Let me tell you a story. Some details have been changed to protect … well, you know.
Once upon a time I was asked to review some records on a young man, about 32, who sustained many fractures in an accident. Let’s call him Charley.
Now, several years later, he’d been back to his regular job as a waiter in a busy downtown restaurant. Well, the attorney was happy because there was a physician note from a pain management clinic opining that lifelong physical therapy was a good idea; the associated physical therapist thought so too. And after all, if a doctor says so, it has to be true, right? What could go wrong? Asked for Charley’s PT records, he said, “What do you want those for? You can’t ever read those things anyway.” Please, I said.
It turned out that Charley did have quite extensive rehabilitation. After he got out of the hospital, he had outpatient PT for months. As the attorney foretold, the PT flow sheets were poor copies of largely illegible scribbled codes in tiny boxes, all scrambled up and hidden in a pile of unrelated material. However, as I anticipated, the admission and discharge evaluations were typed and clear: Charley had done well in PT, been adherent to a good home exercise program, and was discharged having met all of his therapist’s functional goals.
Ten months later a new physician sent him to a different PT because he had stiffness and joint pain. After eight weeks of care, he had again met all his discharge goals, including demonstrating an appropriate home exercise plan. This therapist noted particularly that he had been very successful with this. A pretty routine record, although there was no real reason given anywhere for his increase in symptoms. The therapist also noted that he had returned to his full-time job as a waiter.
A year later, Charley went to a third physical therapy facility, prescribed by a pain management anesthesiologist. Neither the physician’s note nor the intake eval mentioned any previous courses of PT. He didn’t have neuropathic pain, just stiffness. Again, he made most of his scheduled visits, met his goals, and was discharged. Interestingly, this discharge note mentioned Charley’s one particular goal: To play soccer again. The therapist noted that he had, indeed, rejoined a local adult amateur league and reported that he was happy with his abilities to run and kick the ball over the last two weeks of treatment, bolstered by good adherence to the home exercise plan.
When questioned, Charley said that he was experiencing stiffness and pain again, and his pain doctor recommended more therapy. “He says I should have it for the rest of my life.” However, when questioned closely about his home exercise program, he said that he stopped doing it “a few months ago,” and that he “got really stiff if I don’t do my exercises.”
I sighed. I have always told my attorney clients that they might not like what I tell them, but if I can find problems in a record, then the opposing attorney can, too, and they’re probably better off hearing it from me first.
Charley didn’t need physical therapy three times weekly for life. The records from three different therapy facilities clearly indicated that he did quite well when he kept up with a regular home program. Indeed, he did so well that he was playing soccer two or three times a week and hefting heavy trays in the evenings. He needed to stick to his home exercise program religiously, stepping it up when he had a flare of stiffness after a game or a heavy day at work. I recommended a physiatrist (rehabilitation physician) to look at the records to confirm my impression. The opinion: Once- or twice-yearly visits to PT for a few years to reinforce his home exercise plan, to keep him focused and establish good self-care habits.
But big settlement for disability and PT for life? Sorry, Charley.
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