Nelson Marquez, PT, EdD, Physical Therapy Editor

Nelson Marquez, PT, EdD, Physical Therapy Editor

One of my patients went for her regular checkup with her family physician and was directed to undergo several routine lab tests, which she agreed to. On the day that she was scheduled to meet with her physician for her test results, she requested that I accompany her. She was concerned that the physician would prescribe medications she may not need or would not know what questions to ask. She also was concerned that she would end up like other patients she had observed coming to their medical appointments looking like “walking pharmacies,” with plastic bags full of medications.

So there I was with this patient, anxiously waiting to meet with the physician. While waiting, I carefully explained to the patient the purpose of each lab test she underwent in order to prepare her for the discussion with her physician.

After more than an hour of waiting, the physician walked in. I introduced myself as a “patient advocate.” He recognized me, as he had referred patients for physical therapy in the facility where I had practiced several years earlier. He began going through each test result, checking off each lab value and nodding his head, signifying satisfaction. However, there was one lab value that made him pause and do a double-take — it was slightly off the norm with which he was comparing it. However, overall, he and the patient were satisfied with the results.

Before we left his office, the physician wrote a prescription for the patient. He wanted the patient to take the medication in order to correct the one lab value that he found to be slightly off. The patient turned towards me and, in our native language, requested that I ask the physician questions about the prescription. As I am familiar with the physiologic effects of the medication and recent studies about it, I proceeded by asking the physician for any of the adverse side effects of the medication. He was quick to address my question, saying, “Only GI irritation. This can be managed by taking the medication with food.”

I probed further by asking about the most recent studies that had been published about the effects of the medication, citing its negative effects. Instantaneously, the physician’s demeanor changed. His tone became defensive and he turned the tables by asking me where and how I found this information and what kinds of research I had been reading. He also said randomized, controlled clinical trials are not good evidence to guide treatment selections for patients.

I respectfully answered his questions by stating that physical therapy is now a doctoring profession and evidence-based practice is part of our curriculum and training. I also explained that pharmacology, especially the effects of medications and how they may influence our physical therapy interventions, are components of our PT curriculum.

Seemingly stumped, he asked the patient if we should still proceed with the planned treatment or not, as he did not want to “waste the time to talk about nonsense evidence.” Glancing towards me, I gave the patient a signal to go ahead and take the written prescription in order to prevent further escalation of the discussion.

Before we left, I shook the hand of the physician and apologized if I had made him feel uncomfortable with our discussion. He acknowledged this and said that it is quite rare that he meets savvy consumers like us.

As the patient and I walked towards the parking lot, the patient asked me what we should do. I told the patient to keep the prescription in her purse and that she has the right not to take it. Instead, I would give her an evidence-based physical therapy intervention. And why wouldn’t I? That patient is my mother.

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