With all the potential changes on the horizon regarding US health care it may become increasingly important for individuals to properly utilize heath care services. Navigating through the complex health care system in the US can be a difficult task as individuals often have many choices and these choices can significantly impact outcomes.
This year approximately 1 in 6 individuals seeking health care in this country will be diagnosed with an orthopedic related condition ranging from minor sprains and strains to chronic conditions that result in significant functional impairment to the much less frequent serious injuries such as traumatic fractures. Improperly diagnosed orthopedic conditions can lead to ineffective treatment, unnecessary functional limitation and potential disability that can ultimately lead to declining overall health.
Current professional literature often supports the recognition of improperly utilized services in the current health care model that may lead to inefficient, ineffective care, that is often associated with the escalating costs of health care. One example of this in light of orthopedic care is to consider the utilization of MRI (magnetic resonance imaging) in the United States. Since the beginning of MRI utilization in health care in the early 1980’s, its use has been increasing annually to assist in diagnosis of a wide array of medical conditions. This technology is an amazing resource in screening for serious medical pathology such as certain types of cancers and rare sinister conditions. In cases where screening for these conditions is indicated it is a phenomenal resource and during my study of radiology in my doctoral training I was completely amazed that such a technology had been developed as the mechanisms in which this technology works are truly amazing. That being said, conditions that MRI often screens for are very rare as related to specialty of orthopedics and certain clinical criteria utilized during a physical exam and patient history can help determine when to properly utilize such diagnostic imaging with a high degree of certainty. In addition this technology while highly effective at screening for significant pathology is relatively ineffective at determining the cause of an individuals source of orthopedic pain on its own. For this fact this expensive resource may be often over utilized in the current health care model.
To better understand this one may compare statistics of the US health care model versus the United Kingdom health care model. In 2007 the World Health Organization reported that the US spends approximately 15.3% of its gross domestic product on health care services while the UK uses just 8.3% of its GDP on health care. When considering the differences in the health care models this statistic becomes even more significant however we can save that topic for a later date. Now when looking at the utilization of MRI in the US versus the UK we find that 26.6 versus 5.4 units of MRI services per million people are utilized. Now lets consider a broad measure of health in the life expectancy of 77 years of age in the US versus 79 years of age in the UK. We can summarize this very general information and reasonably assume that it is possible that other countries are treating similar populations with less resources and possibly doing a better job. Now my quick assessment using these isolated statistics can hardly prove that however there are many experts on this topic that would certainly agree that other countries are treating in more economical ways with higher quality of care standards.
One theory that accounts for the possible over utilization of expensive diagnostic testing and increasing costs of health care along with potential diminishing quality may be due to what’s recognized by some experts as “the dying art of the physical exam”. It is evident that the modern practitioner has less time to spend with patients and in turn has less time to examine. In addition the use of technology to assist in the diagnoses of conditions leads practitioners away from a skilled examination. While this method may be effective for other specialties this method is less effective in the field of orthopedics where it is accepted that a clinical examination must correlate with diagnostic testing to establish its relevance. It is to this effect that it brings me great joy in practicing orthopedic physical therapy, an area of health care that places high value on physical examination and utilizes a high degree of skill as the result of examination based training. In addition this field also allows me the privilege to spend more time than the average clinician with patients. A skilled examination cannot only decrease the costs of quality care it can also improve outcomes. I have found that in my practice over utilized diagnostic testing and services can often place anxiety and fear in individuals as they navigate the health care system. This seems to often lead to decreased activity levels, which ultimately leads to the orthopedic condition becoming exacerbated as it is well documented that an active individual often recovers much faster than a sedentary individual from musculoskelatal injury.
When taking all these concepts into account I encourage individuals to seek orthopedic physical therapy consultation for orthopedic related conditions. An orthopedic physical therapist trained in the latest in diagnosis and evidence based practice can accurately diagnose and determine the need for additional referral for the orthopedic patient. So the next time you are faced with making a decision about where to get help for an orthopedic injury ask your primary care physician about utilizing specialty physical therapy consultation to maximize recovery and save precious health care dollars in the process by avoiding unnecessary procedures. With this being said not all physical therapy services are equal, make sure to research the clinician you are consulting with to ensure you are receiving the highest quality of care by looking for advanced credentials including the highest standard of degrees and certifications, post graduate continuing clinical education and dedicated up to date knowledge of orthopedic care.
Sincerely,
Keith W. Fandry PT, DPT
