On March 6, 2013, Ann Wendel and I hosted our latest #socialortho tweetchat. This month we discussed reasons why patients often prefer quick fixes over long-term changes for injuries and illnesses and what healthcare providers can do to effect true long-term improvements.
For those of you unfamiliar with tweetchats, people answer questions posed by the moderator and comment on other tweets using the hashtag specified – in this case #socialortho. It often starts slowly, but it can become difficult to follow when many people get involved and respond to many different questions and comments.
If you enjoy fast-paced discussions about important sports medicine, healthcare, and social media topics, join us for future #socialortho tweetchats. We usually hold these chats on the first Wednesday of each month. The next #socialortho tweetchat will take place on Wednesday, April 3 at 9 PM ET.
Ann Wendel β@PranaPT
Do you want lasting change, or a quick fix? Join me and @DrDavidGeier tonight for #socialortho in 15 minutes to discuss.
Ann Wendel β@PranaPT
@PrimalMountain We’re talking long term change vs quick fixes in orthopedics on #socialortho in 2 min if u want to lurk π
Ann Wendel β@PranaPT
Welcome to #socialortho from 9-10 EST – tonight’s topic is encouraging patients to make long term changes. Please use the hashtag.
Jacob Egbert D.O. β@PrimalMountain
@PranaPT thank you! I’ll check it out. #socialortho
Steven Kleinman β@StevenRKleinman
#socialortho very interested to hear what people have to say
Ann Wendel β@PranaPT
@StevenRKleinman Hi Steve! #socialortho
Mike Hopper β@mnhopper1s
RT Welcome to #socialortho from 9-10 EST – tonights topic is encouraging patients to make long term changes. #socialortho
Ann Wendel β@PranaPT
@mnhopper1s Mike, are you going to make this one or are you on the field? #socialortho
Steven Kleinman β@StevenRKleinman
@PranaPT hey Ann, can’t wait to see how tonight’s chat goes #socialortho
Ann Wendel β@PranaPT
I’ll give everyone a minute to check in, then I’ll throw out the first Q. #socialortho
Mike Hopper β@mnhopper1s
@PranaPT I’m sitting in front of the computer watching NCIS π Spring sports haven’t started games yet.. #AT4ALL #socialortho
Dr. David Geier β@DrDavidGeier
@StevenRKleinman I bet most of us deal with this issue with patients in some form #socialortho
Ann Wendel β@PranaPT
@mnhopper1s Sweet spot in the year! #socialortho
Mike Hopper β@mnhopper1s
But as you know, it is National Athletic Training Month #NATM2013 so spreading that message too! #AT4ALL #youthathletesafety #socialortho
Dr. David Geier β@DrDavidGeier
@mnhopper1s @PranaPT A night off, Mike??? #socialortho
Mike Hopper β@mnhopper1s
@DrDavidGeier short day today.. only 3 hours π #AT4ALL #socialortho
Ann Wendel β@PranaPT
Q1: Do you often see patients who want a quick fix vs a long term solution? #socialortho
Dr. David Geier β@DrDavidGeier
@mnhopper1s Good for you! The long days and nights start soon, I bet #socialortho
Steven Kleinman β@StevenRKleinman
@PranaPT #socialortho #1 all the time, patients want to be better yesterday!
