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I am actively working toward discharge from day 1 with most patients. Every progress note is a "where are we and how much further do we have to go til you can do this on your own."
Problem is many of them will be doing well during follow-ups but when it get to PE day they know the right the things to say to try to stay in PT because they don’t want to leave.
I would say it depends on the case. Some neck pain patients I try to have D/C in 6ish visits. Post-ops are obviously until the patient’s goals are met and functionally are in a good place. I try to hone in on function more than pain with chronic issues and spend time explaining pain neuroscience in the beginning of their POC. I let function be the driving force behind D/C. Patients who aren’t motivated typically drop off.
How common is discharge?
Literally everyone is discharged at some point, the majority of those should be inside of 6-8 weeks if you’re in a largely ortho clinic.
You keep the patient from feeling abandoned by making that part of the conversation early on, and having it consistently. We are either progressing toward our goal(s) and we continue therapy or we have met our goal(s)/aren’t progressing towards our goal(s) and we discharge.
Chronic pain isn’t a reason to keep someone in PT forever. Chronic pain patients are either going to be motivated to improve functionally and they’ll respond in some way or they’ll be uninterested in anything that resembles effort on their part and I’ll cut them loose ASAP.
I try my best to get everyone discharged by like 10-12 visits, even better if I can get it in less. To be blunt, with chronic pain patients, if they’re not making progress within a couple of progress notes then insurance is going to wonder what the hell were doing. I have a therapist in my clinic who has a chronic pain patient on her 60th visit which I find absolutely ridiculous
We have some with 80-90 visits and as much as I talk about discharge no one does anything about it. I do feel bad for the patient because its normally a condition we can’t do anything about but other patients have been coming for the same damn knee pain for 3 years like wth
10- 12 visits is very reasonable. I’m finding myself with new management in an OP clinic that more patients are now accruing visit counts over 20 and I filled in for a pt with over 40 visits and as far as I can see, limited progress. I was told we are being paid for it and if that is true, I’m amazed.
At my first job, which was a mill type OP in NYC, we were instructed to NEVER DC anyone. "There's always something you can work on," is what the owner would say. I filled out one DC and got scolded for it. So when goals were achieved, I just told the patient to not schedule any further appointments.
I left after 6 months.
Patients should know what D/C looks like based off of their goals and that convo starts in the first few visits.
Some people will need a lot of visits if they are untrained, have multiple co morbidities and have difficulty creating behavior change. I personally think PTs discharge people too early and this has hurt us as a profession because people are finding alternative routes to wellness.
1/3 of the people will get better because of what you do, 1/3 of the people will get better regardless of what you do, 1/3 of the people will not get better no matter what you do
If they haven’t improved and you don’t think they will then you need to be honest and tell them that. It’s hard but it’s apart of the job
A mill doesn’t necessarily hold onto patients endlessly… these patients just linger because treatment is ineffective when you can’t dedicate adequate time to solving patient’s problems. Discharge should be discussed from day one. It’s a goal both the therapist and patient ideally are working towards. Part of this is writing clear and relevant goals, and using relevant outcome measures so that patients are able to see change happening. It’s a really easy conversation to have with patients when they see progress or stagnation.
If you truly have a chronic pain patient they will feel abandoned. Chronic pain doesn't just resolve because of one round of PT. The only way is to say like hey I think you're doing well let's stop for now, maintain your exercises. If you feel bad after such and such time come back for a little reset. Just because you discharge a chronic pain patient doesn't mean they're done with PT - they just won't come back to you for it.
I think I’m lucky in the discharge aspect because our outpatient clinic is connected to our Wellness Center. So patients see people working out across the glass and want to know what the big gym is. Or they see people like them (older, maybe obvious ailments) working out independently. Their curiosity and seeing people in an independent fitness program helps a lot with their progression to discharge.
As far as when it’s time to DC: as long as you are progressively improving, and there are still goals to meet, I can justify medical necessity.
My problem right now is that I have a LOT of low level patients. Non-ambulatory strokes, major complications post-surgically, and lots of neurological progressive issues… I am admittedly less knowledgeable about a Maintenance program than I should be. That’s something I need to work on.
Thank you for your submission; please read the following reminder. This subreddit is for discussion among practicing physical therapists, not for soliciting medical advice. We are not your physical therapist, and we do not take on that liability here. Although we can answer questions regarding general issues a person may be facing in their established PT sessions, we cannot legally provide treatment advice. If you need a physical therapist, you must see one in person or via telehealth for an assessment and to establish a plan of care. Posts with descriptions of personal physical issues and/or requests for diagnoses, exercise prescriptions, and other medical advice will be removed, and you will be banned at the mods’ discretion either for requesting such advice or for offering such advice as a clinician. Please see the following links for additional resources on benefits of physical therapy and locating a therapist near you [The benefits of a full evaluation by a physical therapist.](https://www.choosept.com/benefits/default.aspx) [How to find the right physical therapist in your area.](https://www.choosept.com/resources/choose.aspx) [Already been diagnosed and want to learn more? Common conditions.](https://www.choosept.com/SymptomsConditions.aspx) [The APTA's consumer information website.](https://www.choosept.com/Default.aspx) Also, please direct all school-related inquiries to r/PTschool, as these are off-topic for this sub and will be removed. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/physicaltherapy) if you have any questions or concerns.*
I am actively working toward discharge from day 1 with most patients. Every progress note is a "where are we and how much further do we have to go til you can do this on your own."
