On Wednesday night, the University of Texas played Texas Tech at the Erwin Center. It really wasn't much of a game. Texas played well enough to win, though they almost stumbled along the way. But Tech couldn't extend their first half 60% shooting into the second half, and balance was restored yet again at the Drum.
But Wednesday was important for another reason: it was the night that the University of Texas retired jersey #35 - that of Kevin Durant.
There are those that argue that it was undeserved. He was at UT for one season - how could we suddenly retire his jersey? But I can tell you that there is no doubt in my mind that it was much-deserved. The accolades were astounding - 7 national player of the year awards. His statistics? Incomprehensible for a freshman. He averaged 25.8 points per game (28.9 points in Big 12 games) - and had twenty 30 point games in the same season (one of which was in the Big 12 final vs Kansas). And though all the numbers and awards would say enough on their own, there is an intangible element that you really had to see to believe.
I've been very fortunate to be witness to many great athletic performances over the years. From Michael Johnson (at the Atlanta Olympics) to Ricky Williams (career rushing record at Texas) to Michael Schumacher (seven time F1 world championship), I've seen athletes perform at a level that many would consider super-human. And I can attest, without a shadow of a doubt, that Kevin Durant's season at Texas falls into this category.
In the state of Texas, you can't see a physical therapist for treatment without a referral. It's the law - plain and simple. It doesn't matter what your insurance company says regarding your particular "referral requirements" because that relates specifically to whether or not they will reimburse for your treatment (or not).
Seeing a physical therapist as a first line of health care and assessment is an accepted standard internationally, in many other U.S. states - and even within our own military. But not in Texas.
So here's the crazy reality of this long-outdated regulatory practice.
Let's say you have back pain … or an ankle sprain … so here are some of your current options:
You can see a massage therapist - who may provide some form of exercise program - though massage therapists have, for all intents and purposes, little or no formal training in therapeutic exercise prescription.
You can see a chiropractor - who may provide some form of exercise program - though chiropractors have, for all intents and purposes, little or no formal training in therapeutic exercise prescription.
You can see a physician - who may provide some form of exercise program - though physicians have, for all intents and purposes, little or no formal training in therapeutic exercise prescription.
You can see an advanced nurse practitioner - who may provide some form of exercise program - though nurse practitioners have, for all intents and purposes, little or no formal training in therapeutic exercise prescription.
You can even see a personal trainer - an unregulated and unlicensed occupation - who may provide some form of exercise program - though personal trainers have, for all intents and purposes, little or no formal training in therapeutic exercise prescription.
Under the current law, you can go to any of these "providers" - all having little or no formal training in therapeutic exercise prescription. But if you want to go to a physical therapist - the internationally accepted "experts" in therapeutic exercise prescription - you have to have a "gatekeeper" (the list includes physicians, dentists, chiropractors, podiatrists, physician assistants, and advanced nurse practitioners) approve it first.
This is where Texas House Bill 607 and Texas Senate Bill 433 come into play. Both of these pieces of legislation have been filed to provide direct access to physical therapy in the state of Texas. Both are consumer access bills. Neither change the scope of practice of physical therapists in the state of Texas, but they do eliminate the current "gatekeeper" scenario that limits a patient's access to care.
The available evidence squarely supports direct access for physical therapy. Here are the reasons why:
1. As I mentioned previously, physical therapists are internationally accepted as "exercise experts". Our training is focused on the use of therapeutic exercise in the treatment of disorders of the musculoskeletal and neurological systems. Physical therapists have the formal training and education to make functional and mechanical diagnoses for our patients. This is the reality. It is part of our task as physical therapists - to evaluate, to assess, to establish a plan of care. Physical therapist professional education prepares us for autonomous practice, and it is already a part of our current scope of practice.
2. Do physical therapists have the training and education to establish "red flags" in the patient's history, assessment, or treatment that would indicate that physical therapy is not appropriate? This is also an absolute YES. Once again, this is part of our current day-to-day patient care responsibilities. We must be able to decide when it is safe for a patient to participate in physical therapy, and when they must be referred elsewhere. The difficult cases, the ones that need further diagnostic work-up, are typically NOT the ones that are going to see a physical therapist first - it's those that have conditions like neck and back pain and sprained ankles, issues that - in the literature - respond readily to self care strategies and therapeutic exercise prescription from a qualified practitioner. Studies have shown that there is no increase in the incidence of any medical problems in direct access states. Again, physical therapist professional education prepares us for autonomous practice, and it is already a part of our current scope of practice.
