Turf Battles in Health Care: The Patients Suffer

The “turf” battle between Acupuncturists and Physical Therapists has waged with ever increasing attention, media coverage and cost. But who really benefits, and more importantly, who suffers? This most recent article is a great example of how the media loves to stir the pot, making obvious the fact that their goal is RATINGS. This battle over a tool, the Solid Fine Filament Needle, has been waging for the last 10+ years with enormous costs of finance, time and resources to both the acupuncturists and physical therapists. We are taught in our professional education to, “Do no harm”. With ever increasing training, skills and techniques that physical therapists employ (many with a potential for adverse effects) to better eliminate functional impairments, pain, and barriers to healing, if we are not able to apply these techniques in our patient management, aren’t we also doing harm? Isn’t withholding effective care another example of “doing harm”?

A recent survey of physical therapy patients treated with dry needling had some very interesting preliminary data. It indicated that for those patients who received dry needling as part of their physical therapy treatment, greater than 79% had a reduction in medication use for pain and functional limitations, and 25% stopped taking pain medications altogether.

As Tim Flynn so effectively identified the significant issues that our medical profession continues to propagate (Keep the Wolves & Opioids Away), we see a continued release of information that should motivate us to fight for all professions to use tools to help patients in pain. The statistics are staggering.

 

 

Pain “management” is a huge industry. Opioids and surgery are the answer being marketed by “Big Pharma” and the media. We have all heard it: “Are you missing out on life…” and “Less than a one inch incision…” are solutions to solving spinal issues. While medical professions fight over “tools” of their trades, we have patients suffering from unnecessary medications and surgeries.

But consider this: Has the patient been asked what they would like to receive by their respective providers?

We know back pain, as one example, is a huge problem with most Americans suffering from it at one time or another. “Carey and Freburger noted that more than 80 percent of Americans will experience an episode of low back pain at some time in their lives and that total costs of the condition are estimated at greater than $100 billion annually, with two-thirds of that due to decreased wages and productivity.”

The issue shouldn’t be whether there is enough business for all medical providers to develop their niche in treating patients, but whether the patient is given the access to the care they need, want to try, or have found really works for them.

If the patient doesn’t know what is available for treatment, of course the commercials for medication and surgery will seem like the answer.

But, rather than continue this battle for “tools” of the trade, we should be educating, supporting and progressing non-pharmaceutical and non-surgical means of treatment and working together to determine proper cross referral strategies and support.

 


Edo Zylstra PT, DPT, OCS

is CEO, Founder and Lead Instructor for KinetaCore–an Evidence In Motion partner company. Learn more about Edo, and KinetaCore’s dry needling continuing education offerings at KinetaCore.com.

Interested in more of Edo’s posts? Click here for a listing of Clinical Pearls on the KinetaCore website.

 

 

4 responses to “Turf Battles in Health Care: The Patients Suffer

  1. Lisa Maczura says:

    AZ won its state battle for DN use against the acupuncturists because PTs and patients took the threat seriously and fought back strategically. PT’s have to care enough about the broader patient population to market widely and ethically. PTs need to stop re-converting themselves and look outward to community and individual needs.

    1. Edo Zylstra says:

      Thank you for the comment Lisa. I couldn’t agree more. This is less about a technique and more about a scope of practice and more importantly, the patient that seems to always lose when professions resort to turf battles. Keep pushing your colleagues to become and/or maintain their professional membership as we can’t afford not to.

  2. Matthew says:

    Edo,

    You ask if withholding a treatment is doing harm to a patient. If the treatment has demonstrated an efficacy and effectiveness that exceeds the risk/harms associated, maybe. There are situations where withholding treatment may be more beneficial than providing treatment.

    http://www.bodyinmind.org/targeted-therapy-for-acute-whiplash/

    The use of a solid fine filament needle for dry needling or acupuncture has been shown to follow a similar trend. The evidence for using such an intervention with a relevant risk/harm and little/no benefit should make us question why we continue this so-called turf war.

    What are we fighting for, if not billable units/money?

    I’ve yet to see a well conducted trial showing this intervention’s efficacy exceeding the risk/harms (money, time are harms). The opposite may hold true.

    http://www.jospt.org/doi/10.2519/jospt.2017.7389
    http://www.jospt.org/doi/10.2519/jospt.2017.6994
    http://www.jospt.org/doi/10.2519/jospt.2017.6698
    http://www.jospt.org/doi/10.2519/jospt.2014.5229

    Being an anonymous poster and having been on the opposite end of an “argument from authority” here I think its important I reference those with more respect in the profession.

    https://www.ncbi.nlm.nih.gov/pubmed/25477053

    http://ptpodcast.com/pain-science-and-sensibility-episode-24-trigger-points-the-third-space-and-the-merit-of-pain-theories-with-dr-milton-cohen/

    http://www.bodyinmind.org/dry-needling-myofascial-pain/

    http://www.pudendalnerve.com.au/2015/02/01/what-do-i-do-with-my-trigger-points-now-dr-quintner/

  3. GB says:

    The above entry by Matthew raises some important points and I am eagerly awaiting some feedback from either Edo or the EIM crew (since they are affiliated).

    Having been involved in clinical practice for 20 years now and also certified FDN level one (by Kinetacore), I am extremely wary of how this “treatment”…. with poor efficacy studies, clear documented adverse effects and dubious scientific merit has been embraced by our profession.

    The notion that Edo appears to be positing that there is an unfortunate turf war interfering with patient care seems to have placed the cart way ahead of the proverbial horse so to speak.

    And to be frank, I find it shockingly over-exuberant to suggest that not providing this treatment is somehow harmful.

    Really?

    Is this evidence in motion?

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