Treating the Whole Patient.

Treating the Whole Patient.

The noncompliant patient who convinced me to study PT 

Megan Cheng, SPT

We didn’t do any therEx. It was, in a way, the least physical physical-therapy appointment I’d ever seen.
But it was this appointment that opened my eyes to the profession and convinced me to go to PT school.
I was shadowing at a physical therapy clinic for the first time. I watched appointments quietly, worried about getting in the way, and asked shy questions. This patient arrived for her follow-up appointment late. Her face was flushed and she talked quickly, spilling out every inconvenience of a bad day, her general frustration with the medical system in general and several nurses in particular. She didn’t understand her radiology report, no one would explain it right, they said she was taking up too much of their time, she was running late, it was too hot out…
The PT nodded along, then gently mentioned the HEP. 
Now the patient looked as if she was going to cry. She hadn’t done it, she didn’t know if there was any progress, it was so warm in here…
My mentor asked if the patient would like to use the session for soft tissue work, ultrasound, and looking at the radiologist’s report together.
The patient finally stopped for breath.
After some quick gross motor tests, we went back to a private treatment room, where the PT gave manual therapy and ultrasound, and listened. She gently offered perspectives (“you know, it’s likely this person didn’t mean it that way…”). She summarized the radiology report in a few sentences, and the patient immediately accepted it (“See, why didn’t they say that?”). In the end, the PT reassigned the previous HEP, and the patient left calm, breathing deeply.
After she left, the therapist saw my puzzled face and quietly told me some previous conditions in the patient’s history to explain her emotional instability.
I left, thinking. 
The patient had a distorted view of pretty much everyone she talked about. She complained about other medical professionals, she was impatient with people in general. But she was convinced that the therapist was on her side. The therapist cared.
One of my classmates says that they were inspired to pursue PT when they realized how physical therapy treatment helped them “mentally and not just physically.” This is similar to my own motivation. This appointment was one of the first times I realized the wonderful opportunity PTs have to treat a whole person – to come alongside people who are hurting or frustrated or just have questions, and to be on their team as they heal. 
 I know I’m preaching to the choir – if you’re reading this blog you’re probably a healthcare  provider  and you know what an influence a person’s emotional health can have on their success in therapy.  But I’m hoping that the story can encourage you when you are teaching students. We learn more from watching you than hand positioning for goniometry. We see you motivate patients to push on and achieve their goals. We see your compassion, and the ways that you carefully gain a patient’s trust. Soldier on! We’re learning from you.

