Healthy Wealthy & Smart 602: Dr. Katie O'Bright: The Primary Care Physical Therapist
In this episode, Physical Therapist and Founder of Redefine Health Education, Dr. Katie O’Bright, talks about the role of the physical therapist in primary care.
Today, Dr O’Bright talks about direct-access in outpatient clinics, patient satisfaction with teams-based approaches, and the sustainability of physical therapy as a profession. What is the primary care physical therapist?
Hear about billing as a direct-pay PT, learning from ED PTs, and Redefine Health, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “The primary care team is a team.”
- “The more we can get integrated into teams, the better.”
- “I don’t think that our profession, the way that we’re doing things, is sustainable at all.”
- “Every health professional has a role in lifestyle intervention.”
- “Do we really know, for different pathologies, what views and types of modalities and studies are actually required in order to effectively rule out a condition?”
- “If we can do anything to make our population more healthy, and to make other healthcare professionals see our value, then do it.”
- “The more I learned about the things that I didn’t know, the better clinician and person I became.”
- “Always have listening ears.”
- “Never drink the Kool-Aid. It’s not a good idea.”
More about Dr. Katie O’Bright
Dr. Katie O’Bright, PT, DPT, OCS is a residency-trained physical therapist and educator who has spent much of her career in multidisciplinary primary care settings.
She started her career as an active duty Army PT where she worked in a team-based Soldier Centered Medical Home. Since then, she has worked in multidisciplinary care settings in academic health systems and private practices, including oncology care. She also serves as adjunct faculty in several DPT programs, teaching foundations in primary care, oncology, musculoskeletal and gross anatomy.
In 2020, Dr. O’Bright founded Redefine Health Education, an education & consulting company with the mission of getting more physical therapists competent and prepared for work in first contact, team-based care settings, starting with primary care. She is the lead instructor in Foundations for the Primary Care PT and contributes to musculoskeletal imaging curriculum.
She currently lives in the Chicago metro with her husband & 2 sons, enjoys being outdoors & Buffalo Bills football.
Suggested Keywords
Healthy, Wealthy, Smart, Physiotherapy, Education, Teams, Sustainability, Primary Care, Redefine Health, Lifestyle Medicine,
Resources
Chicago PC Course (Aug 27-28).
MSK Imaging Certification (Starts Sept. 7) - 2-hour modules, 1x/month for 9 months or online self-study.
Use “HWSPodcast2022” for $50 Discount.
To learn more, follow Dr. O’Bright at:
Email: info@redefinehealthed.com
Cell: 312-772-2322
Website: https://www.redefinehealthed.com
Facebook: Redefine Health Ed
Instagram: @redefinehealthed
Twitter: @RedefineConEd
TikTok: @redefinehealthed
LinkedIn: Redefine Health Education
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Read the Full Transcript Here:
00:07
Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.
