LE therapist has a doctorate: is she a "doctor"?

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kira66715
kira66715 Member Posts: 4,681
edited June 2014 in Lymphedema

I found this article on my google alert and I agree with the substance of it, but checking out the "director" she's a DPT, a doctorate of PT and calls herself Doctor. I've previously discussed this issue with a a great DPT who sits on the LANA board, and she specifically avoids the use of "doctor" to avoid confusion: only her students can call her that. So, while there are few medical doctors who treat LE, there are many DPT's. At least she's treating it...

http://www.seacoastonline.com/articles/20130324-LIFE-303240313

By Suzanne Laurent

news@seacoastonline.com

March 24, 2013 2:00 AM

PORTSMOUTH — As the population ages and there is an increasing epidemic of obesity, health professionals are seeing more patients with a condition called lymphedema.

Most are familiar with the body's circulation system that pumps blood from the heart to the rest of the body. Many, however, are not aware that the body has a second circulation system — the lymphatic system.

The lymphatic system is crucial to staying healthy. It circulates protein-rich lymph fluid throughout the body, collecting bacteria, viruses and waste products. The lymphatic system carries this fluid and harmful substances through lymph vessels, which lead to lymph nodes. The wastes are then filtered out by lymphocytes — infection-fighting cells that live in your lymph nodes — and ultimately flushed from the body.

Lymphedema occurs when the lymph vessels are unable to adequately drain lymph fluid, usually from an arm or leg. Excess fluid collects in the tissues causing edema, or swelling.

"We are seeing and treating an increasing number of patients with lymphedema," said Dr. Joann Brooks, director of rehabilitation services at Portsmouth Regional Hospital. "Last year we had 69 patients."

Brooks said this is due to people living longer, obesity and increasing numbers of joint replacements. Lymphedema can also become a problem after surgery or radiation treatment for any type of cancer.

"Any change in the structure of the lymph system puts a person at risk for lymphedema," Brooks said. "During surgery (for cancer), a doctor may take out lymph nodes near the tumor to see if the cancer has spread."

Lymph vessels may also be removed. Taking out lymph nodes and vessels makes it harder for the fluid in the arms, legs, or other parts of the body to flow to the chest where it can get back into the bloodstream. If the remaining lymph nodes cannot remove enough of the fluid in the area, the excess builds up and causes swelling.

Radiation treatment can affect the flow of lymph fluid by scarring the lymph nodes and vessels. Sometimes a tumor itself can block part of the lymph system and cause lymphedema. Infections that restrict lymph flow can also cause lymphedema.

Lymphedema can be either primary or secondary. This means it can occur on its own (primary lymphedema) or it can be caused by another disease or condition (secondary lymphedema). Secondary lymphedema is far more common than primary lymphedema.

Primary lymphedema is a rare, inherited condition caused by problems with the development of the lymph system and is more common in women. Secondary lymphedema can occur after surgery for cancer, or be caused by radiation therapy, cellulitis infection, inflammatory conditions such as rheumatoid arthritis, cardiovascular disease, injury and trauma.

"We see some people with chronic venous insufficiency that starts out as varicose veins without swelling," Brooks said. "It worsens over time and the legs become heavy, large, shiny and scaly."

Brooks is one of two full-time certified lymphedema therapists at Portsmouth Regional Hospital. She and therapist Michaelina Frackelton assess patients for signs of lymphedema while they are still in the hospital after surgeries for cancer and total joint replacements.

"With joint replacement patients, we want to catch this early and work with them after they are discharged," Brooks said.

Patients with lymphedema are seen in the rehabilitation department for an intense course of treatment that lasts two to eight weeks with patients coming in four or five days a week.

Depending on the cause of the individual's lymphedema, the patient may treated by manual lymphatic drainage using special massage techniques to move excess fluid into working lymph nodes. This may not be suitable for patients with heart disease, deep vein thrombosis or kidney disease.

Patients will also have the affected limb wrapped with multilayered bandaging and compression garments. They are taught how to apply these on their own as well.

While there is no cure for lymphedema, treatment focuses on reducing the swelling and controlling the pain.

Remedial exercises and skin care are also taught during rehabilitation.

