Second Opinion Physical Therapist

Getting and providing second opinions regarding medical care is a common practice.  Getting and providing second opinions from a physical therapist is a less common practice, but why?

Decisions regarding healthcare can by very important. There are times and situations when getting a second opinion regarding healthcare advice are a prudent action.  Studies have shown there are generally better results if you do get a second opinion.

A healthcare practitioner can recommend their patient should get a second opinion from another healthcare provider. The patient can request a second opinion from another healthcare provider.

If you receive advice and opinion from a physician you can seek a second opinion from a physical therapist.  If you receive advice and opinion from a physical therapist you can seek a second opinion from a different physical therapist.

A physical therapist can provide information confirming or disagreeing with advice from the first healthcare provider. For example, patient with chronic hip pain the orthopedic surgeon recommended total joint replacement, contacted me. The patient wanted information whether major surgery could be avoided or delayed. After examination I determined the patient had already been doing the most appropriate self-management for this chronic problem, and additional physical therapy would not likely provide any additional benefit. Another example, a physical therapist suggested his patient consult with me, because the therapist and the patient were concerned the chronic foot pain was not getting better nor staying better. After examination I recommended replacing the worn out shoe insert/orthotic, modification and progression of previous remedial foot strengthening exercise, and finally adding alteration to gait training. The patient reported improvement which had lasting results.

Be aware if your physician is of the opinion that physical therapy is not indicated for your problem you can still request and obtain a physical therapy evaluation without a physician’s referral. Some health insurance plans require authorization from primary care provider to see a physical therapist so you may have to self-pay or use health saving account funds.

Not all physical therapy is the same. If you have seen a physical therapist for your problem without resolution it may be a different Physical Therapist can provide better care. If physical therapy is not indicated for your problem the ethical standards for physical therapist require the physical therapist to share that opinion.

Abraham Maslow, a noted psychologist, said “if the only tool you have is a hammer you tend to see every problem as a nail”. If you go to surgeon he will offer your surgery. If you go to an internist he will offer you medicine. If you go to a chiropractor he will offer you manipulation. If your go to physical therapist he will offer you exercise and movement therapy. Good healthcare professionals recognize in addition to nails there are bunch of nutty patients and screwy patients which may need a wrench or screw driver.

When a second opinion is indicated regarding healthcare:

• Elective surgery is recommended
• Diagnosis and/or treatment is not clear
• Persistent symptoms and lack of resolution of the problem
• Rare condition or diagnosis
• When you are not given a clear explanation of how to self-manage this problem
• If you sense that there is a lack of agreement between your expectations and what the healthcare professional expectations are, and attempts to communicate and resolve this lack of agreement [is] ARE failing
• When your healthy level of skepticism is becoming larger

Seeking a second opinion may feel uncomfortable for fear the action will upset your first healthcare provider. But medical ethics for healthcare professions assert that it is the patient prerogative to seek a second opinion. A good healthcare practitioner understands your right to be well informed and should support you seeking a second opinion.

Considerations when seeking a second opinion regarding healthcare:

• Choose a healthcare practitioner who is independent of the first healthcare practitioner
• Consider a healthcare professional from different back ground
• It is your choice whether to inform the primary healthcare professional or to proceed in stealth manner and not inform the primary healthcare professional
• Take time to shop for best healthcare professional for second opinion
• Check with your health insurance company regarding coverage of second evaluation
• Collect and share results records from previous tests
• Seek second opinion earlier rather than later
• Consult with your primary care physician to help sort out conflicting opinions

“If you find yourself in a whole stop digging” Will Rogers

I have pondered this on my patient’s behalf.  Many times patients sought my assistance for chronic heel pain or IT band pain, and express I have been stretching the injury several times a day and it is not getting any better. After careful examination it is apparent they are in pain because the tissue is stretched out and relatively loose or lax.  Pain can happen because things are too loose and lax. Digging a whole makes it deeper, and therefore harder to get back out. Sometimes it is better to stop carrying on and exacerbating the situation.

I have surveyed my Physical Therapist colleagues by asking the question “how many physical therapy visits will you see a patient if you are not seeing progress with their problem before you refer them to another healthcare practitioner”. The responses have varied from a quizzical look, “I have never thought about that question” to a high end of six to eight visits. My belief is “three strikes and you are out”. If neither the patient nor I see any measureable improvement after three physical therapy visits then it is time to consider getting a second opinion from another healthcare professional.

Why getting and providing second opinions from a physical therapist is a less common practice is not clear. However, there are good reasons why getting and providing second opinions from a physical therapist should become a more common practice.

Damien Howell Physical Therapy – 804-647-9499 – Fax: 866-879-8591 At-Home, At Office, At Fitness Facility – I come to you, I do home visits Damien@damienhowellpt.com