00:35
Hey everybody, welcome back to the podcast. I am your host, Karen Litzy. And in today's episode, we are going to be talking about the role of physical therapy as the primary care P T. So what does this mean? This means that if physical therapists being first point of contact for the patient into the medical system, and what do physical therapists need to know in order to be the primary care PT? So to talk us through this topic, I'm really happy to welcome Dr. Katie o bright. She is a residency trained physical therapist and educator who has spent much of her career multidisciplinary primary care settings. She started her career as an active duty Army PT, where she worked in a team based soldier centered medical home. Since then, she has worked in multidisciplinary care settings and academic health systems and private practices, including oncology care. She also serves as adjunct faculty and several DPT programs, teaching foundations in primary care, oncology, musculoskeletal and gross anatomy. In 2020, Dr. Albright founded redefine health education and education and consulting company with the mission of getting more physical therapists competent and prepared for work in the first contact team based care settings starting with primary care. She's the lead instructor and foundations for primary care PT and contributes to musculoskeletal imaging curriculum. She currently lives in the Chicago Metro with her husband and two sons and enjoys being outdoors. And as a Buffalo Bills fan. We'll let it slide because you know, I'm a Philadelphia Eagles fan. But I want to thank Katie for coming on. We've got a lot of resources on podcast at healthy, wealthy smart.com. And she's actually giving giving healthy, wealthy and smart listeners a $50 discount for courses at redefine health education. So you can use h w s podcast 2022 for the $50 discount. So big thanks for Katie for coming on talking about primary care, physical therapy. Hi, Katie. Welcome to the podcast. I'm happy to have you join us today. Thank you so much. It's really honestly a pleasure and a privilege to be on your show. I've been a longtime listener. So this has been awesome. Oh, that's so nice. Thank you for that. And today, we're going to talk about the role of the physical therapist in primary care, which for those of us like myself, who's been in the profession for quite quite many, many years, I feel like this concept of the primary care PT
03:15
is on the newer side, depending on maybe what part of the country or the world you're practicing in. So before we get into the meat of the interview, I would love for you to define what is the primary care physical therapist? Yeah, that's a really good question. And I think that you're going to get a different answer from, you know, you'll get 10 different answers from 10 different people that you ask, but the way that I really like to think about it, and even my definition has evolved a bit over time, but the way that I like to think about it is
03:50
a lot of people think that primary care PT just equals you know, direct access or first contact or seeing a patient without a referral. But as I've learned more about what it what it is to be a primary care provider, I think that it has a lot more to do with being a being able to comprehensively assess a patient across all different specialty areas. So it's not just you know, you are an advanced neuro musculoskeletal professional. It's you're able to assess and effectively manage the functional needs of a patient, whether they have primarily orthopedic complaints, or primarily, you know, maybe they're a pediatric patient, or they primarily her, you know, dealing with some other non communicable diseases like diabetes and hypertension. You as the primary care PT are able to understand what it all of those how all of those systems play into their functional needs. And you're able to provide guidance on the management in conjunction and in sync with other health care professions.
05:00
Smells like the primary care physician. But you're able to effectively manage a variety of different conditions, not necessarily just their orthopedic or just their neuro or just their pelvic floor.
05:12
So that's kind of what my definition of primary care PT has come to evolve into. And I feel like my colleagues at the primary care sing would probably agree with me. Yeah, that seems reasonable. Have you ever heard of people saying, Wait, primary care? pte. Isn't that overstepping our license? Or isn't that going beyond what we should be doing? How do you respond to that? Well, I respond to it this way.
05:41
I think that pride, the primary care team is a team. And you can have a primary care physician or PA nurse practitioner. And they're typically in most cases, and especially in the United States, you will have a primary care physician and they'll also have a team of, of nurses, maybe they'll have a clinical pharmacist. And oftentimes that doesn't include an in house co located or, you know, maybe not co located but down the hallway, PT. But I think a lot of health systems are starting to see the advantages of having a variety of healthcare professionals that can be first contact. So for example,
06:23
the there there's physicians that can build primary care codes like e&m Primary Care codes, nine, nine series codes, and then there's non physician professionals that can build those codes as well. And that's limit that's not not just limited to pas and nurse practitioners, it also is encompassing behavioral health professionals, midwives, clinical pharmacy to a certain extent, and I think you're gonna start to see more and more primary care teams functioning as a team, which also includes a physical therapist that can contribute to the, you know, the, like managing the patient's functional needs, and everybody contributes to what component they need to contribute to.