Mike Hopper β@mnhopper1s
@PranaPT A1: Many of my patients want quick fix. They want back in the game! #socialortho
Ann Wendel β@PranaPT
@StevenRKleinman How does this behavior manifest? What do they say? #socialortho
Steven Kleinman β@StevenRKleinman
@StevenRKleinman @PranaPT #socialortho; how many times do we get people out of pain who then just go back to old habits and pain comes back
Ann Wendel β@PranaPT
@mnhopper1s What level are you working with again? Mix of HS, college, pro? #socialortho
Dr. David Geier β@DrDavidGeier
@PranaPT A1: I see it with treatment options. Many pts want cortisone injections instead of PT & other long-term treatments #socialortho
Steven Kleinman β@StevenRKleinman
@PranaPT #socialortho: biggest manifestation is seeing a repeat customer for same injury
Ann Wendel β@PranaPT
@DrDavidGeier How do you turn that around? What do you say? #socialortho
Ann Wendel β@PranaPT
@StevenRKleinman “repeat offenders” #socialortho
Mike Hopper β@mnhopper1s
@PranaPT Mostly high school with occasional pediatric.. #youthathletesafety #socialortho
Dr. David Geier β@DrDavidGeier
@StevenRKleinman @PranaPT Steve, do they want you to get them better but won’t do exercises to prevent recurrence? #socialortho
Ann Wendel β@PranaPT
@mnhopper1s HS athletes “bounce back” quickly – both a blessing and a curse! They say “I feel fine!” #socialortho
Steven Kleinman β@StevenRKleinman
@DrDavidGeier @PranaPT #socialortho they are noncompliant with HEP, aren’t consistent with appts, dont listen when u tell them not to …
Ann Wendel β@PranaPT
RT @WKyPT: In today’s microwave society most ppl r looking 4 that quick fix. U often get 1 chance for pt buy in b4 they move on. #socialortho
Dr. David Geier β@DrDavidGeier
@PranaPT Fortunately new research shows cortisone not only not helpful but might harm recovery. It’s been around forever, so hard to change mindset #socialortho
Steven Kleinman β@StevenRKleinman
@DrDavidGeier @PranaPT #socialortho not to go to the gym or perform certain tasks and they do them anyways
Ann Wendel β@PranaPT
@DrDavidGeier Many patients seem to be more aware of this these days, though, compared to a few yrs ago. #socialortho
Dr. David Geier β@DrDavidGeier
@mnhopper1s @PranaPT I bet you get kids who want to get right back to play. If too fast, re-injury rate probably higher? #socialortho
Mike Hopper β@mnhopper1s
patients want the PT to fix them without them having to actually do anything. #socialortho
Ann Wendel β@PranaPT
@StevenRKleinman I try to ask myself “What’s driving their non-compliance?” Lack of time,sick family member,just poor choices #socialortho
Mike Hopper β@mnhopper1s
@DrDavidGeier Absolutely! And parents often are not much help. #socialortho
Steven Kleinman β@StevenRKleinman
#socialortho We are a pain based profession as PT’s and we need to be a function and wellness profession, not just treat pain
Dr. David Geier β@DrDavidGeier
@mnhopper1s Coaches too… #socialortho
Ann Wendel β@PranaPT
@mnhopper1s @DrDavidGeier Amazing how hard it is sometimes to get parents to see long term issues w RTP too soon. #socialortho
Ann Wendel β@PranaPT
@StevenRKleinman How do you educate your patients so you can get their “buy in?” #socialortho
Dr. David Geier β@DrDavidGeier
@PranaPT I see patients who want to go straight to surgery and not try PT, even if no definite surgical indication #socialortho
Ann Wendel β@PranaPT
@DrDavidGeier I’m always so shocked that ppl see surgery as the “quick fix.” Especially arthoscopy…it’s still a surgery! #socialortho
Dr. David Geier β@DrDavidGeier
@PranaPT @StevenRKleinman I’m curious on the education part too #socialortho
Steven Kleinman β@StevenRKleinman
@PranaPT #socialortho, everyone is different from talk, to handouts, to seeing how thru ex. they can feel better
Ann Wendel β@PranaPT
@mnhopper1s How do you approach educating the athlete and their parents? Do you have coach/AD support? #socialortho
Steven Kleinman β@StevenRKleinman
@DrDavidGeier @PranaPT #socialortho I talk a lot about function, I relate everything back to their “needs”, their “daily activity”
Dr. David Geier β@DrDavidGeier
@PranaPT There are always risks. Medical & other complications can occur in these surgeries #socialortho
Ann Wendel β@PranaPT
@StevenRKleinman @DrDavidGeier That’s key to getting them to see value in what we are trying to do. #socialortho
Mike Hopper β@mnhopper1s
@PranaPT It depends. To some extent, it depends on time of season whether coach support or not.. #AT4ALL #socialortho
Ann Wendel β@PranaPT
@DrDavidGeier Plus, they may be exposed to some horrible country music in the OR, geez, who knows what can happen? #socialortho
Dr. David Geier β@DrDavidGeier
@PranaPT Or rap music…allegedly #socialortho
Ann Wendel β@PranaPT
@WKyPT #socialortho How do you get them to buy in before you lose them? what works for you?