The Importance of Language in Your Practice

The Importance of Language in Your Practice 

by Jonathan Lewis, SPT

In school, you will be exposed to a vast and alien vocabulary composed of similar words that denote important distinctions: cerebrum and cerebellum, optical and ocular, eccentric and concentric, ligament and tendon – literally thousands more. And it doesn’t end with just the simple terminology. As you learn the lexicon of your new profession, you must also start integrating these terms into a nearly endless alphabet soup of acronyms. Knowing this shorthand – PICA, CSF, PNF, DM1, BP, PRICE, on and on – will become vital for your ability to be able to quickly and concisely communicate with your fellow students, clinical instructors, and professors.
Developing an ease with the vocabulary and its shorthand will pay off in a lifetime of effortless communication with other medical professionals. Additionally, maybe the most important aspect of becoming comfortable with this peculiar vocabulary is in the valuable seconds you will save when “charting” during your rotations. And speaking of rotations: you will find that any clinic you work at will have a culture that has developed its own argot to describe patients and procedures – slang terms that will have little meaning to anyone outside of that clinic.
It’s easier than it sounds, though. Your mental library of medical jargon will become effortless as you become immersed in reading studies, presenting papers, and cramming anatomy terms. However, the real trouble with using this newly acquired language – and the most difficult part for some new practitioners – isn’t in learning it. It’s turning it off.
When you’re in clinic, you might find yourself telling a patient that you’re going to “perform an HVLA manip – specifically a TJM – to treat their LAS.” You’ll be met with a blank stare. So perhaps you’ll change your approach. You might simplify your language and nonchalantly tell the patient that you’re going to “perform a maitland grade 5 manipulation on their talo-crural articulation and hopefully they’ll feel some relief following the cavitation.” That probably won’t help much, either. If your CI is kind, they will take pity on you and interject: “She’s gonna pop your ankle. Research shows that this helps with ankle sprain recovery.” You’ll wonder why you couldn’t say that – it was a simple, true statement that everyone involved could understand.
Don’t worry, we all do it. We spend years learning that language is important – A’s quickly turn to B’s or C’s on anatomy exams if we use ligament when we should’ve put tendon or vein when we should have put artery. This is for good reason though – we don’t lose those points because our professors are mercurial and censorious academics that love to make us suffer (although, it will feel like it at the time). Instead, it’s to teach us that, in this profession, specificity is essential.
The devil, we often hear, is in the details. And, for physical therapy students, our ability to accurately describe the details and recognize the distinctions is tested and honed every day during our didactics – and this is important. Picking up on the difference between, for example, referred visceral pain and skeletal-muscle pain is one of the reasons we will someday proudly call ourselves Doctors of Physical Therapy. Our ability to be specific allows us to differentially diagnose and refer patients – but it has the side-effect of developing in us the habit of using terms that very few outside of the medical community will understand.
This is why we need to practice switching gears and language often. This is why we need to look for the moment our patient’s eyes start to glaze over and adjust our language. The best therapist I ever shadowed used words like “ouchie” and “bum” with her patients. Her ability to communicate incredibly complex concepts to people of all backgrounds while still being a precise evaluator was amazing. However, this skill was something she had to learn and practice. 
Our professors ask us to “avoid jargon” with patients and we attend lectures on the importance of medical literacy and access for all populations. However, after years of being immersed in the language and culture of the medical field, talking like a medical student is a tough habit to break.
However, to be a truly effective practitioner we need to break it. My advice? Start practicing from day one. Use the terminology with your peers and professors but when you’re speaking to people outside of the discipline, ask yourself “would I have known what this meant a year ago?” If not, see if you can adjust your language to increase understanding between you and your interlocutor without losing the meaning of what you’re saying.
This practice will pay off when you get to your first rotation, I promise. 

August 2017 bestPT Newsletter: Persisting Problems with Leftover Prescriptions

August, 2017 Newsletter

Leftover opiods are a common problem after surgery.

by Lindsey Tanner

CHICAGO — Surgery patients often end up with leftover opioid painkillers and store the remaining pills improperly at home, a study suggests.

The research raises concerns about over prescribing addictive medicine that could end in the wrong hands…



6 New members joined bestPT  in July 2017.

Each new member benefits from and contributes to our network strength.


Let’s welcome bestPT newest members!

Samantha Monahan of Bassett Physical Therapy, Stanleytown, VA

Sopia Polanco of Bit-By-Bit, Fort Lauderdale, FL

Christa Johnson of Comprehensive Hand & Rehabilitation Waterford, MI

Shalaina Russell of Kalispell Rehab, Kalispell, MT

Michele Kurkowski of Kiwi PT, Highland, MI

Norma Garcia of Two Trees Physical Therapy & Wellness, Ventura, CA

 Looking at the landscape of physical therapy practice management, we see a playing field tipped to benefit the payers and hurt the provider. The relationship between payers and providers is adversarial, but billing networks offer solid strategies that allow providers to get back into–and win–the game.

The “network effect” allows a large number of unique providers to capitalize upon their strength in numbers.  Please help us strengthen that network.

If your friend schedules a demonstration of the system, we’ll send you a $25 Amazon gift card
For each friend that you refer that joins our network, we’ll credit you $50 each month the office is contracted with us through the first year!

July 2017 bestPT: PTA, the 1st choice for a 2nd career

PTA: First Choice for a Second Career

Many PTAs began their work lives in other occupations but have come to find a home in physical therapy.

While their individual reasons may vary, many of these professionals are resuming their studies as older students focusing on a second career that is more satisfying than the work they had previously done.  Work that is emotionally fulfilling, stimulating, varied, all the while being educationally affordable and serving a hot job market.