07:08
Yeah, and that's interesting, you bring up the code. So normally, the physical therapists are billing under the nine sevens, usually. So in this case, if you are working with someone within their insurance system, and you're not a direct pay physical therapist, how do you bill for the services? Or? Yeah,
07:33
great question. So I actually just connected with Rick, Glenda last week, and I want to talk to him a lot more about this. So I actually have some, some meetings arranged, or I'm reaching out to plan some meetings with him to consult on that specific topic, because the health systems that I have worked with, or that I've consulted with, they're all doing different things. Some of them are billing nine, seven series code codes within the primary care setting. But a lot of this over the past couple of years, since I've been really into this space, a lot of these clinics have not received the feedback from their billing and finance departments because of, you know, COVID, short, you know, short staffed because of COVID. And, you know, we were shifting our focus to this area, so we can't give you the finance data that you need in PT. So a lot of them don't have reasonable data. So I'll just tell you what I do know, some of them are billing nine, seven series codes, some of them are doing, they have a PT that is co located in primary care, they see a patient for a quick evaluation and may provide them with some treatments, if they do some treatments, the physician or other health care providers also seeing that patient in the same day. And they'll do a warm handoff to pt. So then they do incident to billing under the physician's care because they're so they're kind of like CO treating at the same time, even though the PT is collecting those RV use for that visit. So that's one way that they know it can get reimbursed. Some, some locations are not billing their services at all. They're sort of like eating the cost while they're in the primary care space, but they're seeing downstream, you know, boosts in their revenue because more of their patients that they have touchpoints with in primary care are actually then following up and actually seeing them in physical therapy.
09:29
And then they're also keynotes finding, like we were reducing imaging by being co located. So there's other you know, benefits.
09:38
Then, I mean, there's, I could go on and on, but there's tons of different ways that people are doing this. But we don't have the hard data or anything like in the research to show Yes, this is Effective here. It's going to be effective for every insurance and this and that. It's such a complicated problem.
09:58
So I'm just trying to figure out
10:00
But as much as I can about it so that when people approached me and asked me questions about how to bill for it, in a typical insurance type system,
10:10
I have a variety of options that they could start with. And then I, you know, I hope to eventually talk with some of my, some of my colleagues that are, you know, more more interested and nerdy about research that could actually help me set up a research trial and study the whole thing and report on it accurately. But right now, I'm just collecting data. Yeah, that makes sense. A lot of times as things that are a little bit newer, you kind of go through some growing pains until you can figure out, hey, where does this fit in. So let's say you're a physical therapist in an outpatient clinic, you're not co located with the doctor, and someone does come to you in that direct access. Way, which for those who don't know, it, direct accesses, that means you can see a physical therapist without a referral from a physician, which I think is getting more and more common across the country to a certain extent. So if, if you're
11:12
advertising, your marketing is including like, Hey, we're primary care, physical therapists, what does that look like in the clinic? Can you give some examples or an example? Yeah, I can. So one of the things that I teach in my course. So I, I'm the owner of redefine health education, and the two areas where we, where we teach, in particular, our foundations in primary care, PT, and musculoskeletal imaging, which really go hand in hand. And one of the main feet main things that I focus on in my primary care course is how to effectively perform a systems review in a way that is all encompassing, so that if a patient comes to you with a primary shoulder complaint, not only are you doing a systems review, to rule out red flags related to that shoulder complaint, but you're also identifying problem areas that can affect their health, in you know, in the near term, and in the long term, so that you can learn how to educate them appropriately. So let's say a patient comes in to you, you're not co located with another primary care team or anything like that. But if a patient comes to you with primary shoulder complaint, and you also find that they have have hypertension, and they're pre diabetic, and maybe they have an autoimmune disorder, and you know, oh, by the way, they had COVID really bad and they were hospitalized, and they're having some long COVID symptoms, how to ensure that you're including components in your plan of care that address all of that, whether it's just little bits of education here and there.
12:47
And also, you know, of course, you know, I want to the one of the other things I teach in my course, is not only just understanding all of that from an evaluation perspective, but then understanding how much the patient is willing to go down and actually allow you to intervene
13:04
in their lifestyle habits or, or other areas. So I think that
13:10
that process is something that PTS that are working in a typical outpatient orthopedic clinic, are not doing very well. Because usually, we are seeing patients exclusively for an isolated shoulder condition. And we're not really looking into what the rest of their medical history really spells out for us.
13:36
But what I teach is
13:38
basically intervening in lifestyle and ensuring that they're, you know, if they need medication management for an autoimmune disease, are they actually following it? How is that playing into are related to their shoulder pain? How is that affecting their nervous system? How is that affecting their cardiovascular system?