Mike Hopper β@mnhopper1s
@PranaPT hey careful now! Give me that country music π Guess that’s another reason to observie @DrDavidGeier π #socialortho
Ann Wendel β@PranaPT
@DrDavidGeier Well, @Jerry_DurhamPT would have on the Beastie Boys! #socialortho
Dr. David Geier β@DrDavidGeier
@StevenRKleinman @PranaPT Seems like a good approach #socialortho
Ann Wendel β@PranaPT
@StevenRKleinman I find that if I can show them how an exercise relates to their goal, that helps. #socialortho
Dr. David Geier β@DrDavidGeier
@StevenRKleinman @PranaPT Seems like communication about diagnosis, treatment, prevention is key #socialortho
Ann Wendel β@PranaPT
One thing I used to see in my last job was that the PTs gave pts 15 exercises for HEP. No one can be compliant with that! #socialortho
Steven Kleinman β@StevenRKleinman
@PranaPT #socialortho I agree, sometimes my verbal education is better than my manual Tx with people. have to prove worthwhile to them
Mike Hopper β@mnhopper1s
Agreed @PranaPT Regression for Progression is important! KISS principle definitely applies! #socialortho
Jay Hargrove β@WKyPT
@PranaPT Discussing expectations up front is always important. Also following evidence based practice helps add validity #socialortho
Steven Kleinman β@StevenRKleinman
@PranaPT #socialortho,with experience,i think we tend to read people and learn who can handle what, but i NEVER EVER give a program that big
Ann Wendel β@PranaPT
Does anyone utilize “check ups” w their patients post PT? Schedule appt for 1 mo out? I find that keeps them working sometimes #socialortho
Scot Morrison β@scotmorrsn
@PranaPT Just because you are bored w/ an exercise doesn’t mean your patient is! #dowhatsbestforthem #socialortho
Dr. David Geier β@DrDavidGeier
@PranaPT Would make an interesting study. How many exercises are too many? #socialortho
Nash β@hydrocore
Clients/patients also have to feel we are committed to their goals also. #socialortho
Mike Hopper β@mnhopper1s
@PranaPT our clinic does. 2 weeks out and trying to that to 1 month and 3 months.. #socialortho
Ann Wendel β@PranaPT
@WKyPT Do you find that your patients are convinced to be “compliant” when you present evidence? #socialortho
Mike Hopper β@mnhopper1s
we also encourage involvement in our PT Activation program making transition into fitness center for continued benefit.. #socialortho
Steven Kleinman β@StevenRKleinman
@PranaPT #socialortho, probably much easier to do that being cash based than insurance based. also DA in NJ is only 30days max
Ann Wendel β@PranaPT
@scotmorrsn Are you saying 15 exercises is right? Sorry, I’m confused… #socialortho
Nash β@hydrocore
@PranaPT I do it personally, not an official appt. Insurances wouldn’t cover it. #socialortho
Dr. David Geier β@DrDavidGeier
@hydrocore How do you show them you are committed to their goals? #socialortho
Steven Kleinman β@StevenRKleinman
@mnhopper1s #socialortho, I am trying to impliment that kind of program for my clinic
Ann Wendel β@PranaPT
@hydrocore Agree 100% – ask their goals,design POC,show them how POC reflects/allows for reaching goals #socialortho
Sarah β@BubblyHeart
@DrDavidGeier @pranapt IMHO No more than 8. HEP should be something I can do in 20 mins. Little bit everyday goes a long way. #socialortho
Ann Wendel β@PranaPT
@StevenRKleinman I have never had insurance deny reimbursement for a patient based on there being too long b/w appts. #socialortho
Ann Wendel β@PranaPT
@DrDavidGeier In my experience, more than four are too many for most patients to do consistently. #socialortho
Dr. David Geier β@DrDavidGeier
@BubblyHeart @PranaPT It seems like # different for diff people, problems. Agree that time could become restrictive #socialortho
Steven Kleinman β@StevenRKleinman
@DrDavidGeier @PranaPT #socialortho,I find it helps when I tell a patient your HEP shouldn’t be>15/20min so they know what to expect at home