3. Access to health care is an important issue in our health care system. You currently have to go to a gatekeeper for a referral to physical therapy. This currently adds at least one extra step in the process of a patient receiving timely and effective care that is appropriate to their condition. When given the option to go to a physician first, then to a physical therapist - or simply not bother "jumping through the hoops" (both in cost and in cumulative time), they will oftentimes resort to the latter option, and not get any care at all. This is a barrier to care, making an acute issue a chronic one.
4. Last but certainly not least, there is the cost of care within the current regulatory practices. By adding more steps to get to the appropriate provider, we are creating more barriers to care for the average health care consumer. This "referral" process creates greater costs for the patient and/or insurance carrier. First you pay your "referring provider" (i.e. physician) for him/her to then send you to a physical therapist, who you will then pay to provide therapeutic solutions to your problem. Why have this extra cost involved? Studies have shown that there is a direct cost benefit to the consumer by seeing a physical therapist as the first line of assessment. This cost extends not only to the individual but to the state's Medicare system. It has been estimated that there would be a savings of $1200 per patient episode of care - or 55% of the total cost.
So if all the evidence leads us down this path, why is this not the accepted standard of care for all Texans?
This is where we must simply face the harsh reality of our current regulations. There is no evidence that in countries (or states) that have direct access, the cost of care has shown a dramatic increase or a higher incidence of medical problems requiring further medical intervention. As a matter of fact, it's the opposite. Opponents of more effective legislation are not necessarily driven by patient safety, nor access to care, nor cost of care. So what drives this resistance?
It's not about the patient - and we need to simply stop letting this fallacy be proposed to the public, the legislature, and the media. The primary parties lobbying against this type of legislation are typically physicians and chiropractors, and it is, in all reality, driven by two things: dollars and cents - and power.
Why do these "powers that be" not want physical therapists to have direct access when all of the data supports it being beneficial for the patient and for access to cost-effective health care? Referring sources such as physicians and chiropractors feel that it is not in their best interests financially to have this take place. "It will drop my bottom line" … "It reduces my power as a gatekeeper" … etc.
But as health care dollars grow scarce, and the demand for evidence-based medicine expands, the days of money and power are gone. The gravy train has left the station. The current medical climate forces everyone to be "on their game", to be a provider that a patient would want to utilize to help solve their problem in a cost-effective and timely manner. In order for our health care system to move forward, it is time for all of us to put our best foot forward and foster a medical system that is truly patient-centered.
Let us not forget, it IS about the patient. It IS about your consumer access to health care. And it IS about the cost of your health care.
What can be done? Speak to your state representative and your senator - they work for you - not the lobbyists. Write letters. Do the reading and understand the issues. And support House Bill 607 (Farabee) and Senate Bill 433 (Carona).
For some supplemental reading, refer to the following:
http://murphy.house.gov/News/DocumentSingle.aspx?DocumentID=61988
http://murphy.house.gov/UploadedFiles/HealthCareFYI?53.pdf
http://www.house.state.tx.us/members/dist69/farabee.php
http://www.senate.state.tx.us/75r/senate/members/dist16/dist16.htm
And while we're at it, how about a few videos to help ilustrate the point - one serious, and one slightly more tongue-in-cheek:
The Erwin Center in Austin is affectionately known as "The Drum" - for all the obvious reasons. The home of the University of Texas Longhorns' men's and women's basketball teams looks like, well, a drum - nothing more, nothing less. It is what you would call a highly un-original moniker, to say the least!
But the Drum was rockin' last night as OU came to town.
In Austin, unless you are from Oklahoma, you learn to love to hate OU. Any event that brings together the schools from either side of the Red River will always bring with it a high level of excitement and passion. They hate us -and we hate them. Pretty simple stuff, actually - and perhaps one of the greatest collegiate rivalries in the United States (in Canada, the equivalent would probably be Queen's University and McGill, but I digress).Though the emphasis has always been on the Red River Rivalry in football, it certainly extends to all sports.
Last night was no different. The Texas-Oklahoma game is a must-see every season. I have now seen 19 of them over the years, and they are always a blast. It doesn't matter where either team is in conference - it's always a must-win, bragging rights game.
I always have to chuckle when I hear the phrase "covert war". And here's why ...