13:56
So yeah, I think that I think that you certainly could, you certainly could. And then another thing, I've had a, I had one outpatient clinic team, or they were kind of like a local regional chain. But they also had a kind of a, analogous to them was a local, regional primary care group, that they were interested in it both privately owned, really interested in collaborating together. So even though they weren't co located, one of the things they thought about doing and that they're in the process of building is they're actually going to have a PT hanging out in the primary care office, whether it's 1233 days a week, or a hat, you know, an afternoon here or there, just to be able to be there and to be able to address patient's functional needs on the spot if they need it. So there's there's all different ways that you can do it. Even if you're going to privately owned you know, private practice or you own your own cash based practice. I think that the more we can get integrated into teams, the better
14:58
and do you have any
15:00
Um, data that shows how perhaps a team based approach may may improve outcomes or patient satisfaction? I do. Yeah. So a couple of the a couple, there's there's a number of studies that have looked at this, but one of the one of the main ones that I was looking at recently was, I think it was a Dutch study, I'll have to look, I'll have to look at it. But I'm pretty sure this was conducted in the Netherlands. And it was looking at elderly adults, community dwelling, elderly adults, where they had a team based group. So they they looked at a comparator group work was really just a physician and nurses. And then they looked at basically the same, the same group that had a physician, nurses, social workers, I believe they had clinical pharmacy, they had a recreational therapist. So they had this team that would all work with the patients together. And one of the main things that they found was not only improved patient outcomes and patient satisfaction, but also provider satisfaction. And that's one thing that I have found. So that's just one study with one example. But there are a number of studies that show this and just from my own experience working in team based primary care,
16:16
I, if I would not have been in those settings, I do not think I would have as as good of an understanding of,
16:25
of the other body systems as I would have as I would otherwise. So I think that they, when you work together more frequently, whether you're co located or whether you're just on the phone, or being able to have like a texting relationship with other providers,
16:44
they're going to understand what you do a lot better. And, and then they'll learn and grow from that, and vice versa. So I think that not only is there benefit, not only do patients reap the benefits in their health outcomes, and in their satisfaction, but also providers are, they seem to be much happier and have a lower rate of burnout, when they do work in a team, as opposed to just kind of being around the same old, same old all the time, you know, if you just are surrounded by people that are so much that are like you and think like you and do like you and are trained like you all the time for your entire career.
17:26
You're not going to learn and grow as much as you would if you were around other people who don't, who weren't trained to like you, and who have a different perspective. And I think I'm able to treat my patients better because I for the most for most of my career have have not been around pts.
17:44
And how do you think this fits into the sustainability of physical therapy as a profession? Yeah, so that's, that's this is my favorite question. Um, I gave a presentation recently for the primary care sake, I think it was in May this year 2022. And one of the things I talked about was how I don't, I don't think that our profession, the way that we're doing things is sustainable at all. In fact, I think that
18:17
there are so few patients, you know, it's estimated that seven to 10% of all patients with functional complaints ever end up seeing a PT, which is not a good thing, that is not a good thing at all.
18:29
And the model that we're kind of trained under and the model that a lot of PT clinics tend to follow, especially if you're in the insurance market,
18:38
is they follow where they were, you're seeing a lot fewer, a significant fewer number of evaluations than you are seeing like treatment sessions per day.
18:50
But if if the World Health Organization is saying that, you know, 25% of all complaints 20 to 25% of all complaints give or take, you know, depending on your region, and the timeframe, and yada yada 20 to 25% of any any patient encounter in the primary care space or in the emergency department is going to be neuromusculoskeletal related.
19:11
And only 7% of those are ever ending up seeing us. Imagine what it would be like if we could be kind of that first person to consult with them. Just imagine that. And so you know, we might see a higher number of evaluations per day, but we can be there to intervene, where it's really the most important, where we can ensure that they're not receiving excessive amount of, you know, imaging or medications or unnecessary tests and studies. And we really are the professionals that should be determining and assisting in figuring that out. So I think that if we were able to intervene just in that one area, then we could save our healthcare system a whole lot of money, we could improve our population health tremendously and
20:00
Then we're also going to be leveraging our skills. Because I started my career in the army, I saw a lot of evaluations, like more evaluations than then treatments most of the time. And what I found was my differential diagnosis skills and my ability to screen got really, really, really good really, really, really fast. So the more evaluations and consults that we see, we've been, we're able to recognize more and more patterns, we're able to intervene quickly.
