Welcome to FOXcast physical therapy. A podcast for clinicians made by clinicians. It’s brought to you by FOX Rehabilitation. Find out more at FOXRehab.org.
Jimmy McKay, PT, DPT: Welcome to FOXcast PT. I’m your host Jimmy McKay. Welcome back to the program Jessica Reichel. Jessica good to talk to you again.
Jessica Reichel, PT, DPT, CDP: Yeah. How are you doing.
Jimmy: I’m doing good. Today we’re talking about physician communication. The when’s the what’s and the how. I want to go through all three of those because I feel like this is something that happens. I mean maybe we talk about it with our colleagues and maybe we don’t. But I feel like hearing about it from someone like you and we go through the steps it’ll make some people out there feel a little bit better and that’s that’s the overall idea.
Jessica: Definitely I think sometimes calling a patient’s physician can be a little bit intimidating. So I want to be able to break down the process so that it becomes easy for someone who feels like they need to call.
Jimmy: I feel like I was second guessing myself. I mean I can remember the first time as a student my clinical instructor said Well why don’t you call the physician. And I remember thinking, “Do I really want to do that?” Literally had like a little bit of an anxiety issue about making that phone call. But glad I did in the end. And that’s what we want. If there is an issue we want to make sure that you can facilitate this exchange of information in a great way that benefits you the physician and of course the client in the long run. So let’s start with when. When do you want to call the physician? What are some reasons to initiate that?
Jessica: I think one of the big reasons is when a person’s vital signs are out of the normal range. I personally have come in to a client’s home and their blood pressure is usually you know 160 over 80. And all of the sudden at rest their blood pressure is two hundred. And that is like at rest like just sitting there their oxygen saturation dropping with activity if they’re starting to experience like heart palpitations and response exercise like those are some things that clue me into something medically is going on here.
Jimmy: Yeah it’s what I used to do I used to keep it a little cheat sheet an index card of vital signs and the areas where they shouldn’t be as well as red flags. I think those are definite huge reasons to initiate that physician phone call.
Jessica: Absolutely. And what’s nice about here at FOX we have a sheet called the cardiac protocol that I keep on my desktop if I get the sense that something’s wrong that’s kind of an objective way to kind of validate what I’m thinking and can help guide my decision making and guide where I go from there.
Jimmy: That’s great. So now that you’ve decided this client either has vital signs or is exhibiting red flag behavior you’ve decided that yes I’m going to make this this phone call. What to say how to frame your message? Where does your head go there when you want to make that contact with a physician?
Jessica: I think the most important thing especially the kind of help with the anxiety and kind of improve your confidence is to get all of the details in front of you so you walk in and your client’s blood pressure you know we’ll use the example of 200 over 90. Is that at rest? Is that in response to activity? Did you have them sit for five minutes without saying anything? What’s their heart rate what’s their oxygen like? Are those being affected by the blood pressure? Are they symptomatic? Do they have a headache? Do they have double vision? Like getting all of those things in mind mine really helps to give the physician the entire picture rather than just calling and saying their blood pressure is high.
Jimmy: Yeah try to play out the entire conversation if you bring this. It was one bit of information this one small piece of evidence. What are the things that the physician might ask you? Great. Now you’ve got a conversation going. They’re going to ask you more questions because they want to now know now you’ve brought something of value to them. They’re going to want to know more because they’d like to get to the why as much as you would to make sure to have that additional information ready if and when the physician asks.
Jessica: Absolutely. And I think it’s also important to really own your message. Because I’ve called before and how to say this and be like I don’t know if I really believe that their oxygen levels are always in the 90s when they’re with me. I don’t know why they’re in the 80s when you’re with them. But I think it’s really important to stick to your message and kind of stick to your guns in a way. Because more times than not if they end up going to their doctor’s office and get further testing. I end up being right or at least on the right track or something’s not adding up.
Jimmy: You said you always start with a phone call although there might be occasions where a physician phone call is actually not extreme enough. It’s not a method of contact that’s urgent enough. What’s beyond there and how do you make the leap to doing something like calling 9 1 1?
Jessica: So I think I’ll use a real time example. I had a client with a history of four strokes and a history of heart attack. And his blood pressure tended to be really low. Like it wasn’t uncommon for his systolic blood pressure to be in the 90s. And one day I came in and his blood pressure was like 80 over 50. So I had lie supine and I came up above 95. And then I dug a little deeper and was like oh yeah my chest is a little bit tight but really not a big deal. So we have someone with a history of stroke a history of heart attack who tends to have low blood pressure and it’s lower than normal and he’s symptomatic. And that’s when I knew I had to send him to the E.R. right away. There’s too many things here that tell me something’s wrong.
Jimmy: Imagine the first time you go to make even the physician call or we’re calling 9 1 1 might be more appropriate that Texans still be anxiety inducing.
Jessica: Absolutely. It’s definitely a little bit overwhelming to have EMS come in and you know I’m the health care practitioner. So they’re asking me what’s his blood pressure. And I was actually just talking about this yesterday with my RD. In the event that you do have to call 911. Something that EMS loves is that if you take their vital signs every five minutes and make a log. So at ten twenty three this is what they’re vital signs were. OK ten twenty eight. This is what their vital signs were. So you’re giving them a baseline and kind of giving them a picture of what’s going on rather than having them come into the situation totally blind.
Jimmy: That’s great advice. Other ways besides phone calls too as you can write e-mail communication as well it’s another good way if if it’s not as urgent as a 9 1 1 phone call. If it isn’t as urgent as a call to the physician there in that minute e-mail is a great way to provide information. On top of that.
Jessica: Absolutely like it FOX we have, if I ever call a physician I always write communication though in the client health record. And sometimes we can just have our medical records team send that right to the physician so that they’re getting the same information that I’ve included in that documentation. So everyone’s on the same page.
Jimmy: And that’s the goal getting everyone on the same page. It’s really what what this entire conversation is about is how to keep everybody in the loop in the best possible way. You have the message asking yourself what is the best possible way to transmit that message. Do I need it right now? Is this a 9 1 1 call. It is a call a physician. Is this something that I can frame up and they can read later in an email?
Jessica: Right. Having the confidence like us of PT is and now OTs are doctoring profession or taught medical screening in school now we know this. Don’t be intimidated to call a physician if you aren’t sure. Like if your gut is telling you to call, call anyway cause more times than not I’ve been on the right track or something’s wrong versus I’ve been totally off. Always trust is clinical gut, that will not steer you wrong.
Jimmy: Trust yourself trust your training and realize you’re doing it for a really great reason which is helping another human being.
Jessica: Right.
Jimmy: Jessica Reichel colleague here at FOX Rehabilitation appreciate you taking some time out and communicating with me in the audience about physician communication the When’s What’s and How’s. Appreciate your time Jessica.
Jessica: Yes. Thank you for having me. I think it’s important that we work as an interdisciplinary team so that we can continue to provide the best care for our client.
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