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  • Writer's pictureSabrina Thorpe

Do I need a doctor's referral to see a physical therapist? Heck no!

It feels so good to say that. So let's say it again.

Heck no, you don't need a doctor's referral to see a physical therapist!

Oh, it practically makes me giddy! Do you know why?

It is one these rare instances in our medical system in which you can go directly to the specialist you need without a) spending money on an office visit with a physician in the hopes that they'll agree to write you a referral for physical therapy, and b) you can go whenever you want so you can start working on getting better faster. You win here!

Wisconsin is what we call a "direct access state" meaning you can directly access a physical therapist without needing a referral. It used to be that if you had, for example low back pain, you would have to first haul your sore and painful back to the physician's office. You'd then have to sit in their uncomfortable chairs in their cramped office and tell them how your back hurts and you would like to see a physical therapist. Best case scenario, the physician would write you a referral with minimal fuss. Sometimes no referral would be written because a physician wouldn't see the value in physical therapy despite their patient seeing the value in it. And worst case scenario, a script would be written for opiates because you were in pain, and technically the physician could make the pain go away by getting you to take drugs. Opiate crisis, anyone? Yikes!

So now we can just bypass that middle man and you can come right to the expert on neuromusculoskeletal issues. Thank goodness!

Did you know that many physical therapists today are doctors themselves? Our society has twisted the word "doctor" to be synonymous with a person who practices medicine with MD or DO after their name. In fact, there are many professionals, both in and out of the medical field, who earn doctorate degrees and are appropriately called by the title "Dr." Your physical therapist is very likely included in that list! It is why I insist on calling MDs and DOs by more appropriate titles: physician, medical doctor, or osteopathic doctor. And I refer to myself as a doctor because that's what I am. I am a Doctor of Physical Therapy.

That doctorate degree your physical therapist earned gave them training in normal and abnormal function of all body systems, pharmacology, and rehabilitation of the neuromusculoskeletal issues. Physical therapist education involves in-depth knowledge of how the entire body works. We actively treat the neuromusculoskeletal system and are experts in wellness. But if something funky comes up, we are well equipped to spot the issues that are out of our scope of practice. Physical therapists, just like physicians, can also have a specialty field and have more expert knowledge in certain areas versus others.

Let's take a look at two ladies this week, both of whom are currently pregnant and perfectly healthy, minus some back pain.

Bridget: First time mom and miserable

Bridget is so excited to be a mom, but man is pregnancy harder than she thought it was going to be! From the nausea to the swelling, heartburn, constantly peeing, and so many aches and pains, she is so ready to be done and she's only 26 weeks along.

Despite her best efforts to stay healthy, she's just feeling absolutely miserable in her body. Bridget has a sister and some cousins who have been pregnant, but she is the first of her friends. Her female family members all reinforce to her that being pregnant is a miserable experience. None of her friends have any insight to offer.

Hoping there is something that can be done for her, Bridget brings this up at her OB-GYN appointment. In Bridget's eyes, everything else about pregnancy would be so much more tolerable if only her back and pelvis didn't hurt so much. She would deal with the fatigue and the heart burn and the aching feet and the leaking when she coughs, but the pain she is having in her back and pelvis is absolutely unbearable. Her physician tells her it's very normal to have back and pelvic pain as baby gets bigger and she enters her third trimester. She is carrying all this extra weight you know, yada yada, on and on... take some Tylenol because it's the only "safe" medication for pregnancy and wear a pregnancy belt.

"What about seeing a physical therapist?"

"No, you don't need to. Everything you're experiencing is a normal part of pregnancy. There's really nothing you can do other than the medication and belt."

Ok, that's a depressing and dis-empowering message to get. So Bridget ups her Tylenol dose (which if you've been following the news, this is not a good thing to be doing when there are other alternatives) and buys a pregnancy belt. This helps take the edge off of some of her symptoms, but she is still in a lot of pain and is starting to have a difficult time sleeping at night. She suffers for another 14 weeks until her baby is born and isn't sure she's going to be having any more children. Enduring another pregnancy like the one she had, unable to ever get comfortable or find relief from her pain, just isn't high on her list of things to do with her life. Do you blame her?

