I learned a lot about Pitt and UMPC's Healthcare system. Here are some things they are absolutely doing right
1) They are going to implement tiers or provider gold cards for those who have better outcomes
- more EBP and less visits with better outcomes = higher reimbursement
- why more HMOs and other healthcare payers do not do this is just mind boggling
2) The 3rd year DPT students have a 1 year long final internship
- It is all within the system, mostly controlling for the poor internships we often hear students complaining about
- the 1 year lets the student gain a wealth of experience and lets them manage a full time caseload through evaluation and discharge
- one of my biggest critiques of the 6-9 week internships is by the time they are proficient, students often do not get to discharge patients they started in this timeframe
- they get paid $1400/month stipend for doing this internship!
- there is a good chance of a job waiting for them within the system upon finishing
- I realize most Universities also do not have a built in healthcare system and HMO all as one, but this is a great example of win:win for most (other than the non-par providers)
3) Directional preference for cervical spine is easily understood by most, not so much for lumbar
- one of the Eclectic Approach concepts is pattern recognition
- as a pattern (not a law) the painful/limited ROM side will be ipsilateral
- cervical pain/left shoulder pain will tend to be limited in cervical retraction and sidebending left
- right hip pain/lumbar pain will tend to be limited in sidegliding in standing to the right
- this is named for the shoulders, NOT the hips
- I can say this over and over, on my blog and in classes and this is still confused
- but it's the same for the lumbar spine as it is for the cervical, ipsilateral and think of it as sidebending with a different motion, and there you have it!
4) Here is a quick case video of a Women's Health PT with 1-2/10 persistent right buttock pain while treating, standing and walking.
5) Clinicians, for some reason, particularly women are uncomfortable with cervical thrust manipulation and even mobilization
- two clinicians in particular who were Women's Health PTs did not even feel comfortable with having their necks set up, and that's ok
- again, I'd rather talk someone out of getting a manipulation or mobilization rather than talk them into it
- I joked, so, you're cool with doing intra-vaginal work, but the cervical spine is off limits? They said, yeah and laughed about it
- as soon as we got to upper thoracic distraction, they were all in and practiced.... so I said, "One vertebrae down and you're all good now?"
- I also asked if they ever had a male in any of their courses taking the course, they said no, but my wife (former Women's Health PT) said there were males in her courses, but they had to bring their own model
- this is where #BYOV came to be!
All in all it was a great course and some great quick eval and treats will be put up on the OMPT Channel in the coming weeks! Here are some pics of the course.
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| How you doin? |
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| Much better! Turn your head during the skull crusher! |
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| Happy asymptomatic right LQ - RIGHT SGIS |
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| symptomatic left LQ, LEFT SGIS - name it for the shoulders! |
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| Can't even touch the clavicle with the typical mouth open cheat. DN! |
The above not so much a pass did not have a great movement assessment. One critique of any approach is that you have to have some failures... well TJ is a slow responder and we did take an epic fail 25+ minute vid of me pulling out a decent amount of Tx to try and improve his massively DN ASLR and PSLR which are both limited to around 40-45 degrees bilaterally. He falls into the 13% I am fairly certain.
Keeping it Eclectic....
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