I wanted to share with you, my patients, some of my impressions about medical school especially from the perspective of a forty year old man with a family and small kids, a running physical therapy practice, and quite frankly…. a life. I wondered before starting school how I would handle the pace, the pressure, the change in lifestyle. I also wondered whether my experience as a PT would be of any use and how PT school would compare in intensity to medical school.

Here are some quick impressions. Overall I think it has been easier on me than I anticipated but not from every perspective. I have been able to this day to maintain my practice by hiring help and keeping an eye on things. The experience of still seeing patients is actually refreshing and needed. It helps move my focus from school alone (which is needed if you want to make it to the other side and still have your sanity somewhat intact).

Having a family has also been more a help than a hindrance. Even though I only study when my kids are at school or asleep, I find that I have enough time to have an excellent family life and be a good student at the same time (I am in the top 50% of my class, at least). Family has actually been a blessing because of the high pressure of med school and the need to have something else going besides school in order to maintain sanity (see previous paragraph).

This brings me to the other point about the pressure in medical school especially when compared to PT school. PRESSURE is the operating word here. There’s immense pressure every day without exception. While I found the material in PT school just as challenging as medical school (with some exceptions, of course), it is the intensity that makes the difference. In PT school you could go a week and not study and would still be fine. In medical school that would be fatal. I need to study at least something every day otherwise I fall behind. Now it is true that sometimes I make the decision not to study but I invariably pay with my grade when I do.

Overall, my experience as a PT clinician has been very useful. Not only am I having an easier time in classes like Anatomy, Neuro, Musculoskeletal, Cardiology, but I have a distinct advantage in Clinical Medicine courses in which we learn the practical aspects of being a doctor, interacting with patients, etc.

I am extremely happy with my choice and I look forward to my third year so I can get back to the clinic full time.

What is “direct access”? It is the ability of the patient to choose to be seen by a physical therapist without requiring a physician’s referral. In California (unlike in most other states), due to the strength of the California Medical Association direct access is not permitted. What that means is that the insurance company will not pay for treatment delivered in a physical therapist office unless a physician recommended it.

Let me give you a little background. Most US states have direct access at this time. Along with that, the Kaiser Permanente system and the US military use physical therapists as primary care providers for musculo-skeletal problems. In the 20 or 30 year history of the military, the Kaiser Permanante system or other states’ direct access policies, no increased risks were recorded in patient care. This comes from HPSO, the biggest malpractice insurer in the country. On the other hand, when orthopedic tests have been administered to orthopedists, physical therapists and primary care practitioners (internists, pediatricians, family practitioners) the orthopedists averaged 86%, the physical therapists 82% and the primary care providers………….28%.

Yet when, this month, the California Physical Therapy Association (CPTA) met with representatives of the California Medical Association (CMA) they were met with bitter hostility and were told that they would endanger patients with underlying medical conditions due to inadequate education. Keep in mind that they have absolutely no data to back their claims up, while the CPTA has done countless studies demonstarting patient safety in a physical theapist as a PCP model.

What seems to be the problem? It is called a “turf battle”. It shouldn’t be. Why? Because care for musculo-skeletal conditions is delivered safely by physical therapists at a cheaper cost, saving money in the long run.

Dizziness rehabilitation is not usually associated with physical therapy in our patients minds. But there are specialized physical therapists that can deal with your dizziness and its functional limitations. If you are experiencing such symptoms please let me know.

I have to share this experience with you, the patients, so I can paint a more clear picture of what it means to be a medical practitioner in today’s America. Every day when we open the mail at our clinic, it is an opportunity to confront a number of the latest tactics insurance companies will employ in order to delay payment for the care we delivered to you the patients. Today it all moved to the next level. Here’s what happened. I opened the mail, only to be confronted with a few payment denials from United Healthcare in the cases of a few patients for which there was no reason to deny payment. It has become so commonplace that I recognize immediately when payment has been denied on purpose and a phone call will fix it (the phone call lasts half an hour). But it buys the insurance company a couple of months and all they have to do is apologize for the error. The error, by the way, looks like this: “Since you have submitted this claim outside of the allowed time we have to deny your claim at this time.” On the same piece of paper it states that you have 90 days to file the claim and it is apparent from the date of service that we submitted it within 30 days and yet………..there is a mistake. 