"We also teach our patients about prevention of skin infections, diet and maintaining an ideal body weight to alleviate the symptoms of lymphedema," Brooks said.

Brooks said if someone has any unusual persistent swelling in one or more extremities, it is important to see their physician.

Buried in her CV: she became Norton certified in 2009. http://www.mghihp.edu/about-us/person.aspx?PersonUri=BrooksJoann.xml

I'm not trying to be a jerk (intentionally): it's just that LE is confusing enough. It sounds like she is great resource though.

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  • pebee
    pebee Member Posts: 317
    edited March 2013

    um, yes, she is a doctor.  She has the degree.  As someone coming from education, I encourage people who have their terminal degree to claim the titles that they earned.  She has the right to use it and be called it.

    And, no, she is not a "medical doctor".

    This is an area where consumers need to be careful.  If you are not sure what the "doctor" stands for, then ask. 

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  • Annette47
    Annette47 Member Posts: 957
    edited March 2013

    Yes, she is a doctor, but not a physician (medical doctor).   When you see that someone has a PhD, it means they have studied intensively for a period of years (5 or more is typical) to learn about a particular subject.   To know whether that qualifies them to be an expert, would depend on what their degree is in - I have issues when someone has a PhD in an unrelated area and think that qualifies them as an expert in everything!   Personally, I have a PhD but only use the title "Dr" at work, where it is relevant, but elsewhere I don't even mention it.   In her case, since she is discussing PT and her doctorate is in that area, I do think it is ok that she uses the title, although it would have been nice if the article specified early on that she is a PhD not an MD.

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  • kira66715
    kira66715 Member Posts: 4,681
    edited March 2013

    I agree that she has a terminal degree (and when my department chair asked me what a terminal degree was, I said "dead end job?"--so that shows how clueless I am--and I have a terminal degree....), but I do think in clinical medicine we are now dealing with nurses with doctorates, and PT with doctorates and there is a real possibility for confusion for the patients in understanding who they are dealing with.

    I read the article, and assumed she was a physician: a physical medicine rehab doctor, and then I thought to google her.

    She calls herself "Doctor" and she's the director of the program. I thought "How great, an MD who treats patients."

    It's rhetorical, my question--she has a doctorate, but she is not a medical doctor, and how is a patient supposed to know that?

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  • Annette47
    Annette47 Member Posts: 957
    edited March 2013

    I agree that patients should absolutely be informed what degree she has, but it's not clear to me from the article whether or not they are.   It could be that if you go to see her, she is upfront about her qualifications (or at least has her name with PhD listed on the door or something).  In other words, I don't know whether to blame her or the author of the article for the lack of clarity!

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  • Leah_S
    Leah_S Member Posts: 8,458
    edited March 2013

    In general, the article was informative. For the clueless, I think it's good she's called "dr" since for many it gives etra validity to what she says.

    Leah

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  • hugz4u
    hugz4u Member Posts: 2,781
    edited March 2013

    Ooh...If I was a layman in the Cancerworld as so many BC sisters are and I went to her treatment I would think she was a MD. I may put my full trust in her decisions but If I thought she was a PT I may question her medical decisions a bit more. Just a thought.



    Interesting comments on the use of titles. Our president of a major university here is known and called Mr.not Dr. athough he indeed holds the PhD title. Yes ....after all that hard work towards a PhD. I might want to be called a doctor but I would definitely make it clear I wasn't a MD.

    Some of my friends won't even "doctor google " and stay uneducated to their dieseases, they put full trust and don't question their docs. They surely would be clueless to a title./p>

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  • kira66715
    kira66715 Member Posts: 4,681
    edited March 2013

    There is a strong movement toward nurses getting PhD's and I corresponded with one who works for the American Cancer Society, when there were issues with the LE page, and her staff referred to her as doctor.

    I tend to agree with the wonderful PhD PT who sits on the LANA BOD--do not refer to yourself as "doctor" in the clinical setting, unless you make it quite clear that you are not an MD.

    I used to work with 2 nurse practitioners--both great clinicians, both with masters degrees--one never corrected her patients who called her "Doctor", and the other always set the record straight.

    Again, this is a very good article and points out that obesity and venous insufficiency can cause LE, it's just the confusion--I really thought she was a rehab MD who did therapy, until I googled her.

