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Old 05-17-2010, 12:53 PM
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mtomaino mtomaino is offline
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Default Your Shoulder. Your Choice.

When you are referred to a Specialist, it usually reflects a referral pattern based on a number of factors. These might relate to competency--specialized expertise, focus, and experience, or more pragmatic issues such as availability and a track record of patients speaking highly of the care they have received in the past. Frequently it may be "by default"-----this is where your doctor always sends his/her patients.

Most important is that you are receiving the care you need and deserve--by the Specialist. Just remember--"Your Shoulder (hand and elbow too). Your Choice."

In this region, you do not need a referral unless you have a Medicare Blue Choice product. This means that you can refer yourself to a Specialist of your choosing. At the very least, you can be an active participant in your care as opposed to being passively sent to a provider.

I am not suggesting that your Doctor is in anyway remiss by sending you where he/she sends you. What I am advocating is that you--on the receiving end of the referral--receive the best and most appropriate care, and actively participate it the assessment thereof.

I am increasingly disturbed by patients with shoulder pain who have been referred to large multispecialty orthopaedic practices, only to be seen by a nonspecialist or physician's assistant. This typically results because access in the appropriate Specialist's office is limited. To address this limited capacity, practices are starting to "capture" the referral by utilizing urgent-care providers. Too frequently this delays the most appropriate care or intervention---until the Specialist actually sees the patient.

Equally as disturbing is when a patient is dismissed, effectively, because they have a strange complaint or when it seems as though their condition will not require surgery. In these cases, they may never actually see the Specialist.

Would you think it interesting if you discovered that your Doctor may be informally told that you need to be referred to another doctor within "System"? Indeed, as Hospital System's employed primary care physicians are the gateway to driving that system's utilization, referrals outside the network are discouraged.

So---be empowered regarding who you are sent to for Specialty care. Visit websites; talk to friends. Reachout and make sure you are receiving the care you deserve.

"Your Shoulder. Your Choice".

Last edited by mtomaino; 09-12-2010 at 03:07 PM.
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Old 06-27-2010, 08:17 PM
DonJ DonJ is offline
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This resonates with me. I recently tore my biceps tendon and was given the name of a surgeon. After doing some research on the web, your name came up. Is it possible to see you for an evaluation? Even though surgery may be necessary, I want to make sure it is the only option, and I would like a sense of what to expct either way. Thanks.
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Old 06-27-2010, 09:11 PM
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mtomaino mtomaino is offline
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Don--thanks for your question. Happy to see you and provide an evaluation. For starts, see the article on the Elbow section of www.drtomaino.com
Feel free to email me if you have questions. Just visit the "Contact Dr Tomaino" section.
Dr T
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Old 07-17-2010, 02:06 AM
PeakPT PeakPT is offline
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Dr Tomaino makes a great point about patients advocating for their own care. There are lots of skilled health care providers out there and it behooves patients to actively participate in the process. When patients feel a sense of true concern by their physician/surgeon, when time is spent addressing their needs and concerns, when treatment decisions and options are explained in terms that can be understood and digested - these are just some of the things that reassure patients.

Injuries that prevent one from participating in normal activities can be a really stress-producing situation. It not only adds to a patient's confidence and comfort level with the whole process, but I think definitely impacts the actual outcome when a patient has a truly positive attitude about their doctor and feels they enjoy a working relationship and not just a dictatorship of sorts.

Just as different orthopedists might have differences in how they'd approach your injury, the same is true in Physical Therapy. There are a wide variety of specialty training areas that a PT can gain further expertise in that might create a more unique approach or expertise that would benefit patients.

Physical Therapy as a profession has grown far beyond the old ideas of tossing a hot pack on a particular body part, rubbing it for a little while, doing some ultrasound or electric stim, and doing a bunch of simple, generic exercises with a strap-on cuff weight.

Ultimately, most of our patients want to know why this injury happened and want some level of reassurance or confidence that they've done what they can to minimize chances of it recurring again. Unless someone was hit by a car or had some other sudden unexpected trauma, I believe a big key is assessing not only the injured shoulder or elbow, for example, but assessing what we call the "kinetic chain" - the connectedness or "linkage" of how other body parts effect that injured area.

An example might be a patient who has R shoulder pain. Discovering a limitation at their L hip can be key in understanding why the shoulder developed problems during throwing. But it could be even closer areas to that shoulder - a stiff elbow, or a shoulder blade that's all gunked up that is causing the rotator cuff to be overused.

Finding PT providers who blend direct one-on-one time with fostering confidence and independence through effective home exercise programs, and who are willing to spend the necessary time problem solving an injury situation, who can include skilled manual therapy techniques along with use of modalities (ie. ultrasound or electric stim for example) when needed vs over reliance on machines can be some of the things patients can look for.

Making sure your PT's schedule allows for adequate personal attention is another critical factor. We've seen patients in the past who were frustrated that the place they had been going to before had patients staggered only 15 min apart and their PT had 6 people going at one time - they felt zero personal attention. Days can be unpredictable and can backlog depending on how particular patients might be doing on any given day...but, it simply takes time to accomplish some of the things PT should be providing you in your care. Make sure you're getting that!

As Dr. Tomaino said....Your Shoulder. Your Choice.....(Your Body - Your Choice!)

Mike Napierala, PT, SCS, CSCS, FAFS
Peak Performance PT
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