Covert [adj. koh-vert, kuhv-ert; n. kuhv-ert, koh-vert] - concealed, secret, disguised
If the media can report on it (at will) then what makes it "covert"? There's not much disguise or secrecy there!!
And once again, we've found ourselves in yet another covert operation. In a remote part of the world. Fighting a moving target. Hmmm ... that Santayana quote "those who cannot learn from history are doomed to repeat it" rings louder than ever.
Now don't get me wrong - I think there is a highly justifiable war on terror. This assumes, of course, that there are more nations than us involved and that they all pull together and pull their own weight in the equation. I think they call that a "united front". This becomes all the more important when this battle is waged inside another country without the specific goal of "occupation". Suddenly, there is no need for phraseology like "covert", since we're all in it together and we're all fighting the same enemy.
Case in point: Afghanistan ... and Pakistan.
And from this morning's news, a classic ...
Let me start off by saying that I can never remember who the evil one was ... Jekyll, or Hyde. Having said that, it's the contrast between the two that is most important right now - and most pertinent to the UT men's basketball team as they head down the stretch to the Big 12 conference tournament.
This team has bewildered me all season. You can't really seem to get a good feel for where they stand anymore. Rick Barnes is a tremendous coach. I have always thought that Barnes' teams tend to be a little shaky in the early part of conference play, but they always end up playing their best basketball at the end of the season. He generally does a good job of getting them ready for the Big Dance. They almost always improve their shooting, playmaking, and defense as the season goes on. This is one of the reasons why I have truly appreciated Barnes since he took over from Tom Penders.
But this season, there is something elementally different.
Sometimes the reality of our world is stunning ... bewildering ... and just plain sad. And then there is the story of Nadya Suleman - all of the above, and then some.
If you've not read the story, let's give you the Reader's Digest abridged version: Unemployed single mother of 6 (all via in-vitro fertilization), living with her parents, has octuplets (again, all via in-vitro fertilization), bringing the total to 14 children. You can read more about her story here, here, and here .
As it stands on it's own, that might be enough to make you wonder. In my eyes, this isn't about whether a person should or should not have children, nor is it an issue of morality (or lack thereof). What it amounts to is a simple reality check.
We are in difficult financial times. Along with that, our health care system is struggling to meet the demands of both the insured and uninsured. We live on a planet with 6 billion people, many living in squallor and without any form of supportive family network of which to speak. The planet's resources are slowly dwindling, and climate change is evident.
And within all of this, there is a woman who wants to have 14 children by in-vtiro fertilization - and a doctor (or doctors) who are prepared to meet her request (ethics be damned) - because, well, "she can".
There is a lot to be said - for not having anything to say.
Maybe my brain is just tapped out today. That is certainly possible. Maybe I'm just not in the "writing zone". That is also a fair possibility. In all reality, right now I may not even be able to tell you what zip code the "writing zone" is in.That's how bad it can get.
In a perfect world, I like to write every 2 or 3 or 4 days. That is certainly dependent upon "life" and time and schedules and all the stuff we all wrestle on a daily basis. It's not a rigid schedule, and I don't live any die by whether I write anything earth-shattering or not. I remind myself that I can always do like most major media writers and pen something on Sarah Palin - oh wait, I've tried that a few times already - or some other noteworthy (or not-so-noteworthy) personality in the news.
Creativity finds us in strange times and places. It doesn't care to arrive at times that are convenient. It is opportunistic and happens when you least expect it. There goes a writing schedule - out the window, into the stillness of the night.
Much as we all struggle with the push and pull of our worlds, I should probably just acknowledge this struggle unto it's own, like any other - and just "let go". It is "being" - it is the "Zen of writing". It is "as it is". It can't be forced, because when it is, it pushes back at you with even more force. As I always try to remind myself, the universe will provide ... and when we let life happen, good things prevail upon us.
Up to 60% of runners will sustain an injury within any given year. Poor running mechanics, in conjunction with poor, ineffective and outdated training methods, can pose a significant injury risk. "RunSmart" was written to address these issues in the running community.
"Running Injuries: Etiology And Recovery- Based Treatment" (co-author Bridget Clark, PT) appears in the third edition and fourth editions of "Clinical Orthopaedic Rehabilitation: A Team Approach" by Charles Giangarra, MD and Robert C. Manske, PT.
Allan Besselink, PT, DPT, Ph.D., Dip.MDT has a unique voice in the world of sports, education, and health care. Read more about Allan here.
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