The importance of communication between physicians and physiotherapists for rapid and successful patient rehabilitation
communication between physicians and physiotherapists
An interview with an orthopaedist, Dr. Ralph Kirschner, and a physiotherapist, Johannes Fetzer.
Good communication is important for successful therapy and the patient's recovery. That is why the Medical Therapy Guidelines (HeilM-RL) call for close collaboration between contract physicians and healthcare professionals. Even in actual practice, it is difficult to find any doctors or physiotherapists who would deny the logic of this policy. Patients are rarely aware of the importance of communication between doctor and patient, and they often assume that communication is functioning smoothly. Yet actual practice shows that this is far too frequently not the case.
At FIBO 2019, orthopaedist and sports physician Dr. Ralph Kürschner and sports physiotherapist and osteopath Johannes Fetzer will be sharing their professional expertise and experiences with interested physiotherapists in presentations at the FIBO CAMPUS and in workshops at the Physio Meeting Point in Hall 7.
They have been working together closely at the Therapiezentrum HafenCity in Hamburg for a year now, and they are very familiar with perfect collaboration – as well as its opposite. We met with them in Hamburg for our interview.
FIBO: Dr. Kürschner, time is considered to be one of the key factors standing in the way of good communication between physicians and physiotherapists. How have you dealt with this in the past?
Dr. Kürschner: When treating the musculoskeletal system, I believe that close collaboration between the physiotherapist and the physician is absolutely essential in order to achieve the very best therapy outcome. I always try to provide patients with information for them to pass on to their physiotherapists, but have found that it is best when I contact the physiotherapist directly, so that I can properly attend to the treatment process as well. I make sure to allow time for this, and have found that even a brief dialogue can be very effective. Unfortunately, however, I have also heard from colleagues about an entirely different situation, one in which communication between the physician and physiotherapist is neglected.
FIBO: Mr. Fetzer, I’d like you to think back to the beginning of your career for a minute: How often was it that a feeling of insecurity towards the physician got in the way of good communication?
Fetzer: It is clear that this played a role – on the one side you have a ‘demigod in white’, and on the other a ‘minion in a tracksuit’. In hospitals in particular, where we physiotherapists generally have contact with physicians early on in our careers, there is often a ‘class distinction’ between doctors and healthcare professionals. It was frequently difficult to enter into a fruitful dialogue in such circumstances. Naturally, however, there are also some excellent examples of how things can be done differently. I had outstanding opportunities to share thoughts and ideas with physicians in various departments. This worked best in areas in which physiotherapy represented an important part of the treatment being provided, such as for burns, paraplegia and mobility rehabilitation. It’s really quite simple, though: people can earn respect by working well together. People who work well together for a longer period foster this respect and gain increasing trust in the competence of those they are working with. The result: differing professions and ‘class distinctions’ become irrelevant, beca use anyone who spends a long time working with patients eventually learns that we can do more working together than separately...
FIBO: Dr. Kürschner, how often have differing levels of specialist expertise resulted in problems in understanding one another?
Dr. Kürschner: Specialist subjects are not a problem, because everyone is an expert in their own field. No one can expect a physiotherapist to have the full range of knowledge of a physician, any more than a physician can be expected to have a physiotherapist’s know-how. The important thing is to show respect when communicating with one another, including when explanations of diagnoses and treatment plans are required on both sides.
FIBO: Mr. Fetzer, do you know any doctors who are well-versed in the Medical Therapy Guidelines (HeilM-RL)? Or would it perhaps be safe to say that physiotherapists are the only ones who really know these guidelines well, as they are the basis of their livelihood?
Fetzer: We are usually pretty happy if the physicians know the most important provisions. No one really knows the guidelines well. Sometimes, physician assistants are a bit better versed in this material, but we have to consult with the relevant physicians about numerous regulations, as health insurance providers simply will not pay for treatment if there are any irregularities. It's really quite absurd: as physiotherapists, we are duty-bound to follow the doctor’s orders, yet we must review these instructions closely to make sure that treatment will also be paid for.
FIBO: Dr. Kürschner, how often have you had to correct changes requested by physiotherapists for the ICD (International Classification of Diseases) codes, for example?
Dr. Kürschner: Quite often. Whenever it can be justified by the facts of the case, I try to comply with the physiotherapist’s wishes. The most important thing is to ensure that the patient enjoys the very best treatment while ensuring that everything runs smoothly with the health insurers. If at all possible, we also want to avoid enquiries or refusals by health insurers as this simply results in unnecessary work.
FIBO: Mr. Fetzer, do fascia, or, to use the more conventional term, connective tissues, play a role in treatment for physicians? Do you see any major differences in knowledge here?