(by Eric Ries,  at PTinMotion)


6 New members joined bestPT  in June 2017.

Each new member benefits from and contributes to our network strength.

Let’s welcome bestPT newest members!

Lauren Sahagian of Big Sky Pediatric Therapy, Austin, TX.

Colleen Lafferty of Bit-by-Bit, Ft Lauderal, FL.

Sarah & Linzie Schwindt of Health Rehab Solutions, Kalispell, MT

Adrienne Martinez of Prime Therapy & Pain Center, Riverside, CA.

Bruce Wihongi of Kiwi Pt, Highland, MI

June 2017 bestPT: 10 Easy Ways PTs Can Promote Fitness

10 Easy Ways Physical Therapists Can Promote Fitness

Unlike many medical providers, physical therapists have ample time to talk with patients, to learn about their lives and to educate.

This extra time gives physical therapists (PTs) the opportunity to do more than help patients heal from injuries and regain mobility–they can also help them learn to pursue wellness, achieve greater fitness and possibly avoid injuries in the future.

And we’re not just talking about sports physical therapy. PTs can work with all patients to help them achieve the optimal fitness level for their level of ability.

Welcome New Members to the bestPT Team in May

7 New members joined bestPT  in May 2017.

Each new member benefits from and contributes to our network strength.

Let’s welcome bestPT newest members!



Ingrid Cruz and Gordon David of Prime Therapy and Pain Center

Riverside, CA.

Jeanne Cunningham and Lisa Dennis of Big Sky Pediatric Therapy,

Austin, TX.

Christopher Leck of Health Rehab Solutions,

Kalispell, MT.

Amy Adler of Bit-By-Bit Therapy

Fort Lauderdale, FL.

Jennifer Huyser of Northland Pediatric Physical Therapy,

Pleasant Valley, MO.

Five ways technology is improving the physician-patient relationship

Few things are as perplexing to healthcare providers as the challenge of nurturing more meaningful, intimate relationships with patients in an era of rising healthcare costs.

Vendors have rolled out a number of healthcare technology solutions to address these challenges, such as app-enabled patient portals, but much of the time, these tools simply serve as data repositories — underutilized by both the patients whom they are intended to serve as well as the physicians who are supposed to be using them.

However, some physicians aren’t hesitant to adopt technology.


Caring for the complex pelvic patient with Physical Therapy

Physical therapists specializing in pelvic health are confronted with a myriad of pelvic floor diagnoses and impairments which may result in pelvic organ prolapse (POP). Pelvic floor weakness secondary to muscle fiber damage or connective tissue abnormality may account for this phenomenon. Extenuating circumstances, such as a vaginal birth after cesarean section (VBAC), add further dimension to the patient’s presentation clinically. A 2014 study suggests that 65% of women experience successful VBAC deliveries, and there seems to be a growing trend of women requesting them.

I recently had the privilege to treat such a woman in the clinic. The patient was a 34 year old female referred to physical therapy (PT) by her obstetrician-gynecologist (OB-GYN) for evaluation of pelvic organ prolapse. The patient presented to physical therapy para 2 grava 2 (P2G2) indicating 2 pregnancies and 2 live births. On the day of evaluation she was 5.5 weeks post vaginal birth after cesarean (VBAC) of her second child. This three part series will analyze how documentation supported the evaluation, treatment, and outcomes of the patient.

At the time of initial evaluation her physician had not assigned a grade to her pelvic floor prolapse. Furthermore, the patient had not been evaluated for prolapse during cough; bear down, or in standing position, per patient report. Her primary concern was a feeling of heaviness and a sense that her organs were falling out, especially during standing and lifting tasks. Her physician had not yet performed a complete six week post-delivery examination, though this appointment was scheduled for three days after physical therapy evaluation.

