will I be working with the same physical therapist each and every visit?

In many cases, you will work with whoever is available to meet your scheduling needs, whether or not it is with the same therapist. Every physical therapist (PT) would agree when asked, that you receive the best care from a single physical therapist that knows you and your case, and follows the exact plan of care he or she wrote specifically for you at your initial evaluation. Of course, PTs do go on vacation, call in sick, or go on maternity leave, but for the majority of the visits, your best care will come from your own dedicated PT.

Solution: Ask specifically if you will be working with the same physical therapist each visit.

3. Will I be given one-on-one care throughout my course of treatment?

Hopefully, when you ask before your first visit, you get a straight answer. If you are in the middle of your physical therapy regime and notice your physical therapist is working with another patient or two in the gym at the same time (this happens on a regular basis), realize that this is not the type of skilled care your insurance company likes to reimburse for (in fact they consider this fraud).

Solution: This is sub-par medical attention, and you should not settle for this. Leave and find a different PT.

4. Has my physical therapist attended continuing education for the type of care he or she will be giving me?

This is a great question, especially for people with low back pain, neck pain, tension headaches, women’s health issues and a host of other more complex patient diagnoses to treat. Quite honestly, (myself included), physical therapy education provides basic training. Specialist evolves from the course work, certification, residencies and fellowships they pursue independently. It takes mentoring, education, experience and passion to truly be a great physical therapist, especially for complex, difficult cases in the out-patient orthopedic and sport medicine settings.

Solution: Ask about credentialing, years of experience treating a specific diagnosis and training in this area.

5. Do I want to be treated by a physical therapy assistant?

For most patients, there is a big difference in the size and complexity of the tools that a physical therapist and physical therapist assistant tend to have, especially when it comes to manual therapy skills. In our profession, physical therapist assistants are not allowed to learn these skills. If you have a diagnosis that requires a significant amount of manual therapy, such as low back pain, neck pain, headaches, frozen shoulder, post rotator cuff repair, hip pain, knee osteoarthritis, and even total joint replacements and ACL/meniscus repairs, you will recover faster with the skills of a physical therapist with
significant manual therapy skills to mobilize the affected joint itself along with the other, more typical interventions.

Solution: Ask if you will continue your treatment with the same physical therapist to allow for continuity of care, or do they team up with a physical therapy assistant.

6. How can I tell if I am receiving good care?

Search for an alternative practice if –
• You receive ultrasound, e-stim, hot packs and cold packs each treatment
• You receive the same treatment each time, even though you are not getting better.
• Your therapist tells you “you are not trying enough” when you “fail to respond.”
• Your physical therapist is billing you for time he or she is not spending with you in a one-on-one setting with skilled care delivery.
• You feel like you are getting the same treatment and exercises as everyone else around you.
• You are billed for non-skilled exercises: riding a bike to warm up, doing the same exercises you do at home (unsupervised).

When health care dollars are at a premium, expect value for the services rendered. No one is more vested in your recovery than you. Seek professionals who want a relationship centered on your well being.