Great insight, thank you.
Tim

Hi Selena,

I wish I could be at CSM - sounds like you'll have a great time!

Tim

Eric,

I wish I could have been there!

Tim

I agree Selena - too many stakeholders. Let's get healthcare back to being about patients and providers. Only!

Thanks for commenting,

Tim

Hi Paul,

You're right - even though Mary Hayashi committed a felony the judge reduced her conviction to a misdemeanor which means that she would be eligible for re-eleection.

She is terming out in Hayward County in 2012 so she will have to find another district to run in.

Thank you,

Tim

Thanks Liza!

"Blink" is an amazing book - I recommend every physical therapist get a copy and read it.

Here is my blogpost on the Goldman decision rule, from Blink: http://bit.ly/AadAx3

Malcolm Gladwell's captivating essays on decision making in Blink will probably inform the people designing the next generation of physical therapy software for use in clinical decision support.

Thank you for commenting.

Tim

Skot,

In my opinion, the New York Physical Therapist practice act appears narrowly written and prescriptive. You can read it yourself here: http://1.usa.gov/ydpznr.

The passage that refers to physical therapy diagnosis is § 6731:

"Physical therapy is defined as: The evaluation, treatment or prevention of disability, injury, disease, or other condition of health using physical, chemical, and mechanical means including, but not limited to heat, cold, light, air, water, sound, electricity, massage, mobilization, and therapeutic exercise with or without assistive devices, and the performance and interpretation of tests and measurements to assess pathophysiological, pathomechanical, and developmental deficits of human systems to determine treatment, and assist in diagnosis and prognosis."

I can't imagine that physical therapists wrote or passed this intentionally - likely this language is heavily influenced by the Physician lobby in New York state.

Tim

Thanks Jen,
Are you using telemedicine in your setting?
Tim

Hi Bob,

I think chiropractors' problem is that their business model TEACHES them that maintenance therapy is Medically Necessary - its NOT.

Patients are fully capable of managing their own health.

Chiropractors will have to abandon their business model of lifetime adjustments for every family member in order to "wrap their heads around" Medicare's Medical Necessity payment guidelines.

Otherwise their error rate will never decrease.

Thank you for commenting.

Tim

For those interested in a lesson in archaic history, here is the link to DonTigny's original Mechanics and Treatment of the Sacro-iliac Joint first published in Volume 1, Number 1 of the Journal of Manual and Manipulative Therapy in 1993.
http://bit.ly/zPB4ew

I was initially impressed by Mr. Don Tigny's article in that described a deductive, causal linkage between sacro-iliac mechanics and lower back pain symptoms.

A causal linkage is perhaps the most dangerous and deceptive aspect of DonTigny's work.

As displayed by Christine's comment above, too many physical therapists still believe a generation's worth of medically-based education and training.

Too many physical therapists still try to find the "cause" of lower back pain.

Go to a radiologist's convention or to a room full of Interventional Pain Medicine physicians and you'll hear lots of talk like "We need to find the "pain generator"".

Thanks, John, for getting permission to post DonTigny's 2012 email; I'm surprised that he is still insistent on his original mechanical model.

Since he deduced the "truth" in 1993, I guess he no need for the evidence?

Tim Richardson, PT
http://www.PhysicalTherapyDiagnosis.com