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  • Outfield
    Outfield Member Posts: 1,109
    edited March 2013

    Referring to oneself as "doctor" when the doctorate is other then an MD is frowned upon where I work, too.  It's unfortunate, because I think people deserve the respect of their training, but I also think it can be very misleading for patients.  I wish people had been a little more creative when these titles were invented, seems late to go back and make up something new.

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  • exbrnxgrl
    exbrnxgrl Member Posts: 12,424
    edited March 2013

    I only have mild lymphedema so I apologize for posting here but I was interested in this thread. I am an elementary school teacher and some educators choose to use Dr. if they've earned their doctorate however, because of our field it is always assumed that their degree is in some aspect of education. I can see how it might cause confusion in a medical setting.

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  • JoyE1947
    JoyE1947 Member Posts: 6,485
    edited March 2013

    My son is a PsyD (Doctorate in Psychology)  4 years of college plus 5 years in graduate school.  I feel that he earned the right to call himself Doctor.

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  • proudtospin
    proudtospin Member Posts: 5,972
    edited March 2013

    hmmmm, I need to ask my trainer next week, he is working on his PhD in athletic or physical training after getting 2 masters.  He is also working on a program for rehab for cancer patients and hoping to get local hospitals to include it as part of there suggested treatment.

    I need to ask Tim if I should call him Dr Tim after he gets this next degree!  Somehow I do not see him calling himself Dr...

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  • kira66715
    kira66715 Member Posts: 4,681
    edited March 2013

    Exbrnxgrl: Your opinion is valuable and anyone can post on this thread.

    Look, there are all sorts of distinctions and hierarchies in the medical world and in academia, I just brought it up due to patient confusion,and personal confusion when I read the article.

    When I read her CV, what struck me is that she's very involved in the APTA and teaches at the Mass General Institute, and just got LE trained in 2009, a training the APTA doesn't recognize. Good for her.

    I thought about it, and we've had quite the struggle to figure out who is qualified and well trained as a LE therapist, and LANA was supposed to fix that, but only a small percentage of qualified therapists take the exam, and it's just a written exam--no guarantee of clinical excellence. So, transparency and clarity are important in health care and LE, and when I can't figure out someone's qualifications without googling her--it's confusing.

    I was fascinated by the Mass General Institute, as it is clearly separate from Harvard.

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  • Binney4
    Binney4 Member Posts: 8,609
    edited March 2013

    This is sure an interesting topic. And it's complicated by the fact that Medicare doesn't pay for MLD if it's performed by an MD or an RN. Just PTs and OTs (can you guess who has a very strong and self-serving lobby?WinkTongue Out)

    I have a strange situation locally. There's a therapist in my area who recently earned her doctorate in PT from a (online) school that is only certified in certain states. So she's "Doctor" when she's west of the Mississippi, not "Doctor" when she goes east. She has "Dr." embroidered on her scrubs along with her name. Naturally her patients don't know the terms of her school's certification or the quality of the course she took, nor can they distinguish what "Dr." means when she uses it. She's a self-promoter and talks at bc support groups, where I'm sorry to say the patients tend to be bowled over by her credentials and simply don't ask themselves whether the information she's spouting is accurate or not (much of it is not).

    I found the article above amazingly accurate (good for the reporter!Cool good for the therapist who obviously spent a lot of time educating the reporter!Kiss) If I were being interviewed on the subject and wanted the readership to believe what I was saying and take it seriously, I'd sure use the title. Still, I hope she's clarifying her doctorate for her patients, if for no other reason than that it's misleading in a setting where trust and mutual understanding are so critical.

    (xgirl, goodness, don't apologize! You'd be welcome to post here even if you had no lymphedema at all!)
    Be well,
    Binney


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  • vlnrph
    vlnrph Member Posts: 1,632
    edited March 2013

    I don't think the DPT can be equated with a PhD=Doctor of Philosophy which is usually acquired in an academic discipline, requiring original research, thesis and oral exam. Therapists receive clinical degrees, much like my younger colleagues in the profession of pharmacy are now earning: that would be a PharmD, and you can bet they are called "doctor"!

    It also rankles me to see chiropractors advertising themselves as doctors without mention of their 'DC' designation. In healthcare we also have DO and OD (osteopathic physicians vs optometrists) to add to the alphabet soup.

