"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Tuesday, October 6, 2009

How to Sell Physical Therapy

How good are you at 'selling' your therapy?

Can you 'close' the deal?

Or, do you let the customer slip away?

If your customer slips away does another, better 'marketed' professional (MD ortho, DC, Pain doc, etc.) provide the care they need?

Maybe physical therapists should consider how we position ourselves when it comes time to 'close the sale' - according to Israeli researchers using American outcome tools:
"Compliance with self-exercise programs was one of the strongest predictors overall and the strongest predictor among process variables.

Better outcomes were achieved when patients were more compliant with their exercise program. This result has important implications for clinicians.

Ability to improve patient compliance is probably more of an educational skill than a clinical skill. One could perceive this as a marketing skill.

Physical therapists need to know how to educate and persuade patients that what they are “selling” actually works."
Daniel Deutscher and the folks at FOTO examined 22,019 people in 54 clinics in Israel over a two-and-a-half year period to see how the process of therapy affected the outcome of therapy. One of their findings was the association between exercise compliance and improvement.

If any non-physical therapists read this blog then that last statement could sound like a 'no-brainer' but physical therapist education does one thing very well - it makes believers out of physical therapists. We believe in the power of physical therapy to improve our patients lives.

Too bad physical therapy educational programs don't also provide training in 'selling' and 'marketing'. I'm thinking of calling up my alma mater and asking for my tuition money back!

The Israeli researchers are right - home exercise 'compliance' (I prefer collaboration) and adherence to scheduled visits separates the patient winners from the losers. Small setbacks can prevent patients from meeting their therapy goals- a painful flare up, arriving late due to traffic, the therapist changes the plan of care...

One telling example happened to me yesterday.

I employ physical therapist assistants - one of my PTA's asked a returning patient "How are you today?" the patient replied, "I'm sore from lifting at work" to which the PTA promptly said, "Well, let's put you on lumbar traction"...
  • no neurological testing
  • no leg signs
  • no clinical rationale at all
...other than activity-induced lower back pain. The exercise program was aborted and traction was begun.

Why does the physical therapist culture encourage easy modality, massage and traction treatments when the accumulated evidence seems so heavily weighted against these interventions?

Why does it take a sample of 22,019 patients to show us the optimal treatments for persons with musculoskeletal injuries - when most physical therapists recognize the futility of modality therapy after six months on the job?

A 2005 study by Riddle and Jewell showed poorer outcomes associated with ultrasound and electrical stimulation therapy for sciatica patients.

Is there a way to break the physical therapy cultural modality mindset?

I think there is.

Make a culture of measurement.

Simple tools now exist that make measurement easy - easier than I had it in 1992 when I graduated with a Bachelors in Health Science, armed with Manual Muscle Testing to go forth and cure back pain and prevent folks from falling down.

No, physical therapy measurement tools are better now and we no longer have so many excuses for not knowing why the patient can't or won't get better.

Unfortunately, we are no longer in the driver's seat when it comes to determining our own fate or the fate of our patient's - government mandates are gobbling up therapy time with 17-page home health assessments and 30 minute outpatient therapy assessments - no time left for the patient.

I'm from the Government an I'm here to help

Government mandates are different from standardized assessments. Frequently, the government messes things up by trying to satisfy too many constituents.

We already have many good assessment tools:
  1. Self Report measures
  2. Performance measures
  3. 'Old School' impairment measures
  4. Classification measures
Fewer than 50% of physical therapists in the United States use outcome measures - that's like driving your car without a speedometer - with your eyes closed! No wonder modality treatments dominate therapists' thinking.

Sell the Outcome

We saved my traction lady.

She went back on exercise and functionally oriented training the next session, I gave her a follow-up questionnaire and she showed improvement over last week - traction did not help.

I asked her what she thought - she said she was sold on physical therapy.

Free Tutorial

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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

"Make Decisions like Doctors"

Copyright 2007-2010 by Tim Richardson, PT.
No reproduction without authorization.

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