The patient reported neither pain nor unintentional loss of urine (incontinence), though she felt weak throughout the abdominals and pelvic floor. Pertinent past medical history consisted of cesarean section 11/19/12 (almost two years prior to PT evaluation date) with subsequent hematoma at the surgical site which resolved with use of an abdominal binder. She is otherwise a very healthy woman with no comorbidities. The patient lives at home with her husband and two children, works as a physician assistant specializing in hospital based gastroenterology which requires prolonged standing during procedures and patient rounds.

She is an avid runner and aerobics instructor. She reports that there is good stress in her life with the birth of her second child. She was concerned that she would be unable to safely lift her toddler, run, or teach classes in her current state. Her primary goal was to be able to safely lift each of her children without the sense of heaviness in the pelvis. Secondary goals were to return to running and teaching aerobics classes which are her primary sources of recreation and stress reduction.

Physical Therapy Electronic Documentation

Click to Enlarge the image.


Past medical history is easily entered and accessible in the electronic chart.

There is burgeoning evidence to support physical therapy intervention for pelvic organ prolapse. A Cochrane Database System Review analyzed three randomized control trials (RCT’s) and found that pelvic floor muscle training may result in prevention of symptom worsening, and better self-reported patient outcomes. Furthermore, there is Level I evidence via 3-D ultrasonography that supervised pelvic floor training can increase PFM volume, close the levator hiatus, shorten muscle length, and elevate the resting position of the bladder and rectum in patients with POP. The researchers noted improvement in muscle thickness in both stage I POP and in symptomatic women with stage II or greater as determined by the Pelvic Organ Prolapse Quantification Scale (POP-Q).

As a measure of functional outcome, the patient was asked to complete the Pelvic Floor Impact Questionnaire-short form 7 (PFIQ-7). This outcome measure is a patient report of impact of symptoms of bladder, bowel, and prolapse impairments, and allows the therapist to gauge the level of impact and frustration that the patient experiences due to their symptoms so that treatment may be tailored to fit their individual needs. The PFIQ-7 was found in long form to be valid and reliable for women with disorders of pelvic floor including urinary and fecal incontinence, as well as pelvic organ prolapse. It is internally consistent (0.96-0.97), and reproducible (0.77-0.92), and the prolapse section was found to be significantly correlated with the stage of prolapse of the individual. The short form is faster for the patient to complete, and was found to maintain excellent correlation with the long form (r=0.95 to 0.96), with test-retest reliability P<.001). The outcome may be analyzed in subsets for bladder, bowel, and pelvic symptoms, respectively. This patient received a score total of 0 on the bladder and rectum subsets, and a score of 19 on the pelvis subset for a total score of 19 on the scale.

Musculoskeletal screening included assessment of posture in standing and sitting as this can be beneficial as an assessment of structural alignment according to the American Physical Therapy Association’s Guide to Clinical Practice 2nd Edition. The patient demonstrated mild forward head, mild anterior shoulder positioning with mildly increased thoracic kyphosis and lumbar lordosis. Pelvic symmetry was assessed by palpating the bony landmarks of the anterior superior iliac spine (ASIS) bilaterally, and the pelvis was mildly anterior rotated on the left. This pelvic position was verified in the supine position to account for possible interaction of limb length discrepancy. Limb length was measured and found to be insignificant with the right lower extremity measuring 1 millimeter longer than the right. Abdominal strength was graded 3+/5 as she was able to lower her legs no greater than a 60 degree angle while maintaining posterior pelvic tilt, according to Kendall’s muscle testing scheme.

PT examination sought to determine the nature of the heaviness in the pelvis through observation and palpation of the pelvic floor in supine hook lying position. This is done in order to assess the response of the pelvic floor and determine which walls of the pelvic floor appear to be affected.
Musculoskeletal physical therapy differential diagnosis included pelvic floor dysfunction resulting in prolapse, and increased abdominal pressure due to visceral adhesions from previous c-section.

Physical Therapy Electronic records

Click to Enlarge the image.

Documentation to demonstrate verbal and written consent for external and internal pelvic floor examination are pertinent.

bestPT is able to create unique objective components to demonstrate that consent has been verified. Furthermore it is possible to scan in and attach release forms that have been signed by the patient.