20:28
And other providers around us see our value more significantly. And then insurance companies on the other end CRC or value more significantly, if you if you flip the role, and we don't, let's say we don't do that we just continue down the road that we're currently on, where we have, you know, an evaluation or two a day and you know, all of these treatment sessions in order to keep the lights on, if you're still in an insurance based market, in order to keep the lights on for any private clinic owner, you have to you have to maximize the number of visits, that a patient is being seen. Whether that's necessary. Or if you're maybe just loosely saying that's necessary to make sure that you can keep the lights on
21:12
if reimbursement is only getting worse and worse and worse, because insurance companies are like, well, we don't really think that's necessary. And we're saying, oh, yeah, yeah, that's necessary. And maybe in some cases it is. But for the vast majority of musculoskeletal health, musculoskeletal problems, we know that if we intervene early, if we reassure if we educate, if we say stay active, and exercise, the the natural history is that they will probably improve and get better. So if we can intervene there,
21:42
then we probably will kind of see it shift where we'll do like more evaluations and consults and less treatments and therefore save the insurance company a whole lot of money, save the patient a whole lot of time and money. And then everybody's everybody's happy. So I think that if the roles flip a little bit, and we learn as as a profession, how to be how to serve in more of a consultant role for population health neuromusculoskeletal conditions, maybe, maybe just maybe, maybe I'm crazy, but maybe just maybe the tides will turn and we can be says more sustainable as a profession in the insurance market.
22:21
Does that's a long way of answering that question. No, that was a great answer. And you brought something up kind of
22:29
more and more people who are going to emergency rooms, a lot of times for musculoskeletal health, and we are starting to see PTs in the ER. And would you? I mean, that's obviously so certainly a primary care physician, right. So what do you think that your typical outpatient or inpatient
22:54
physical therapist can learn from those emergency room PTS, that we can kind of take into different settings? Does that make sense?
23:07
Sort of I'll start by addressing the the the IDI PTS, by the way, shout out to Rebecca Griffith who is you know, just launched her IDI DPT because this year and she's doing a great job with that but um so if you need specific questions about how to V any how to be a physical therapist in the IDI I personally don't have any experience in that space. But but she does so reach out to her
23:35
and maybe we can put her her name in the show notes
23:39
but there's a lot of overlap and I think you know we there since there are more there are more PTs in the IDI you'd be surprised actually I've been finding out more and more about PTs in primary care than I ever thought was actually there and probably maybe the the IDI has just been more there's been more exposure given to PTs in the IDI so, so to answer that question, what can
24:11
there's a little bit of a difference though. So PTs in the IDI typically don't see their patients back, you know, they might, they might see them one time and it's truly Well, unless, of course the EDC has a lot of repeat offenders but But if we're talking just like the average patient showing up at the IDI, they see their patient one time and it's truly there to to rule out red flags to ensure that they're receiving the most of if they need imaging, the most appropriate, most necessary type of imaging study and that they're getting the most adequate referrals and consults that they need.
24:50
Reducing opioid prescriptions and other types of unnecessary excuse me prescriptions and also giving them something to go home with
25:00
whereas if they if they just see, like an IDI physician or or another type of typical IDI care provider, they're not as, and I don't want to speak for them I am. So I'm such a huge proponent of working with physicians and nurse practitioners and PAs. But I know that from my experience, even they have told me that I have, I have the knack for just talking to those patients and being able to do that, do that little bit of motivational interviewing and figure out figuring out what's, what works for them, what's going to empower them what they need. And that little bit of education is is important. So but it typically in the day, they won't see their patients back, it's kind of like you're doing a quick evaluation, determining their needs, and then like discharge planning, or the patient is admitted or whatever, right? In primary care, my my whole theory, and really my vision for PTs in the primary care in primary care teams is that we would be co located and or just affiliated, maybe you're not in the same location, but you are affiliated somehow, or you have a close relationship with a primary care team, where you can have lots of good integrative care planning for the patient, and it becomes almost like a revolving door. So with your, with your patients that you see,
26:20
like I have my own primary care physician, I can go to my primary care physician whenever if I have a problem or for my annual visit or whatever.