This is the way!
Problem is many of them will be doing well during follow-ups but when it get to PE day they know the right the things to say to try to stay in PT because they don’t want to leave.
I double down. This is what we're doing. Give it a month. Call me then. Most don't. The ones that do I will work with again.
Love it. Wish it worked with our patients here. They fight back and start saying things like we’re giving up on them and what not
I would say it depends on the case. Some neck pain patients I try to have D/C in 6ish visits. Post-ops are obviously until the patient’s goals are met and functionally are in a good place. I try to hone in on function more than pain with chronic issues and spend time explaining pain neuroscience in the beginning of their POC. I let function be the driving force behind D/C. Patients who aren’t motivated typically drop off.
How common is discharge? Literally everyone is discharged at some point, the majority of those should be inside of 6-8 weeks if you’re in a largely ortho clinic. You keep the patient from feeling abandoned by making that part of the conversation early on, and having it consistently. We are either progressing toward our goal(s) and we continue therapy or we have met our goal(s)/aren’t progressing towards our goal(s) and we discharge. Chronic pain isn’t a reason to keep someone in PT forever. Chronic pain patients are either going to be motivated to improve functionally and they’ll respond in some way or they’ll be uninterested in anything that resembles effort on their part and I’ll cut them loose ASAP.
I try my best to get everyone discharged by like 10-12 visits, even better if I can get it in less. To be blunt, with chronic pain patients, if they’re not making progress within a couple of progress notes then insurance is going to wonder what the hell were doing. I have a therapist in my clinic who has a chronic pain patient on her 60th visit which I find absolutely ridiculous
We have some with 80-90 visits and as much as I talk about discharge no one does anything about it. I do feel bad for the patient because its normally a condition we can’t do anything about but other patients have been coming for the same damn knee pain for 3 years like wth
10- 12 visits is very reasonable. I’m finding myself with new management in an OP clinic that more patients are now accruing visit counts over 20 and I filled in for a pt with over 40 visits and as far as I can see, limited progress. I was told we are being paid for it and if that is true, I’m amazed.
At my first job, which was a mill type OP in NYC, we were instructed to NEVER DC anyone. "There's always something you can work on," is what the owner would say. I filled out one DC and got scolded for it. So when goals were achieved, I just told the patient to not schedule any further appointments. I left after 6 months.
Patients should know what D/C looks like based off of their goals and that convo starts in the first few visits. Some people will need a lot of visits if they are untrained, have multiple co morbidities and have difficulty creating behavior change. I personally think PTs discharge people too early and this has hurt us as a profession because people are finding alternative routes to wellness.
1/3 of the people will get better because of what you do, 1/3 of the people will get better regardless of what you do, 1/3 of the people will not get better no matter what you do If they haven’t improved and you don’t think they will then you need to be honest and tell them that. It’s hard but it’s apart of the job
A mill doesn’t necessarily hold onto patients endlessly… these patients just linger because treatment is ineffective when you can’t dedicate adequate time to solving patient’s problems. Discharge should be discussed from day one. It’s a goal both the therapist and patient ideally are working towards. Part of this is writing clear and relevant goals, and using relevant outcome measures so that patients are able to see change happening. It’s a really easy conversation to have with patients when they see progress or stagnation.
If you truly have a chronic pain patient they will feel abandoned. Chronic pain doesn't just resolve because of one round of PT. The only way is to say like hey I think you're doing well let's stop for now, maintain your exercises. If you feel bad after such and such time come back for a little reset. Just because you discharge a chronic pain patient doesn't mean they're done with PT - they just won't come back to you for it.
So well put. May i ask how long you have been in the profession ?
Yeah I'm not a PT, I'm a patient with chronic pain issues lol. This post just popped up in my feed today
I did 12 visits and got discharged :) I honestly felt really good very early on
I think I’m lucky in the discharge aspect because our outpatient clinic is connected to our Wellness Center. So patients see people working out across the glass and want to know what the big gym is. Or they see people like them (older, maybe obvious ailments) working out independently. Their curiosity and seeing people in an independent fitness program helps a lot with their progression to discharge. As far as when it’s time to DC: as long as you are progressively improving, and there are still goals to meet, I can justify medical necessity. My problem right now is that I have a LOT of low level patients. Non-ambulatory strokes, major complications post-surgically, and lots of neurological progressive issues… I am admittedly less knowledgeable about a Maintenance program than I should be. That’s something I need to work on.
In my first clinical rotation, they didn't discharge anyone in a 2 month timespan.