21.10.08
Self-regarding
OK so I’m incontinent today but:
Coo there’s your actual news story about us physios on the BBC. It’s about the idea that people should be able to self-refer to physios rather than taking time up going to see the GP first.
This has been taken in some strange ways on their HYS about the topic.
First off people seem to think that it means that people can just phone in and get a physio appt. This isn’t what self-referral is. When a GP refers us a patient s/he has to fill in a referral form with lots of questions on. This then gets looked at by me (usually) and then I decide whether it gets accepted or not (and if not, why not and a letter written back to the GP), and then whether the patient needs to be seen urgently or whether they can be left on the waiting list for a while. All self-referral means is that the patient will fill a form in to start the process rather than the GP filling it in.
Then there are comments like:
In theory, this sounds like a fantastic idea.
In practice, I fear that physios will be over-burdened with hypercondriacs and time-wasters, something that is becoming more common in recent times.
For example, Mrs A is recovering from a car accident and needs a physio appointment, but the physio cannot see her because she is busy with Mrs B who is just overweight, lazy, and looking for attention or a sick note.
Unfortunately this is what happens anyway. The person who refers is irrelevant. Yes we’ll get more people into the system at first but we won’t be letting regular malingerers in on a regular basis (and yes we do know when you are malingering). I refer you back to the bit about me writing back re why we’re not accepting a referral.
Then the worry seems to be:
This pre-supposes A) The referring individual knows what’s wrong with them, and B) That they know physio will be of benefit to them.
This also means that the physio will have to be able to effectively screen out those who need to see a doctor.
Given the above, I’d be prepared for a lot more mis-diagnosis, complications from inappropriate treatment, and a few people dropping dead as their back pain turns out to be something altogether far more worrying indeed!
and
I am aware of someone who went to his GP and asked to be referred to a physio for back problems etc. The doctor was not happy and referred the person to hospital. The back problem was caused by pressure from a tumour!
Paragraph 1 is pure rubbish. Part A: so people need to know what’s wrong with them before they see a GP? And part B: Why? Surely finding out that physio is not helpful just leads to further investigation. This is what happens now.
Paragraph 2: Erm. Ok I can do condescending (as DB once said, “I know I’ve read your blog”) but that is appalling. What does this guy think we’re trained in? No doubt he’s a “give me some massage” type. Assessments routinely ask “red flag” questions - IE looking for stuff that needs urgent follow-up. We know what musculo-skeletal patterns are there. We know the commonest symptoms and patterns of non-MSK origin. That’s why we spend 3 years or more at uni then years of on-going training on the job.
So paragraph 3 is rather redundant. I’d pick a physio to spot nasty back symptoms in a 45 minute assessment over a rushed non-specialist GP in an 8 minute assessment any day of the week.
The second one is again just what we do day in day out. I’ve spotted tumours, MS, cancer and so on in patients who have been “screened” by GPs. It’s one of the things we’ve been trained for.
And then there’s the political argumentative types:
I wish these imbeciles would stop meddling with the system, they havent got a clue what they are doing as has been found with the contracts and out of hours care….
Let the reshaping suggestions come the other way……far to much meddling from the top is costing us Billions in waste…..
You mean like the large number of studies done re self-referral that show it’s worked well, is cheaper, quicker and less wasteful than GP controlled care? Yeah really top down that stuff.
Oh and the lunatics:
GPs should always be the gate keeper but would benefit from more pain management training and a wider choice of therapies to offer such as massage.
and
The physio also needs to be given the power to refer someone back to their GP if they feel that they should.
So massage is useful (quote from the European Back Pain guidelines “We cannot recommend massage therapy as a treatment for chronic low back pain.” NB this is written by an international committee looking at vast amounts of published and reviewed literature - not merely some bureaucratic nonsense) and someone thinks that physios should be able to refer back to GPs. Like they can’t now? Again it’s what I do multiple times daily should I need to.
But one of the comments made me smile:
Given that most visits to a physio make a trip to a medieval torture chamber seem like a gentle day out, the more malingerers that get folded and half and have their big toes poked up the noses, the better.
Have fun.
PS AAARRRGHHH!!!!
However, telling folk to exercise more isn’t the answer to stop physio referrals as it’ll just increase sports injuries cause by lack of warm ups/downs and good posture.