The Medical Doctor Is Not Always Right: A Guide for Physical Therapists

A common disconnect in clinical practice arises when therapists feel compelled to strictly follow a medical doctor’s instructions for patient care. While collaboration with physicians is crucial, there are instances when blindly adhering to their recommendations can lead to suboptimal outcomes. It’s important to recognize that medical doctors, like everyone else, are human and prone to errors or oversights.

Why Doctors Aren’t Always Right

Doctors, especially orthopedic surgeons, often operate under intense time constraints. They may see upwards of 60 patients in a single day, relying heavily on physician assistants (PAs), nurse practitioners (NPs), or nurses for patient information. In such a fast-paced environment, it’s understandable that a doctor might miss key details or provide generalized recommendations.

Primary Care Physicians (PCPs) and General Practitioners (GPs) present another scenario. While they are highly skilled, they are generalists, not orthopedic specialists. When you receive a referral or recommendation from a PCP, take it with a grain of salt and rely on your own clinical expertise to guide your treatment plan.

Trusting Your Clinical Judgment

As physical therapists, it’s your responsibility to perform thorough evaluations and develop individualized treatment plans. Sometimes, this means deviating from the doctor’s recommendations when your professional judgment indicates a better approach for the patient. Always conduct a comprehensive subjective and objective exam to inform your decisions.

To illustrate, I once had a referral for a patient with knee pain where the doctor’s script specified the wrong joint entirely. Had I blindly followed the script, the patient’s actual issue would have gone unaddressed. By conducting my own evaluation, I was able to identify the correct problem and provide effective treatment.

Communicating with the Patient

Effective communication with patients is key when your approach differs from the doctor’s. In many cases, patients appreciate the time and effort you invest in explaining their condition and treatment plan. This builds trust and positions you as a knowledgeable partner in their care.

Here’s a common scenario: a patient tells you, “I trust your judgment because you took the time to explain everything, while the surgeon only spent a few minutes with me and didn’t even review my MRI.” When patients feel heard and understood, they are more likely to follow your recommendations.

However, not all patients will be comfortable deviating from their doctor’s instructions. In such cases, respect their wishes and adjust your treatment plan accordingly. For example, I recently treated a 15-year-old ballerina recovering from ACL surgery. Despite recent research supporting open-kinetic chain exercises in post-ACL rehabilitation, the surgeon advised against them. After discussing the differing opinions with the patient and her family, they opted to follow the surgeon’s recommendation. Respecting their decision, I adapted my approach while ensuring the patient still received effective care.

Balancing Professionalism and Autonomy

It’s important to strike a balance between respecting a doctor’s expertise and exercising your own clinical autonomy. Physicians play a vital role in the healthcare team, and their input is invaluable. However, as a physical therapist, you have unique insights into patient care that can complement or, at times, challenge the doctor’s recommendations.

When you find yourself in disagreement with a doctor’s advice, consider the following steps:

1. Perform a thorough evaluation: Ensure you have a clear understanding of the patient’s condition.

2. Communicate openly: Explain your rationale to the patient in a respectful and clear manner.

3. Gain patient consent: Always involve the patient in the decision-making process and respect their preferences.

4. Document thoroughly: Record your clinical findings, rationale, and the patient’s preferences to protect yourself and ensure continuity of care.

Final Thoughts

Doctors are essential members of the healthcare team, but they are not infallible. As a physical therapist, you have a responsibility to advocate for your patients by using your clinical expertise and judgment. When done thoughtfully and respectfully, challenging a doctor’s recommendation can lead to better outcomes and stronger patient relationships.

Remember, it’s okay to have differing opinions as long as you prioritize the patient’s best interests. By maintaining open communication and involving the patient in their care, you can foster trust, ensure informed decision-making, and ultimately provide higher-quality care.