Ann Wendel β@PranaPT
@StevenRKleinman It’s a great way to transition patients into exercise/wellness. What steps are you taking to start this? #socialortho
Mike Hopper β@mnhopper1s
@PranaPT We schdl apt with fit staff ASAP to orient to gym. We believe whole body ex can benefit in rehab program. #socialortho
Dr. David Geier β@DrDavidGeier
@PranaPT Makes sense. They don’t need to know just the exercise but the precise way to do it #socialortho
Ann Wendel β@PranaPT
@StevenRKleinman I agree. I often say “Set 10 min aside,do what you can in 10 min.”It’s the getting started that’s hard! #socialortho
Jay Hargrove β@WKyPT
@PranaPT When you can present evidence or historical success it is easier to get that buy in. #socialortho
Steven Kleinman β@StevenRKleinman
@mnhopper1s @PranaPT #socialortho, i dont have a fit staff, only 1 PT, so hard to impliment program
Dr. David Geier β@DrDavidGeier
@mnhopper1s What is your PT Activation program? #socialortho
Mike Hopper β@mnhopper1s
Our pts have access to fitness center during course of PT. We want to be THE source for PT, health and wellness in our area. #socialortho
Ann Wendel β@PranaPT
@WKyPT Do you give your patients research articles to read? Just curious… #socialortho
Ann Wendel β@PranaPT
@mnhopper1s That is ideal! #socialortho
Mike Hopper β@mnhopper1s
@DrDavidGeier We schdl apt with fit staff ASAP to orient to gym. We believe whole body ex can benefit in rehab program. #socialortho
Steven Kleinman β@StevenRKleinman
@mnhopper1s #socialortho, what are is that?
Ann Wendel β@PranaPT
@StevenRKleinman Back to this – DA in Virginia is only 14 days,but I just get POC signed. Isn’t that what you do? #socialortho
Nash β@hydrocore
@DrDavidGeier Listening is the first thing, “active” listening, then designing rehab/exercises toward those goals #socialortho
Ann Wendel β@PranaPT
@hydrocore Have you tried and actually seen that insurance rejects? I haven’t seen that happen. #socialortho
Ann Wendel β@PranaPT
@hydrocore Do you offer any Wellness services they could transition to? #socialortho
Steven Kleinman β@StevenRKleinman
@PranaPT #socialortho, yes, but how do u do a fitness program or “gym program” afterward? I wanted to do a cash program for indepen. ex.
Ann Wendel β@PranaPT
@StevenRKleinman I do cash for supervised exercise w me – Pilates sessions, regular exercise. Less expensive than PT session. #socialortho
Steven Kleinman β@StevenRKleinman
@PranaPT #socialortho, pt would need a script for a fitness program from a MD is the only way i learned to do it
Ann Wendel β@PranaPT
@StevenRKleinman Not true – you should email me about this! #socialortho
Steven Kleinman β@StevenRKleinman
@PranaPT #socialortho, but you are still supervising them as a PT right? So how do you get around the DA law?
Dr. David Geier β@DrDavidGeier
@StevenRKleinman @PranaPT Steve, do you have gym equipment in your clinic? They could pay fee to use? #socialortho
Steven Kleinman β@StevenRKleinman
@DrDavidGeier @PranaPT #socialortho, yes we have gym equipment, but under PT license in NJ I can only supervise for 30day w/o MD direction
Ann Wendel β@PranaPT
So let’s talk about WHY patients are “non compliant” not just w HEP but overall health. Ideas? #socialortho
Dr. David Geier β@DrDavidGeier
@StevenRKleinman @PranaPT PT group here bought gym they were in. Pts can pay to use it during, between sessions, after PT done #socialortho
Mike Hopper β@mnhopper1s
@DrDavidGeier we operate 6 PT clinics. In 4 of the 6, the PT clinic is inside of full fitness center. #socialortho
Ann Wendel β@PranaPT
RT @Monicabaker33: Assess who can handle what.sm pt’s handle more sm only handle 4.Compliance 2 HEP key to long term success #socialortho
Steven Kleinman β@StevenRKleinman
@DrDavidGeier @PranaPT #socialortho, but who is supervising their exercise… a PT? a trainer?