Fetzer: Medical professionals are paying increasing attention to fascia. As a result of the growing number of medical studies highlighting the importance of fascia and of connective tissues for various symptoms, a number of medical fields have come to recognise the importance of connective tissues to what they do. Even so, I have the feeling that there are still very few doctors who play close attention to this field. Most of them heard very little on this topic during their studies, or still view connective tissues as the ‘superfluous blah blah’ that was cut out of their preparatory course.
FIBO: Dr. Kürschner, both the fear of being the subject of complaints and patients’ expectations have led to an increase in the pressure placed on physicians in recent years. What role does this new situation play in communications with physiotherapists?
Dr. Kürschner: We place a great deal of emphasis on good documentation, and this helps us deal with enquires and claims for damages. It plays more of a subordinate role in communication with physiotherapists. It goes without saying that special instructions for physiotherapists are absolutely essential when dealing with high-risk patients.
FIBO: Dr. Kürschner, how has the markedly improved communication that comes from working together in a therapy centre impacted the success of patient treatments?
Dr. Kürschner: It has had a huge impact. We work hand-in-hand and the treatment we provide is mutually reinforcing. A successful operation by the physician is simply the foundation for successful recovery. Subsequent treatment supervised by a physiotherapist helps the patient reach their goal more quickly and efficiently. Particularly, however, when it comes to functional disorders that may have been identified by the doctor, the actual treatment is often performed by the physiotherapist. Sometimes, however, after the physiotherapist has completed a few sessions with the patient, treatment plans are modified because they have noticed other potential causes for the patient’s complaints. Naturally, this only works if there is a trusting and positive working relationship. It is a way to help avoid unnecessarily long recovery processes.
Mr. Fetzer, Dr. Kürschner, thank you very much for taking the time to talk with us. We look forward to seeing you again in your presentations and workshops at FIBO CAMPUS.
About Dr. med. Ralph Kürschner
Specialist for orthopaedics, trauma surgery, sports medicine and chirotherapy
Dr. Ralph Kürschner belongs to an up-and-coming generation of orthopaedists that are combining established medicine with the very latest forms of treatment. He ‘lives’ the interdisciplinary concept. Close cooperation between physiotherapists and osteopaths makes it possible to provide the very best treatment. He studied medicine at the Saarland University in Homburg/Saar, at the University of Cape Town in South Africa and the University of Hamburg before going on to earn his doctorate at the Institute of Sports and Preventive Medicine in Saarbrücken under Prof. W. Kindermann, who has been the Director of the Medical Department at the German Olympic Sports Confederation (DOSB) for many years now. Dr. Kürschner gained wide-ranging experience as part of his residency. Deployments in endoprosthetics, spinal surgery, septic bone and soft tissue surgery, trauma surgery, emergency medical care and his training in sports and chiropractic medicine enable him to provide a differentiated diagnosis of complex cases. Furthermore, he also has close ties to the world of competitive sports as both a team physician and an active athlete.
Presentations by Dr. med. Ralph Kürschner at FIBO CAMPUS 2019
5 April 2019
‘Chronic musculoskeletal ailments: Recognising and treating tennis elbow, Achilles tendon inflammation, shoulder impingement and other similar ailments’ (3:30 – 4:30 p.m.)
6 April 2019
‘Postoperative treatment following knee and hip prosthesis implantation – what to do if the patient is experiencing problems’ as part of the theme (10:30 – 11:30 a.m.)
‘Recognising and treating chronic back and neck pain’ (3:30 – 4:30 p.m.)
About Johannes Fetzer Sports physiotherapist and osteopath
Johannes Fetzer has 20 years of professional experience in treatment and training. He is a sports physiotherapist, osteopath, homoeopathic practitioner and fascia therapist. In addition to his professional activities, he is also active as a specialist author, speaker and trainer in his field, and is a recognised expert. Johannes Fetzer is a partner of the Hamburg/Schleswig-Holstein Olympic Training Centre and has been serving Germany’s national women’s field hockey team as a sports therapist and osteopath for many years. He is also responsible for providing osteopathic support for other Olympic teams and disciplines, including golf, badminton, track and field, rugby, football, swimming and ice hockey. In his current home city of Hamburg, he works with patients and athletes at the Therapiezentrum HafenCity and at his Bellevue practice.
Presentations by Johannes Fetzer at FIBO CAMPUS 2019
5. April 2019
‘Modern fascia-conscious back training with Blackroll etc.’ (2:00 – 3:00 p.m.)
6. April 2019
‘Sitting is the new smoking: Fascia therapy and training for people who spend a long time seated’ (9:00 – 10:00 a.m.)
‘Fundamentals and treatment examples for migraines and tension headaches’ (10:30 – 11:30 a.m.)