    Certainly, verify credentials as well as where and when they were conferred. I would consider changing clinics if an NP or PA referred to themself as doctor in addition to notifying the management of that institution...

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  • kira66715
    kira66715 Member Posts: 4,681
    edited March 2013

    Vlnrph--you nailed it, the Doctorate of Physical Therapy is offered as a tDPT--purely on-line course or, from the school where this woman teaches:

    The entry-level Doctor of Physical Therapy (DPT) program prepares people with Bachelor's degrees in other fields to become licensed physical therapists. The program:

      • Is a 3-year, full-time program that starts each summer.
      • Includes an intensive academic, clinical and research program of study over the first 2½ years.
      • Culminates in a full-time, year-long paid internship for more than 94% of its students (3-year average). The internship program is being used as a model by schools across the nation.
    • Is accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE). The program is scheduled for its next accreditation site visit in spring 2014.

    Upon completion of the program, graduates are eligible to apply for licensure in all 50 states and the District of Columbia.

    http://www.mghihp.edu/academics/physical-therapy/degree-options/doctor-of-physical-therapy/default.aspx

    I had forgotten that the problematic PT who Binney has dealt with, who doesn't have her patients wear compression and lets them swell, got her "Doctorate" from an on-line school that is only regionally accredited.

    If you google "on-line doctorate in PT" all sorts of reputable schools come up: Temple, BU, etc.

    So, I would strongly argue that a doctorate in PT can be either a purely on-line course, or a three year curriculum, that is nothing like a PhD program in other areas of study.

    I find this very upsetting as I don't consider a terminal degree to consist of 12-24 on-line credits (the tPTA at Temple.)

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  • Outfield
    Outfield Member Posts: 1,109
    edited March 2013

    Funny, vinrph.  In my institution they are called "PharmD's, " never doctor.  I have to explain what they are to people all the time because non-medical/pharmacy people have never heard of it.  

    Going over that article again, I do agree it's pretty darn good.  Imagine that - they are seeing people in the hospital before they leave!  That's amazing.  

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  • carol57
    carol57 Member Posts: 3,567
    edited March 2013

    A few years ago, I watched proudly as my niece received her PharmD. The person handing her the diploma addressed her as 'Doctor.'  Afterward, I asked my niece if she would be called 'doctor' professionally, and she laughed and said absolutely not, because the pecking order at the university medical center where she had landed a job would never allow that.  Another woman I know is a partner at a large multinational law firm. Before pursuing her law degree, she got a PhD in English literature. Asked if she would ever be addressed with the 'doctor' title, she said no...definitely a faux pas in the legal world...but to acknowlege her hard work in getting that degree, she makes sure that all her magazine subscriptions coming to the house are addressed to her as 'Dr.' 

    Outfield is spot on with her observation that the titles needed to be made more distinctive a long time ago, and it's not going to happen now.  Just one more instance of caveat emptor- buyer beware!

    Carol

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  • Hwally
    Hwally Member Posts: 14
    edited March 2013

    Hi There,

    PT Wife here - my husband is currently in school for his doctorate. While he does not like using the title DR some of his teachers and clinical instructors do use this term. It seems to be a matter of preference. I don't think that it takes away from their credibility as a health care professional though. This woman is obviously highly qualified from a background check I did - Lots of memberships, chair positions and not only a BS in PT but then she went back and got her doctorate.

    I would note that most PTs and OTs are the one's who are treating the patient and administering therapies. They are the ones most qualified to do research because they treat it every day. They should be the ones administering therapies because that is their job - rehabilitative therapy. I would rather see research from them anyway - not a DR who just diagnoses and points you on your way to therapy.

    Again, slightly biased perspective here.

    My husband went to the APTA student convention this last year and was really suprised that there were some students from an online school there. He said it must be hard going to an online program because setting up the clinical experiences would be hard. Those students seemed to be ok - at least they were involved with the APTA which is a good organization.

    There are several types of programs that offer DPTs - online, traditional. There are also "tDPTs" (note the "t" in front) which mean that you are already a practicing therapist and you just go back to school to get your Doctorate (for additional education). There are Masters in PTs as well. And, to cap it off, there are "assistant" PTs which is a totally different program.