Dr. David Geier β@DrDavidGeier
@PranaPT I hear they are too busy for PT or other long-term tx. Want cortisone or surgery & be done with it #socialortho
Mike Hopper β@mnhopper1s
@PranaPT it’s easier to just take a pill. They don’t want to take the time to improve themselves. They just want it done #socialortho
Ann Wendel β@PranaPT
@StevenRKleinman @DrDavidGeier PTs CAN provide Wellness services,which are NOT covered by insurance,therefore DA doesn’t apply. #socialortho
Mike Hopper β@mnhopper1s
@StevenRKleinman Fitness staff. Skilled PT is completed and they can do personal training or independent exercise.. #socialortho
Nash β@hydrocore
@PranaPT same reason obesity is rampant, people want the easiest and shortest way to results or they are out. #socialortho
Steven Kleinman β@StevenRKleinman
@PranaPT #socialortho, ann, where should I email u?
Dr. David Geier β@DrDavidGeier
@StevenRKleinman @PranaPT Not sure. Think they teach them exercises in PT & observe from distance when on their own. I’ll ask #socialortho
Ann Wendel β@PranaPT
@mnhopper1s But my deeper questions is WHY? What makes it so hard for people to make real changes? #socialortho
Dr. David Geier β@DrDavidGeier
@hydrocore @PranaPT Frustrating but often true #socialortho
Ann Wendel β@PranaPT
@DrDavidGeier Ha! Do you explain that even w surgery, they most likely need PT after? What do they say? #socialortho
Steven Kleinman β@StevenRKleinman
@mnhopper1s #socialortho, I dont have a fitness staff, just me alone π
Sarah β@BubblyHeart
@PranaPT because they don’t see improvement. #socialortho Rare person who can stick w/change.
Ann Wendel β@PranaPT
@StevenRKleinman @mnhopper1s Me too, but it works π #socialortho
Dr. David Geier β@DrDavidGeier
@PranaPT I hear them say they don’t want to take chance that PT won’t work & then they will have wasted months #socialortho
Ann Wendel β@PranaPT
@BubblyHeart You mean they don’t see improvement fast enough? So they give up? #socialortho
Steven Kleinman β@StevenRKleinman
@PranaPT #socialortho, where can i email u?
Ann Wendel β@PranaPT
@hydrocore Yes.I’m getting at crux of the problem-brain-it is hard to stop doing things that “feel good.”Overeating,laziness #socialortho
Nash β@hydrocore
@DrDavidGeier @PranaPT Good PT is never a waste and will usually improve their surgical outcomes. #socialortho (key word: good)
Ann Wendel β@PranaPT
@mnhopper1s True. Human condition. Now how do we change it? #socialortho
Dr. David Geier β@DrDavidGeier
@BubblyHeart Agree completely. And I can usually convince them. But I hear it often #socialortho
Ann Wendel β@PranaPT
@hydrocore @DrDavidGeier Agree – David, are you able to get them to buy into theis? #socialortho
Ann Wendel β@PranaPT
RT @BubblyHeart Instead they’ll waste time&$ on painful surgery&recovery they probably didn’t need had they just done PT first #socialortho
Patrick Myers β@PatrickMyersPT
@DrDavidGeier @PranaPT I tell my pts I need to see a positive outcome in 3-5 visits. MDs and pts have been burned by “3w4″POCs. #socialortho
Dr. David Geier β@DrDavidGeier
@hydrocore @PranaPT Unfortunately “good” PT seems true. I see some patients get ultrasound & ice only at a few PT groups… #socialortho
Ann Wendel β@PranaPT
@DrDavidGeier @hydrocore #facepalm #socialortho
Dr. David Geier β@DrDavidGeier
@PranaPT @hydrocore Usually I can. But I also hear them share stories of friends who had surgery & got completely better.. #socialortho
Ann Wendel β@PranaPT
@PatrickMyersPT Pt’s shocked when I tell them I will see them 1x/wk not 3x.But they do get better&take responsibility. #socialortho
