Can any physiotherapists tell me if this is standard?

[SuchProspects]

I recently had problems with my knee and was referred to our area physiotherapy service by my GP.

I got a phone call from a physiotherapist during which she asked me a bunch of questions, diagnosed me with arthritis and said she'd send me some exercises to follow. If I didn't improve within four weeks I should call back, but I shouldn't expect it to get completely better. I was a bit taken aback by a diagnosis of arthritis over the phone and questioned this, she offered me a face-to-face appointment but the diagnosis was correct and that a face-to-face appointment would simply be a repeat of the phone conversation.

A week later I got a sheet of A4 in the post with a bunch of exercises, 4 of which had ticks by them and a few notes. There was a letter saying again that I should call back if I did not improve and that was it.

I was so taken aback by the idea that adequate care for a diagnosis of a chronic, degenerative condition consisted of a few exercises with no other information on management I ended up going to a private physiotherapist. The private physio said she was shocked at a diagnosis of arthritis over the phone, and that the care seemed very in adequate to her, but I'm not sure how much that is a difference between private and NHS practice. I wrote to the physiotherapy service saying I thought the care was inadequate because it failed to inform me about the condition, how I should manage the condition, what action I could take to minimize the symptoms and what the options and outcomes of treatment were likely to be. They wrote back to say come in for a face to face appointment which I declined because I'd gone private by then, but then wrote to me saying phone appointments and mailed exercises were a good way of dealing with many cases they came across. I got the impression they just wanted to defend the phone appointment (which I didn't have a problem with in theory - much more convenient than getting childcare while I go to a face-to-face), but didn't address the lack of actual care, however it's delivered.

So I guess I'm wondering - does this sound like good care for a painful knee? Can you diagnose arthritis over the phone? And is it worth taking the complaint further?

you can get a lot of information from the right questions but i would assess a knee face to face and yes, you'd expect more information than just the exercises about the condition, symptom management, prognosis etc.

although it may the service that is flawed, not the therapist.

Thanks nevergoogle (that's a world of wisdom in a name!).

My suspicion is very much that the therapist was under pressure to get as many cases as possible coped with in one call over the phone rather than that she was some rogue therapist dodging her responsibilities.

I'm a bit torn about what to do, because while I feel it's really shoddy treatment, I'm guessing it's because they don't have the resources to do more. So if they had to treat every case like me with the resources my private physio is giving me, I'd probably have waited 6 months just to speak to someone. On the other hand, if I had just done the exercises I'd be back there soon with my knee in worse shape and probably costing a whole lot more...

What happens to complaints? Might it impact their approach as a service? Would they ever tell me "we just don't have the resources to do it well" (in which case I'd have something I could take to me MP)?

Hmm I would complain on several levels....Tha main one being a qualified doctor (your GP) referred you to the physio service. The physio although I am sure well qualified for their profession is not a doctor. My ds for instance has an excellent physio (who is at the top of her grade) and she will often say things like "I think this is what is happening, but I am not a doctor, and we need to get them to officially dx before we make assumptions". Therefore it is not only wrong to dx over the phone, I regularly see a rheumatologist for both me and my ds, and they would never dream of dx over the phone, but the physio is not qualified to do so anyway. The GP has referred for exercise support, if arthritis is felt to be the cause the phsyio as a professional should be referring on to a rheumatologist.

It is too some extend irrelevent whether or not the physio service is too over stretched to offer appropriate care. If they are then that needs to be fed back to the pct, not attempt to offer substandard care that could be dangerous and could cause greater medical complications. I would contact the pct, via pals and make a formal complaint. I have ben through the complaints procedure the nhs takes them very seriously and does act on them, so steel yourself and do it if you think you can, not just for yourself, but for others more vulnerable who could not do it for themselves. good luck.

Not a phsiotherapist but do have arthritis and am waiting to be seen again by a physio with a recurring problem, having been signed off previously. I think this a very good way of dealing with patients whilst waiting to be seen.....on the basis that a lot of things they have tried with me initially were fairly standard and you can be doing them yourself - but I dont think that should ever take away from physically being seen. I think I would be inclined to complain

I've been thinking about this today and it wouldnt surprise me if your gp wrote that you have arthritis and the physio was asking questions to confirm it.

But I wouldnt want to be diagnosed over the phone either. I have heard of GPs doing telephone consultations that end with prescriptions of antibiotics being issued.

What did your private physio diagnose op?.

Thanks for the responses.

My GP didn't pass on a diagnosis. Our PCT physio service is basically a self-referral. My doctor's referral consisted of giving me a leaflet with the physio service's phone number on, she did not send notes to them and told me they would decide if scans etc. were necessary.

My private physio would not give a diagnosis without further scans, but said her initial feeling was that it wasn't arthritis yet and but was something I can't remember exactly and would have to dig the paperwork out. But my understanding of what she told me was that my knee cap was being pulled out of place by my big muscles because I've been lazy about keeping my smaller muscles in shape and I've been foolish taking up running again without doing any core and stability exercise and by being overweight straining it (but she said it much nicer than that). I don't really see the difference between this and what I've read about arthritis really - but I specialize in numbers and computers, not the human body.

Ouch! YADNBU.

hmm, you can't diagnose a maltracking patella over the phone that's for sure. it's something that needs to be observed. definitely treatable though so make sure you do your exercises.

btw, physiotherapists are qualified to make diagnoses. they are often better at it than the doctors for musculoskeletal problems.

there will be opportunity to complain but the process will depend on where you are. there is an official process or you could call up and ask to speak to the physiotherapy lead or manager and talk it through with them.

I am following the exercises to the letter! 3.5 years ago I was at pretty much the fittest in my life. Since then had 2 kids, put on Kgs and turned 40 and suddenly everything's falling to pieces! I'm definitely looking to halt the demise and turn things around. Along with some pulled muscles that have taken months to heal, it's been a bit of a wake up call.

I've just been looking into the PALs complaint route and discovered that the physio service is outsourced to a private company. Somehow makes me feel better about complaining. Not sure why.

I have arthritis and I think this has been handled badly. Arthritis is the common name for a group of over 100 different joint disorders. I'm guessing by the almost blasé phone 'diagnosis' she is referring to osteoarthritis (the most common) which is degenerative joint disease which is the result of trauma, infection of the joint or age. I have Rheumatoid arthritis which is an auto immune disease which attacks your joints, tissues & organs... treated by lots of wonderful toxic drugs.. Whatever type of arthritis you should be assessed by a specialist dr who can advise if further treatment is required and can sort out appropriate pain relief. Physio may also assist with relief but should be part of a treatment plan to ensure you don't do further damage. I can't currently do physio on my knee effectively as it is likely to cause more problems than it would solve.
Push for adequate dr led diagnosis

Hear hear wonkylegs!

interested to know if you took this further.

Hi nevergoogle,

I haven't yet. I'm in the middle of some other stressful (but good!) stuff that is rather overwhelming me at the moment. I do mean to. I guess it depends on whether I feel up to it before it feels like too much time has past...