re: Defeat the Nurse Practitioner scope of practice expansion - Louisiana SB 187

IV injections can cause retinal detachments, dropped lenses, endophthalmitis and potentially from that even blindness

Let me first say that I am very much pro-Doctor.

I cannot tell you how many times I have seen patients with non-specific diagnoses such as shoulder pain, back pain, etc. And these referrals mostly come from FP, internal Med, or an OB/Gyn acting as a primary.

It's 100% up to me to figure out what the problem is and what to treat.

I will evaluate the patient and his or her body part utilizing a fairly exhaustive series of special tests to determine whether or not we have a lesion of contractile tissue, inert tissue, combo of both, while looking and listening for systemic and autonomic issues that I need to refer out for.

My evaluation and subsequent progress reports go to the MD telling them what I think is the problem (tissue), i.e. Rotator Cuff, sub-acromial bursa, or both, disc pathology, radiculopathy symptoms, arthrogenic signs, etc. Depending on the Doctor and the flow of the day, we may have a short phone call or text exchange regarding the patient. My input has value to them and is appreciated. PT is a collaborative profession.

If a patient has been seen by Ortho and Neuro, a substantial workup has already been done.

What the public needs to know is that the physician evaluates, diagnoses, and treat disease, and......

The PT evaluates, diagnoses, and treats movement dysfunction.

MD treats the stroke. PT treats the weakness, the gait dysfunction, the balance dysfunction due to the stroke.

We give the physician as much information as we can to assist them with making the most appropriate medical diagnosis.

We do not seek to practice medicine in any way. Medications and injections are not at all a part of our practice. That remains as it should be in the MD realm.

Our profession has a high barrier to entry. We are the rehabilitation professionals of choice, and we will always be.

Our profession began in the hospitals in the early 20th century, and has flourished in many other environments, like independent private practice.

We have been and always will be hand-and-glove with medical practice.

I'm sure the barrier to getting in PT is high. The barrier to getting in med school is higher than all these fields mentioned in this thread. None of this is meant to show lack of appreciation for different fields. MD opposition to any of this is based on concern for patient safety

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Optometrists doing intravitreal injections is pretty far fetched. I would say that is way out of their scope by like a mile.

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Dumb me was thinking the one time I saw an injection of a substance into the eye it was in the anterior chamber. I do take it back because it's like my rules of surgery-
1) don't cut something you're not comfortable cutting
2) don't make a wound with the intention for someone else to manage it

People doing procedures should be able to handle all the non-acts-of-God complications that arise from it. And if they can't, they shouldn't do the procedure. I get very angry when ER providers I&d things then admit them to me.

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We receive referrals all the time that have "shoulder pain" "neck pain" "leg pain"

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Probably a substantial portion of this is lack of provider to provider communication. There's not enough time in the day for me to talk to all the people I want to give a good story to. Physicians should write or at least dictate what to write to their office provider on a referral. This doesn't happen often. Usually you see someone who you're managing, they've got a pain in the shoulder started by this and worsened by that, and by the end of the exam, you're reasonably sure you've got a supraspinatous injury.


But when you bill for the encounter, you bill the ICD10 code for shoulder pain, and the much lower level part of the team in terms of patient interaction and critical thinking- because you mention that physicians are smart. All parties involved are very smart. The difference is in the way we are trained. Not IQ/big Q/whatever intelligence measure you prescribe to- sees "(not looking up the icd10 code right now)" and that gets written. A lot of times we assume our clinic note is attached when it isn't, either.

In my utopia, I'd eat a working lunch with my specialists and talk about patients/problems/misunderstandings. But in reality, the simple things like this get overlooked, and you get a referral that seems to (or in at least a real number of cases) says, "she's all yours. I don't know what's wrong."


Sorry for my field in general

I will never forget the 50 yr old woman who came to me for low back pain. She came back to me after having a good outcome from a prior ailment. She related to me a new co-morbidity of breast cancer. When I pressed her to accurately describe her LBP, she says, it feels like a bunch of little pac mans (the 1980's video game) are chewing on my back. I sent her back to the doctor and subsequent workup showed she had mets to the lumbar vertebrae. Terrible prognosis and she died about 6 months later.

Do we beat up the MD about this? No.

He evaluated what looked like simple back pain. I did what I was trained to do and referred her out. Private practice PTs are generally very conscientious about these things, and don't want to "miss anything" either.

Oh I'm not for chiropractors. I'm not sure if u could find too many MDs who advocate In support of that

god help us if this goes through. an NP can't hold a candle to the training my wife has endured as an OBGYN resident.

Right and what happens if the newly autonomous midwife runs into a surgical emergency and has no surgical experience. Does the baby just die?

Ok but that still doesn't make you first line in triaging any kind of body pain without going to medical school. PTs are great but patients need to see a doctor that's why we have doctors