Ann Wendel β@PranaPT
@DrDavidGeier @hydrocore Everyone knows “someone” who had this miracle cure… #socialortho
Ann Wendel β@PranaPT
Resource for understanding addictions (and why it’s hard to make changes that last): http://amzn.to/10hZdNA #socialortho
Patrick Myers β@PatrickMyersPT
@PranaPT we treat 1-2x weekly in 95% of cases. Keeps our CX rate low too. #socialortho
Ann Wendel β@PranaPT
#socialortho in nutshell:involve patients in goal setting,make goals relate to daily life,educate patients about long term change,HEP short
Ann Wendel β@PranaPT
Any last thoughts anyone? Resources you want to share? #socialortho
Dr. David Geier β@DrDavidGeier
@PatrickMyersPT @PranaPT I try to explain on front end that PT takes time & not just a few visits #socialortho
Ann Wendel β@PranaPT
@DrDavidGeier @PatrickMyersPT Awesome! More education from the start of interaction w patient = better outcome #socialortho
Dr. David Geier β@DrDavidGeier
@BubblyHeart I’d rather be too conservative than too aggressive.Can always revert to surgery later.Can’t go back once it’s done #socialortho
Steven Kleinman β@StevenRKleinman
Goodnight all. thanks for the thought provoking chat like usual. can’t wait for the next one #socialortho
Ann Wendel β@PranaPT
@DrDavidGeier @BubblyHeart Word. #socialortho
Ann Wendel β@PranaPT
@StevenRKleinman Thanks for joining! #socialortho
Ann Wendel β@PranaPT
@DrDavidGeier @BubblyHeart No such thing as a “little surgery.” #socialortho
Dr. David Geier β@DrDavidGeier
@PranaPT @BubblyHeart “Word”….Nice, Ann! #socialortho
Monica Baker β@Monicabaker33
@PranaPT I find active pt’s r compliant bc its part of lifestyle. Key is convincin pt’s who rnt 2 make it a lifestyle #socialortho
Ann Wendel β@PranaPT
Thanks everyone 4 joining #socialortho tonight! Keep asking yourself WHY the patient is non-compliant & let’s see if we can lead and support
Ann Wendel β@PranaPT
@DrDavidGeier That’s how I roll. #socialortho
Nash β@hydrocore
@DrDavidGeier @PranaPT that’s unfortunate, but common π #socialortho
Dr. David Geier β@DrDavidGeier
@PatrickMyersPT @PranaPT Love that comparison! #socialortho
Ann Wendel β@PranaPT
@Monicabaker33 True! If they can find something they enjoy or equate to reaching their goals, it helps. #socialortho
Dr. David Geier β@DrDavidGeier
@PranaPT Lots of great ideas from the #socialortho participants, as always! Thanks everyone!
Ann Wendel β@PranaPT
MT @PatrickMyersPT Difference bt Crockpot v. Microwave medicine.Chili can be cooked in both but which one tastes better? #socialortho
Nash β@hydrocore
@PranaPT @DrDavidGeier depends on the type of surgery, first, then secondly the skill of the surgeon. #socialortho
Ann Wendel β@PranaPT
@hydrocore @DrDavidGeier And also the patient! One in better general health, fit, young vs obese, diabetic, etc etc π #socialortho
Ann Wendel β@PranaPT
Thanks everyone! See you for the next #socialortho on April 3rd!
Dr. David Geier β@DrDavidGeier
@PranaPT Too funny. Well I have surgery early in the morning. Sorry no country music @mnhopper1s – Night all! #socialortho
Monica Baker β@Monicabaker33
@PranaPT yep. Lately had motivated pt’s video me showing them their HEP ex’s wit their phones. Definitely helped wit compliance.#socialortho
Donn Dimond β@Donn_DimondPT
@PranaPT Sorry missed chat. Love the summation. Fwding this on to my staff to discuss further. Tks #socialortho
Remember to join the #socialortho tweetchat every month. We hold them the first Wednesday of each month at 9 PM ET unless we announce a change. Follow me on Twitter, and follow co-moderator Ann Wendel, for more information!