26:27
Within my primary care team, I also have access to if I needed, I also have access to a behavioral health provider who is part of that behavior primary care team. And if at any point, I had, you know, a mental health crisis or something like that, I would go to this person because she's a part of my primary care team, and then they all work together and figure out what to do. And, you know, with with my, with my input, figuring out what is the best situation for me. So with PTS, being a part of those primary care teams, you you get access as a patient, you would get access to a PT on a revolving door basis. And then you have established, you have kind of, um, you know, if I, if I was, if I was
27:12
the, how do I jump jumbling up, because I get so excited talking about this. If I were a patient coming to see your primary care, PT, my very first visit would be a well visit. And then I would kind of like go through, maybe figure out identify some risk factors or maybe identify, you know, you're not necessarily having a problem. Now, here's what your body normally does and looks like. And this is what you do for physical activity. Let me give you some pointers, maybe, you know, maybe you want to increase your exercise, here's how to do it safely. And then if and when problems do develop down the road, we can address those and I know what your baseline is like. And it doesn't have to be this this finite linear relationship, where there's an evaluation, treat, treat, treat, treat heart discharge, for this one problem. You know what I mean? So I do like, yeah, so it becomes this, you have a team of care professionals that are on your side, and that know you and that know each other, and, you know, maybe they all they're all trained differently, and they all see things from a different perspective. But they all collaborate as a team to help you be able to help yourself the best. And I think that's that, that is my vision for what the future of pts and team based care looks like. And I am like just dying for it to happen, you know, I will make it happen thrive in this. I think that, you know, the rate of burnout in our profession is substantial. And it kills me like I some of my my students are coming out of school after their first couple of clinical clinical rotations. And they're like, this isn't what I signed up for, like, what are my other options? I don't want to be a PT. That's scary. And I think that PTS would
28:59
be able to at least at least delay the onset of burnout. If we were able to shift into these types of care models. It would be so refreshing. Yeah, I mean, it definitely sounds like that patient centered care that we talked about the bio psychosocial system of care model of care that I would say most health care professionals are moving towards hopefully.
29:28
But it does sound like it's a good environment for the patient a good environment for the clinician, and like you said, you have the opportunity to learn from different professions and from different folks who might not have the same skill sets as you and vice versa. And it also kind of started to bleed into a little bit of lifestyle medicine and things like that, which is something that we can all use. Absolutely. Yeah. I love it. I love all of it. Now
30:00
So you had said, you briefly
30:05
talked about redefine health. So do you want to go in and and tell the listeners a little bit more about that if they're interested in learning more on how they can brush up on their skills to be a better primary care? PT? Yeah, for sure. So,
30:22
um, I've always wanted to I had always wanted to get into the education space, but never in a million years did I think I would ever be starting my own education company. COVID did this to me. But you know what, thank you COVID For that, you know, if there's one,
30:39
there's like these unnecessary, I guess unprecedented things that came out of the pandemic. And for me, it was I lost my cash business after it just started.
30:52
And it there was a number of things going on with that. But I decided to just jump right into education. And it was a it was an evolving thing for me, I really didn't know exactly what what direction I wanted to take it at first. So it's taken, you know, almost two, it took almost two years to really find my to find my niche and really find my truth and what what I'm the most passionate about, and well, for me, it has always been primary care.