In the next installment, we will discuss treatment techniques in this unique women’s health sub-population.

-Amanda Olson, DPT

Getting Started with Practice Management Software

images-17Today’s the Day

Should Shannon wait any longer before using bestPT practice management software?

Shannon strode into her physical therapy practice with a purposeful smile. Her office manager looked at her dubiously.

“Uh-oh,” Theresa said. “I know that look. You’re about to make changes.”

“Change is good,” Shannon said.

“Are we going to redecorate, the way you’ve been promising we would for months? That’s a change I could get behind. Otherwise, changes usually just mean more work for me.”

Shannon ignored Theresa’s banter. “You know that software we’ve been talking about?”

Theresa nodded. “bestPT.”

“Right. Today is the day.”

“Well, I’m very impressed by bestPT,” said Theresa. “It collects practice stats and makes them accessible and actionable, and makes it easy not only to track information but to translate it into work assignments so we get the follow-through we need.”

“That’s how it seemed to me,” Shannon agreed. “So many of the issues and problems we face day to day could be solved by the kinds of automated systems Vericle offers.”

“I agree,” said Theresa, “but can we afford it? We’ve just hired a new person and the holidays are coming up — you know that can be a slow time for us.”

“If it’s slow, we’ll have some time to get comfortable with the new system,” said Shannon. “If it isn’t slow, we’ll benefit from the streamlined workflow. And as for cost, I think it’ll save us money and help us make the practice more profitable.”

“I know that’s the idea,” Theresa said dubiously. “But what if it doesn’t work?”

“We’ve seen that it works.” Shannon thought about the demos they’d watched.

“I mean — what if it doesn’t work for us? What if we can’t get everyone to buy in or what if we’re too busy or it’s too hard and we don’t learn how to do it? Everyone I know can tell a story about some great new program that they sunk money into and then gave up on.”

Shannon considered. “Well, first of all, I think bestPT is different because of the kind of support they offer. They have lots of training materials, plus actual human coaches.”

Theresa nodded.

“Second,” Shannon went on, “we’re not just everyone. We’ve accomplished a lot already, building up this practice from nothing, and I know we can do this, too.”

Theresa smiled. “We are fairly amazing, aren’t we? I guess you’re right. I’ll call them today.”

Shannon smiled back. “I think we’re making the right decision.”

Should Shannon wait any longer before using bestPT practice management software?

Disclaimer: For HIPAA compliance, all characters appearing in this post are fictitious. Any resemblance to actual persons or actual events is purely coincidental.

Generating a Steady Stream of Referrals Is Not That Complex

By Erika Trimblesimplicity

Yes, to generate a steady stream of referrals and grow your practice you need to market. But marketing need not be complex. In fact the easiest and most affordable marketing strategy open to you is to build your client referrals.

This is a case of your clients doing your marketing for you. Consider this fact: people who refers once can refer many more times. They will refer many more times when you nurture your relationships with them. Nurturing your relationships means that you ensure your clients are satisfied, come back to you over and over again. These satisfied clients will always be willing to talk about you to others, and tell them about the great experience they had with you. This is what we call very powerful marketing because such testimonials are proof of the value of your services.

It is important to remember that at the very core of marketing your business is building relationships. Relationships bring you new clients, they influence your reputation, they spread your ideas, and much more.

Bear in mind that it’s not just about quantity of relationships (though that helps), it’s also about quality. Nurturing and cultivating good relationships is what results in having more clients, with less work.

If you’re tired of worrying about how many clients will walk in the door next week, and whether it will be enough to keep your practice afloat, then it is time for you to stop leaving referrals to chance!

Getting your current customers to stick with you is key to your practice’s growth and long-term profitability. When they stick with you, you have every chance of generating even more referrals from them.

In fact, for every 1 percent increase you achieve in customer retention, there’s a 7 percent increase in profitability. That’s huge!

When you lose a customer, it is absolutely worth your time and effort to get them back. Why?

Learning why customers leave your business is the first step in managing your referrals. Once you know the reasons people aren’t returning to you, you can prevent this from happening again.