 But I digress. Here is the surprise of the year…………..

Wait for it…………….

Calls are being tranferred to India!!!!!!!! Now this is not computer technical support which has become mainstream in India. Noooooooooo! This is help with your medical claim. The questions are being answered by “Ricky” or “Penny” with all the other”Brians” and “Beckys” helping other customers in the background. I would imagine the insurance companies had to make this move seeing how all these intentional mistakes they make create a high call volume. Of course there aren’t enough people in America to answer all these questions! We need to enlist the help of 1 billion Indians to solve the crisis at United Healthcare.

Give me a break!

The picture was taken on July 21, 2007 on Mount Rainier, WA. Together with Dr. McKinley, a family physician at Valley View Wellness Center we joined a group of friends and set off to watch the world from the top. It is worth mentioning that even though we were first time mountaineers we were tackling the most expansive glacier range in the continental United States. Just a good place to start!🙂.

There are a lot of things to be said about the beauty that surrounds us, the challenges that such an expedition presents, and the reasons why one would even consider doing this. However, this being a blog focused on health, fitness and…..pain, I will focus on these issues. Let me start by saying that both myself and Dr. McKinley were worried about the physical shape we were in and whether it would be enough to allow us to climb such a mountain and have some amount of fun while doing it. We tried to stay informed by asking people that had already summited this mountain, reading online posts and recommendations of such people but we never had the feeling that we had gotten a clear picture of exactly how fit a mountaineer had to be. With this in mind, I think both of us decided that it would be better to overtrain that to be “rejected” by the mountain. How is this concept important for you, the patient? I think that in life we should always strive to be better than average…….better than what the consensus says we should be. If you have an injury that has been plaguing you for a long time and the mainstream tells you you should do this or that to get better…..you should do more. As I always tell my patients: If you want to maintain the status quo, you have to always put up a battle. It is an uphill struggle for constancy.

What turned out to be important for me was the aerobic exercise done over extended periods of time. It was very clear to me leaving on this trip that we will be climbing for many hours at a time, therefore rendering any short length exercise virtually useless. We had to get used to sustained amounts of effort over many hours. This not turns your heart and lungs into pumping machines but quite frankly makes you tough mentally. The mental aspect is very important when putting your body to the test. Paying attention to pain and discomfort is a sure way to get discouraged and turn around on a trip like this. One should also keep in mind that both myself and Dr. McKinley trained at sea level, while our trip took place at between 5,000 and 14,000 feet. The other important factor was the weight of the backpacks which exceeded 60 pounds. None of us exercised while carrying that amount of weight on our back.

To our delight, even though we did not reach the summit on this trip due to severe weather, we both became quite confident that our individual training had paid off and fitness was not the limiting factor in reaching that summit.

Here is an interesting article I found today. Good to read it if you’ve been smoking a lot and have knee pain.

Knee Pain May Signal Lung Cancer


It could give an early warning and improve treatment success, researchers say

— Madeline Vann

WEDNESDAY, Sept. 5 (HealthDay News) — Heavy smokers with knee arthritis may be experiencing an early sign of a difficult-to-treat lung cancer, research shows. Researchers at Prato Hospital in Italy reviewed the case files of 296 patients with inflammation in one knee between 2000 and 2005.

In just under 2 percent of these patients, the mild knee arthritis was accompanied by non-small cell lung cancer. All patients were middle-aged men who had been heavy smokers for most of their lives. Once the cancer tissue was surgically removed, the knee pain cleared up as well.

About 85 percent of all lung cancers are non-small cell lung cancer, according to the American Cancer Society. Unless it is caught early, non-small cell lung cancer is difficult to treat. It spreads to the bones in one in five cases and is well advanced by the time it is diagnosed in half of all cases.

Writing in the September issue of The Annals of Rheumatic Diseases, the researchers noted that early warning signs such as knee pain could lead to earlier diagnosis and more successful treatments.

To learn more about non-small cell lung cancer, visit the American Cancer Society.

content by:

Healthday

SOURCE: The Annals of Rheumatic Diseases, news release, Sept. 3, 2007