What Should I Expect From My Health Professional?
By Marie-Catherine Bruno, BScPT, Cped(C).
I often refer to your health professional in my monthly column, but I have never really thought about those of you that have never been out to see one. “What should I expect” you probably wonder… Or you might even worry whether the treatment or consultation you just paid for was really worth it. Also, one may wonder: “what is the difference between a physiotherapist and a chiropractor – aren’t they all the same?” So I will give you certain guidelines and general descriptions, hoping to bring some clarity into your mind. But remember, this is coming from North of the border, so standards might be slightly different in the United-States. You will also notice that I am not giving you any guidelines in terms of cost for those services, as it varies way too much from one country to the other, and from one side of the country to the other.
The Medical Doctor – General Practitioner (GP)
They are usually the first ones on the line of fire. Everybody consults their family doctor when something goes wrong. Their training usually takes them through 5 years of university, and then through some clinical work called Internship and Residency. They pretty much learn a little bit about everything, from giving birth to auscultation, and from stitches to popping dislocated shoulders back. Unless they chose to they may not really have a specialty. In the event of a musculoskeletal (bones and muscles) injury, they will usually refer you to a specialist. Depending on the state or province you live in, you may or may not need to see your GP first before you can see a specialist.
What to expect: you should have just enough time to sit down and describe your problem. Their workload is unbelievably heavy. But if your GP does not even put his/her hands on your problem, look for another one. You should at least expect (and receive) a 5-minute hands-on exam. If you do not think you will require special tests (like X-rays), you might want to skip the visit to your GP and go directly to one of the below specialists, as this is probably what your doctor will recommend anyway.
The Medical Doctor Specialist (orthopaedic surgeon, sports doctor, dermatologist, podiatrist…)
The specialist is first of all a Medical Doctor (MD) with a specialty in a certain field (with the exception of the podiatrist who does not go through regular med school, but directly into Podiatric Medicine) The specialty usually requires another 2-3 years of schooling and another set of internships and residency. The list of specialties is exhaustive, so I only listed the ones you are likely to consult in the case of a running injury.
They too have a very heavy caseload, so expect the same amount of time spent in their office than with your GP, maybe even less. Depending on your state/province, they sometimes are the only ones allowed to order special tests like MRI (magnetic resonance imaging) and CAT scan (computerized axial tomography). They are also the ones to see for corticosteroid injections as they usually have more training in palpation, making the needle a little more precise (always good!).
The Doctor of Chiropractic (DC)
Commonly called Chiropractors, they are more and more present in the medical community. In fact there are projects in some Western States to put DC’s in charge of medical clinics (instead of MD) as the government and insurance companies have realized their efficiency and good diagnostic skills (in other words, they cost less to the State because they prescribe a lot less medications and special tests and also reduce the number of needed surgeries). Just like GP’s, their training consists of 4-5 years of university, a Board exam and then some internships. They also learn a little bit about everything, but most of them specialize in the spine and its effects on the nervous system. They mainly use high velocity hands-on techniques to influence the nervous system and change the muscle-firing patterns.
What to expect: they tend to see many patients a day, just like your GP. Expect your first visit to be a little longer (at least 10 minutes, usually 20-30 minutes) so that an appropriate assessment can be done. Then they will follow you up regularly with short visits (5 minutes) to keep targeting the nervous system until it settles.
The Physical Therapist – or Physiotherapist (PT)
Physical therapists are the specialists of rehabilitation. They go through 4 years of university, a Board exam and internships. Like GP’s and DC’s they cover a lot of ground in School, from burns to brain injuries, and from pre-natal exercises to sciaticas. Most of them will also specialize through continuing education programs. They are trained to work and rehab muscles, ligaments, joints, nervous system… anything that affects movement.
What to expect: clinics typically have a caseload varying from 2-5 patients/hour. If possible, choose a clinic that has a lower caseload, even if it means more dollars – you will get your money’s worth and will not waste any time during your visit. PT’s tend to use a lot of electrical machines (electrotherapy) that all work very well if used appropriately, but if you feel that they are using them for time management purposes, speak out. They also rely on home programs (usually 10-20 minutes worth of exercises to do at home), so do what you are told, otherwise you will not progress as fast. Lastly, seek PT’s that favor hands-on technique (as opposed to hooking you up to machines and then sending you to the gym). Your visit will typically last 45-60 minutes.
The Registered Massage Therapist (RMT)
Registered Massage Therapists are the soft tissue specialists. They typically go through 2-3 years of College where they learn all about soft tissue (muscles, ligaments, tendons, capsules, fascia…). Be aware of masseuses, as they are not registered and therefore unlikely to be covered by your insurance company. They also have much less training (typically a 6-weeks crash course), so look for a Registered MT.
Unlike all of the above health professionals, they are trained to rely on a prescription, meaning that they do not make their own diagnosis or clinical impression. So before consulting a MT, make sure to have the problem sorted out first (although I have had the pleasure to work with MT’s that had much better diagnostic skills than some other health professionals… but diagnosis remains legally beyond the scope of their practice).
What to expect: you can usually decide how long you want your session to be, as you will typically pay an hourly rate (as opposed to the above professionals where you normally pay a consultation fee, regardless of how much time you have spent in their office). I always recommend booking a full hour for your first visit. Then your MT will be able to tell you if you need more (or less) for future consultations. Time spent with your RMT is typically one on one (meaning that they are not treating someone else at the same time!) and mainly hands on, so expect to pay accordingly.
Osteopath and kinesiologist
They too are specialists of the movement and skeletal alignment, but are still not recognized in most states and provinces. They are very present in Europe and are slowly starting to become more popular in North America. Although they do not have a College or any form of governing body to protect the public yet, some insurance companies may cover for their services. Check with your company.
Acupuncturist and hypnotist
They are the specialists of pain relief and brain control. They can have very good results with chronic pain and recurrent injuries, as they target higher systems like your brain and nervous system. Although they do not have a College of Acupuncturists and of Hypnotists, they both have a Board that you can contact for more information. When looking for one (unless you have a specific referral from your specialist), make sure you find one that specializes in the discipline you are seeking (do not go to a stop smoking specialist if you are suffering from chronic back pain – although some evidence now shows that smoking is related to low back pain…). Some insurance companies may cover their services.
What to expect: the first visit is usually about ½ hour, then depending on the treatment you need, it can vary from 5 minutes to an hour for hypnotherapy. With acupuncture you will usually need at least 8-10 visits for a good permanent result. Hypnosis varies.
There are a lot more health professionals out there that I did not even mention. I chose to focus on the ones that you are most likely to run across, and also the ones that are recognized and honored by most insurance companies.
It is also important to note that very often, a combined approach (meaning that you are working with more than one specialist) is the best way to get rid of a recurrent problem, a chronic one or simply one nasty injury. If your health professional recommends that you consult someone else, ask if they have a name to suggest. Make sure that there is communication between the different specialists you are consulting because a good communication is the key to success.