I know some of you may feel uncertain and overwhelmed when I mention the idea of building referral relationships or even getting referral sources.

Just know there are people and resources to help you. Contact us at to learn how we can help you.

Physical Therapy Software | Improve Patient Retention with Care Plans

Physical Therapy software_ patient-treatment-plansAre you worried about paying next month’s bills because your patients don’t show up for their appointments? If your patients are noncompliant with your prescribed care plans, you cannot predict the cash flow at your physical therapy practice. What’s even worse is that your patients won’t get better.

Without consistent patient flow your practice cannot grow or be profitable. But unfinished care plans can also cause compliance issues and hurt your cash flow even further when you have to return payments. You can figure out just how much money your practice might be losing due to unfinished or unused care plans. Simply replace the assumptions below with your own practice numbers and complete the calculations.

For example:


  • 1 visit = $89
  • 1 care plan = 10 visits
  • Average number of no-shows per care plan: 5

Calculations: Potential income and losses from unfinished care plans per patient:

  • Potential income from 1 care plan: 10 visits x $89 = $890
  • Potential loss from no-shows per care plan: 5 visits x $89 = $445

Conclusion: You risk losing half of your income when patients don’t finish their treatment plans!

Identifying patients who don’t understand  the need for multiple visits to achieve their health goals is easier said than done, however. You really need to know what the entire plan looks like in order to track multiple visits. For instance, you need to track any patient that goes through a traditional  treatment step-down ladder, such as four visits per week for the first four weeks, then three visits per week for the next three weeks, and so on. Such unique nuances on many patient schedules are difficult to track manually, and this difficulty grows dramatically with each added care plan. Not to mention, tracking the respective discounts given for each care plan is nearly impossible without a tool.

Thousands of care plans are created for new patients every month to schedule multiple appointments and then track all payments and visits with your bestPT EHR software. When patients don’t show up for their appointments you can receive automated alerts on your physical therapy software workbench. You can also receive alerts via tickets when patients don’t have a future appointment scheduled or when they cancel their existing appointments. That way you can assign your staff the task of scheduling the next appointment. Another useful tool for helping your patients stay on track with their care plans are appointment reminders sent via phone, text, or email. bestPT physical therapy software has integrated several apps which serve this purpose.

Physical Therapy Software_ CarePlan

To set up care plans when your patients come into your practice, simply go to bestPT’s Scheduler and click on the “More” tab to open the wizard. You can also create a full care plan from the patient account. Make sure you turn on the settings in your bestPT physical therapy software for Patient Relationship Management and Reminders.

Physical Therapy Software | The Ugly Truth About Your No Show Costs

Physical Therapy Software | Losing Money from NS and NFAAre you anxious about wasted time when patients don’t show up for their appointments at your physical therapy practice? No-shows (NS) and No Future Appointments (NFA) can certainly slow down your patient flow and rob you of the opportunity to help your patients get better. But they also affect the bottom line of your practice and diminish your profitability.

Even patients who don’t miss their appointments should always have a follow-up appointment scheduled to ensure care plan compliance and consistent patient flow for your practice. You should also keep in mind that you might have to return any payments received when a patient stops treatment. Naturally, you won’t be getting any referrals from patients who don’t get better, which further increase the amount of lost income due to NS and NFA.

It is important to know exactly how much income your practice is losing due to NS and NFA. If you replace the assumptions below with your own numbers you can calculate your estimated NS/NFA loss per month, just like in the following example.


  • The average payment for one Patient visit is $89.00


  • Daily Cost
    Two no-shows per day cost you $178 per day:
    2 x $89 = $178

  • Weekly Cost
    Ten no-shows per week cost you $890:
    10 x $89 = $890

=> Annual Cost
In a year your loss of income is $46,280:

         52 x $890 = $46,280

You can reduce this lost income by taking action on all of your practice’s NS and NFA with bestPT’s scheduling and ticket system. Plus, you can view NS and NFA trends at a glance on your Radar Chart.  When you make sure all of your patients have another appointment scheduled, relationships improve and your practice grows along with your profits.