Enter Eliza: Mom of two with one in the oven

Bridget meets a friend, Eliza, a few months after her son is born at a local library story time. They hit it off and get to talking about pregnancy. Eliza is currently pregnant with her third baby.

"I don't know how you are doing it for a third time!" Bridget says to Eliza. "How can you stand to be so miserable for nine straight months?"

"Oh, I love being pregnant!" is Eliza's reply. Of course, go figure. Only people who like being pregnant have more than one baby. She must be one of the lucky ones.

"I see a physical therapist. I'd be a wreck if it wasn't for her." Ok, maybe not just lucky then.

Eliza shares further that her first pregnancy started out much the way Bridget's had. Right at around 34 weeks, her back and pelvic pain reached a point of being absolutely debilitating. She could never find a comfortable position, sleep was nonexistent, and she was popping Tylenol like it was candy without much effect. Her doula had suggested seeing a physical therapist to see if it would help. Eliza started by calling her OB-GYN to get a referral. Her OB-GYN wanted to see her for an office visit before writing a referral. Since Eliza already had an appointment coming up in two weeks, they told her they would deal with it then since it wasn't an urgent situation. Wanting to be proactive, Eliza then called the physical therapy department with the health system her OB-GYN was associated with to get scheduled. However, they were booking two to three weeks out and were requesting that she have a referral from a physician, as this was their hospital system's policy. She could potentially be kept waiting for up to five weeks to be seen! A five week wait was absolutely too long. Her baby could very well be here by then, and she did not want to go into labor feeling like this. Eliza was utterly miserable and felt like her body was totally out of control. Hoping to get an appointment sooner, Eliza kept searching and found a private clinic that was able to get her in the next day. She asked if they needed a physician's referral, and they gave her a resounding "no!" She started getting relief after her first session and felt so much better that she was able to start taking control of the situation.

Eliza tells Bridget that seeing the PT changed the entire trajectory of her first pregnancy. She was able to reduce her symptoms and have a wonderful remainder of her pregnancy. Seeing the benefit of physical therapy, Eliza also decided to give PT a try postpartum. Her recovery after her first two pregnancies was incredibly smooth. Any time there was an ache or a twinge, her PT was there to help her through it. Eliza tells Bridget that if she hadn't been able to take control and get in to see a physical therapist to help her during her pregnancy, she probably would have stopped having children after her first baby.

Feeling a little less alone, Bridget gets the contact information for Eliza's physical therapist and decides to make an appointment to see her. She's still struggling with pain postpartum and rather than listening to everyone else in her life who is telling her that pain is "normal," she decides to do something about it. Bridget is able to take control of her body again and start feeling better. She even starts to consider the idea of having more kids!

Not needing a referral for physical therapy is a bonus for everyone

It truly is. Everyone benefits.

You benefit because you don't have to waste time like Eliza had to. Getting in to see a physician first and then dealing with potential wait times at hospital based clinics can leave you suffering for much longer than necessary.

You also benefit because if you do choose to see your physician first and they don't think PT is necessary, you can just get a second opinion right from the person you want to be seeing anyways. This is what Bridget should have done.

You benefit a third time because it's also going to save you money. You won't be paying several hundred dollars for a physician's office visit that is essentially useless.

Your physician also benefits. It takes some burden off of their plate and eases some of the strain on the medical system. I'm not sure if you've noticed this, but our medical system is stretched to the limit right now. Physicians are booked up for weeks, sometimes months if they're a specialist. They and their office staff don't need to waste any time writing up a referral and faxing it. Plus why use up an office visit when they aren't going to be the one to fix your problem anyways. It doesn't make sense to use up their time that way when it's not necessary.

And finally, your community benefits. Related to the benefits for your physician, you now are not taking an appointment time that someone else, for whom the physician might actually be the right person for, can use. Once again, it's easing the strain on the medical system.

Ready to start physical therapy to ease your mom-related aches and pains? Hit the contact button below right now and let's get you taken care of.

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