Physical therapist responds to physician about annual exam

After the News Transcript published my article about the importance of an annual exam with a physical therapist in March, an emergency room physician, Dr. Joshua Bucher, commented in a recent letter to the editor about a statement I wrote which said, “Your primary care physician isn’t specifically trained to assess your musculoskeletal system.”

For the record, I would like to offer clarification of my statement and the intent of my article.

I appreciate Dr. Bucher’s comments and offer a rebuttal to his statement that “you must see a physician before obtaining physical therapy.”

The purpose of a PT annual exam is to establish a relationship with your local physical therapist and to have an evaluation performed as a baseline of your functional health. It should be no different from then going to your primary care physician for a medical evaluation or to your dentist for oral screenings.

When you go for your annual physical with your primary care physician, do they include range of motion, muscle strength, flexibility and balance in their evaluation?

They do not include these tests because the purpose of the medical exam is to assess your risk for disease, but not risk factors for injury, and as Dr. Bucher states, to “diagnose other medical conditions you might be experiencing.”

Of course your physician is trained to assess your musculoskeletal system because their education and training is all-encompassing in every aspect of medical evaluation and treatment.

During these times, it is not necessary or prudent to go to your primary care physician
or to the emergency room (where Dr. Bucher practices) for assessment of your musculoskeletal system or simple pain syndromes.

All 50 states now allow direct access to a physical therapist without a referral from your physician. This is contrary to Dr. Bucher’s comment which is misleading to the public and not consistent with state rules and regulations where he states, “you must see a physician before obtaining physical therapy.”

Direct access has been in New Jersey since 2003 and I am concerned that Dr. Bucher is not aware of this as a medical school educator.

Physical therapists are now entry level doctoral trained health professionals with the skill and expertise to determine if someone presents to them with a condition or “red flag sign” that requires an immediate referral to a physician.

In fact, New Jersey physical therapy statutes clearly states that “it shall be considered an unlawful practice of physical therapy if a physical therapist does not immediately refer a patient to a physician when they appear with something outside their scope of practice.”

I work with many outstanding physicians in our community. I take great pride in having a collegial relationship with each of them and often become a referral source when a patient presents outside our scope of practice.

The physicians are always willing to hear our findings in helping them make a medical diagnosis that we are not trained to do.

David Bertone, PT, DPT, OCS