31:20
And it just took a while for me to like figure that out from a business perspective. So
31:24
So yeah, I teach foundations for the primary care pt. And my my partner, Dr. Lance Mabry teaches our musculoskeletal imaging certification. So I'll talk just briefly about both the foundations for primary care PT is an 18 hour CTE course, and it's really meant for the the physical therapist that wants to wants to like break free of this, this model where patient comes in for neck pain, and you're just really looking at their neck. And
31:56
lifestyle medicine, for me has been something that has been really actually life changing. For me personally, I after having kids had a lot of autoimmune problems that I had no idea what was going on. And I just was like kind of scattering going to different physicians here and there. And everyone was like, almost kind of like mandating all of my problems. And then I finally connected with a lifestyle. She's a board certified family medicine and lifestyle medicine physician. And, um, honestly, she helped me so much by just helping me intervene with my diet, and really looking deeply into you know, those six pillars of lifestyle medicine. So, after really kind of seeing what that did for me personally, and what I was able to do as a trickle effect with my patients, and then just diving into the research and seeing wow,
32:50
we really need to intervene in lifestyle, if we're going to affect population health. And everybody, every health professional has a role in lifestyle medicine, and lifestyle intervention. So in my primary care course, the whole first day is all about just taking your everybody learns a little bit of medical screening, or should learn pretty solid medical screening and their DBT education, taking what you learned and your DBT education to the next level, where you know, if somebody circles Yes, on a certain number of, you know, past medical history or symptom profile, if they certainly yes, on those things on their intake form, you know exactly what questions to rule up or rule down different conditions to bring you to your, you know, your final set, or your initial list of differential diagnoses. So that's kind of all day one. Day two is more,
33:44
kind of a deep dive into visceral pathophysiology. So, okay, we all learned about anatomy and physiology, the heart and the lungs and the GI system and all that stuff.
33:56
But when was the last time you really actually spent time with it. So day two is all review of visceral pathophysiology. And I focus a lot on the cardiovascular system, because let's be honest, everybody has Atheros everybody has some level of atherosclerosis. And for most people, it's just it's just your dislike a day or two away from becoming pre hypertensive. So I focus a lot on that and what PTS can do to intervene in patients in their, you know, in that sweet spot, you know, ages 25 to 45, where we can really have an effect on somebody developing or not developing those those chronic illnesses.
34:38
And then I also talk about, you know, you can maybe identify, excuse me, you can maybe identify that somebody has some lifestyle factors that need to be assessed, but how do you assess their readiness and their willingness to change? And how do you make sure that you're respectful of their wishes, maybe they don't want to go there. And maybe that's okay, so
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I'm so that and then of course, interdisciplinary collaboration and communication as part of my core series I have, I've interviewed other physicians in different specialties of practice and kind of their thoughts on what what PTS are what PT should do. And I play these videos in my course. Because I think that overall,
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I don't want to speak for my whole profession, but from my experience, there's more PTS than not that are afraid to pick up the phone and call a physician and tell them what they think and recommend what they want to or what they what they feel is appropriate and and say, Hey, I, you know, this patient seems like there, they've got a neurologic profile that kind of looks like Ms. And, you know, maybe you want to take a closer look at that. So, so what these other fishes physicians actually think and say about PT.
