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Should I see my MD or go straight to a PT?

Updated: Aug 24, 2022

Yes, I have a Doctorate. I am a Doctor of Physical Therapy (DPT). I am NOT, however, a Doctor of Medicine (MD). And I am quite aware these are completely different.

If you have a fever, a rash, a persistent cough, or you’re nauseated and vomiting I am basically completely useless to you. And frankly I don’t want to deal with that kind of stuff…. some of the main reasons I didn’t consider going to med school.

If you’re dealing with these types of things, then go to your physician (MD). But if you have knee pain, back pain, shoulder stiffness, a muscle strain, a joint sprain, etc….I am 100% the Doctor for you to see! With the growing number of Doctorate’s within the healthcare industry these days, it can be confusing for patients to understand what each of our scopes of practice actually are.

For the context of this blog article, when I refer to a MD or physician, I mean a General Practitioner or Family Practice Physician or Primary Care Provider. Typically, most insurance companies will mandate you see one of these prior to seeing an Orthopedic Surgeon or a Sports Medicine MD. Physicians that function in this capacity fill a vital role. They go from seeing a patient with the flu to a sprained ankle to food poisoning to earaches. It is important for them to know a little bit about everything to either treat you appropriately or refer you to the proper healthcare practitioner when it is necessary.

They’re sort of a jack of all trades, but master of none…and I don’t mean that to be disrespectful whatsoever. As I stated before they are hugely important to the landscape of the healthcare field and how well it can operate. But there’s no way to be a master of every system in the body. Plus, on average an MD will get to spend 8-10 minutes with a patient. That’s not a lot of time to establish trust, listen to what the patient has to say, do a thorough exam and then actually treat that person if it’s needed. Therefore, they’re better suited to refer out and help a patient navigate this difficult healthcare landscape.

Like I said, that is a pivotal role, however, when it comes to diagnosing a musculoskeletal issue accurately, you’re probably better off seeing a Doctor of Physical Therapy!

There are research studies which have examined the accuracy of healthcare professional’s accuracy in diagnosing musculoskeletal injuries and ailments.

They rank as follows:

1) Orthopedic Surgeon

2) Physical Therapist with Orthopedic Specialty (Dr. Greg!)

3) Physical Therapist without a Specialty

4) Physical Therapy student (shocking!)

5) General Practitioner/Primary Care Provider Physician

This may be surprising to you! I personally was stunned when I learned it. But when you think about it, general MDs must know so much that they cannot be experts in everything is we previously discussed.

The purpose of me explaining this isn’t too sound pompous or be braggadocios. I really hope it didn’t come across as that! :P

My point in presenting you with this information is purely to help try and save you some time and money and get on the right track to feeling better ASAP!

Did you know that in Florida, you can see a physical therapist without a referral from a Physician? Most people I talk to don’t know that.

So, if you have some type of orthopedic issue arise, come see me first. If it is something within my scope, we can start a treatment plan right away.

If we think it is something requiring additional examination, then we will refer you to an orthopedic surgeon to get necessary imaging or other treatment that may be beyond my scope such as injections or surgery if indicated.

At Movement Driven, we also pride ourselves on adequately screening all of our patients for something more sinister that could be presenting itself as a simple musculoskeletal issue such as low back pain.

Although very unlikely there’s always a small chance your musculoskeletal pain could be caused by something internal. This could be pathology such as cancer, internal organ referred pain or a number of other systemic diseases. This is where red flag questions become an important part of evaluating someone.

Red flag questions are asked to help rule out pain that is not coming from muscle, joint or bone problems. Also, any good medical professional, no matter what their degree should be able to tell when something just doesn’t seem right. In my career, thanks to my advanced residency training, I’ve found endometriosis which presented as simple low back pain, shoulder pain caused by an underlying neurological disorder and a case of upper back pain which turned out to be a gallbladder issue. The additional time I’m allotted with my patients as a physical therapist (1-hour long sessions sometimes multiple times per week) allows me to dig a little bit deeper with questioning to help rule out these potential causes of pain that seem to be musculoskeletal in nature.

Here is an example list of red flag questions typically asked when someone has back pain. If you answer “no” to most these questions you can feel pretty confident that your pain is coming from muscle, joint or bone related issues.

  • Do you have constant pain that does not change with activity or rest?

  • Do you have a previous history of cancer?

  • Is the onset of the pain insidious (meaning there is no specific incident that caused the pain?) Anything that makes it worse?

  • Do you have a fever (>100 F)?

  • Do you have tenderness in the gut (belly or lower abdomen)?

  • Have you noticed difficulty with bowel or bladder activity?

  • Do you have any recent unexplained weight loss or weight gain?

  • Does the pain wake you up at night?

  • Does your pain worsen after eating a fatty meal? Does it improve after a bowel movement?

  • Does your pain worsen when you’re menstruating?

So, when you hurt your back, or any other joint or muscle, you have two options. Option one, go and see your MD, have them spend 8-10 minutes with you and ask you the above set of red flag questions. Most likely they will give you an anti-inflammatory medication and a referral to see a physical therapist. Or you can pick option two and go see a physical therapist, spend 60 minutes with that individual, answer the same set of red flag questions and then start working on fixing your back that day!

Save the time and money. Feel free to give us a call if you have any questions about an issue you’re dealing with. At Movement Driven, we offer free Discovery Calls to all prospective patients to ensure we are the right fit for each other.

-Dr. Greg Goldberger

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