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So that's kind of my primary care course, in a nutshell, and Lance's musculoskeletal imaging course. I mean, a lot of people think that imaging is just kind of like, something that's done, you know, if like, you have a if you suspect a fracture, you know, you got your auto ankle and, you know, you've got your, your,
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your auto when he rolls and like all the you're Canadian CCI rules and all that. But do we really know for different pathologies? What views and what types of modalities and studies are actually required? In order to effectively rule out a condition? Do we recognize and understand that radiographs are inherently specific not inherently sensitive? So if you have a high level of a high index of suspicion for something, you need to continue the workup? And what do you continue the workup with? Is it MRI? Is it CT? Is it something totally different? Are you doing this to rule out something that's vascular or something that's soft tissue or something that's bony? And I think that, in general, probably not just PTS, but there's a whole lot of people that don't understand those things. And I think we're doing our patients a disservice by not fully understanding those. Because let them I mean, we have to face the fact that imaging is a part of the diagnostic process, whether we want to recognize it or not. So we have to whether you can place the order yourself or not. You need to understand how you need to understand how and why it's done for what purpose, and then how to clinically respond once a patient has had imaging, and who to communicate with and you know, when to pick up the phone and ask some questions to the radiologist. And so Lance does a tremendous job with a way better job than I would do with all of that. So. So yeah, that's kind of the the courses that we have to offer. And, really, I want to, I am not doing this to make money, trust me, like I would be
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my husband just graduated with his MBA, like a little more than a year ago. And he's always like, go get your MBA, like you can use how much potential you can make so much money in this space. And I'm like, I don't know, I was put here to do a certain thing. And PT is the profession that I have just like it's, it's more of a vocation for me than anything else. And I just really feel like our profession needs some dire change, and needs people, certain people in it to make moves and make changes. And I understand that my, the visions that I have in my head right now for what our profession could be seem like pie in the sky, craziness, especially with the way that insurance is right now. But if this is the one area where I can have an impact, and start to make more PTS more confident and competent doing this, than Hey, I will, I will retire a happy woman, if that's the case.
38:47
Well, and I think that's a great way to start wrapping things up. And I was just going to ask you, like, hey, what do you want the listeners to take away from this discussion? I think you might have just said it, but is there anything else that you really want the listeners to take away?
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I mean, basically just that, like, if you if you can, if you want our profession and see the value in what our profession has to offer, we have got to make moves. And and if we can do anything to make our population more healthy, and to make other healthcare professionals see our value, then do it. You know, don't don't like get stuck in your your ways of you know, one patient after the other and then you're home at the end of the day and you know, try to try to do those things to make a change for yourself and for your community.
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Just by setting a positive example of what right looks like from a from an evaluative perspective, and from like a from a health care provider management perspective. And the one thing I will my one little parting, parting gift
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for everybody, if they if you are interested in taking either one of our course tracks, I you can use the I have a discount code a $50 off discount code for, for either one of those courses for any of the listeners, if you just put HW s podcast 2022 And we'll just maybe put that in the show notes. That'll give you a $50 off discount and it's always Yeah, always happy to chat with anybody or,
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you know, hear any inquiries, my email addresses info at redefine health ed.com You can call or text me any time and I'm so open to it at 312-772-2322 and I'm on social media and trying to trying to turn it into something so go and follow me at redefine health Edie on all the social medias except for Twitter because it was one character too long, which is so annoying at right so it's Twitter ad redefined Con Ed. Perfect. Well, thank you so much. I can't believe you gave out your phone number. That's insane.
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Hopefully, business number.
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Oh my god, I was like, I'm gonna have to edit that one out.
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That's, that's, that's the big number. So all right, good, good. Good. Okay. Now, last question. It's when I asked everyone and that's knowing where you are now in your life and in your career? What advice would you give to yourself as your younger self maybe right out of PT school? Yeah, I think as a as a young PT, I really thought I knew a lot. And
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I really thought I knew a lot I really thought PT could do everything. And
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the more I learned about the things that I didn't know, I think the better clinician and person I became and I think that's just kind of the natural evolution and the natural evolution if you're really paying attention to who you are and what you do is you'll find out you just know less and less about you know, you know a little bit about less than less over time and
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and yeah, so like always be open to learning other things in different ways from people that you didn't think were were were experts or
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you know, just always have listening ears and never drink the Kool Aid. It's not a good idea. Kool Aid is not good for you anyway.
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I love it. And you know, that's that is
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definitely something that I've heard again and again, as the advice that people would give to their younger selves. So you are in very good company. So Katie, thank you so much for coming on and really, hopefully lighting a fire under some of the physical therapists who are hearing this to
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be open to new ways and be open to the to primary care and lifestyle medicine and incorporating that into physical therapy so that we're more than like you said more than just treating the shoulder and the person goes away. So thanks so much for for all of this info was great. Yeah, absolutely. Thanks so much for having me. It's really a privilege. And everyone thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
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Thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy smart.com. And don't forget to follow us on social media.