    It seems that this woman went to school way back in the day when they only offered B.S (which is now defunct) and then she went back to school to get her tDPT. None of which means she is not qualified.

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  • carol57
    carol57 Member Posts: 3,567
    edited March 2013

    Hwally, what does the 't' actually stand for? Does it denote 'therapist'?

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  • Binney4
    Binney4 Member Posts: 8,609
    edited March 2013

    Hwally, congrats to your DH for his persistence and dedication! I'm guessing he really loves what he does, which is great for both him and his patients!

    APTA may be a good organization in some ways--at least for PTs--but it sure is not friendly to lymphers!Frown Their lobbying power is the reason we have no training standards for lymphedema therapists, and anyone with PT certification can treat us--no real knowledge needed! Untrained and undertrained PTs have been (and continue to be) the cause of considerable damage to LE patients, because this therapy is unique and specialized, and calls for more than a weekend course to really understand and master. The current LE legislation that everyone is trying to get past USED TO have a provision for full (135 hours) training for all therapists treating LE patients, but APTA opposition quashed all chance of getting it passed. As a result, not only do we continue to encounter patient damage from undertrained therapists, but our ability as patients to bring complaints to our local PT boards is seriously limited--there's no one on my state's board, for instance, who has any clue about what LE therapy should involve, yet they all feel qualified to judge whether a lympher has been treated correctly or not! APTA is also responsible for the legislation that makes it impossible for RNs with full LE training to collect from Medicare for treatment, a move that may have provided a work guarantee for PTs, but it closed the doors of clinics all over the country, when we are already very short on therapists. Patients now sometimes travel an hour or more for treatment, when a few years ago there were RNs treating close to home.

    Sorry for the rant. I'm one of those lymphers seriously damaged by an undertrained PT who thought she knew what she was doing.Frown I just want your DH to know what we're up against with APTA, because we truly need his voice in that organization to begin to turn around the LE therapy experience for so many of us.

    Whew! Hit a nerve!Embarassed

    Hugs,
    Binney

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  • Hwally
    Hwally Member Posts: 14
    edited March 2013

    Hi Carol - the "t" just means "transitional" in that they are transitioning from a masters/bachelors to a doctorate.

    Binney - I don't want to stray too far off topic with you but by "the APTA is a good organization" I simply mean they generally don't have kooks on their boards - if they allow a school to participate in their events then it is an accredited school. That doesn't mean its a great school - just that it meets the standards of CAPTE. There are always specific politics and individuals with agendas involved in any health care situation. Being someone who was personally effected by a untrained PT, of course you feel the way you do. I personally was helped by having a great OT and if my husband was not a PT I would have never known about lymphedema (he asked his other friend in PT who is certified and they told us what to watch out for). If I had gone off of the suggestion of my untrained surgeon and Drs I never would have gotten treatment. From the perspective of someone who has an RN for a mother, a Dr for a grandfather and a PT for a husband, I have a lot of respect for the different fields of health care. That doesn't mean I think each one of them fills the same position or has the same training, or is qualified to fill the same role. I feel that if interprofessionalism was promoted more across the board our system would be better. This whole "us vs. them" mentality needs to be reversed.

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  • Outfield
    Outfield Member Posts: 1,109
    edited March 2013

    Hwally, 

    Right on!  

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  • purple32
    purple32 Member Posts: 3,188
    edited March 2013

    She has "Dr." embroidered on her scrubs


    YUKKK....dr. or not !

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  • kira66715
    kira66715 Member Posts: 4,681
    edited March 2013

    I just came from a visit to my long standing ENT, and the audiologist introduced herself as Doctor. I knew she wasn't the ENT....

    I know an accupuncturist who also insists on being addressed as Doctor.

    As medicine becomes more and more multidisciplinary, so much confusion and "turf battles".

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  • JoyE1947
    JoyE1947 Member Posts: 6,485
    edited March 2013

    Where I live dentists are addressed as Doctor.  I think most dental programs are 4 years of college followed by 4 years of graduate school.

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  • carol57
    carol57 Member Posts: 3,567
    edited March 2013

    My dentist is called 'doctor' too, but that's not likely to cause any confusion about the credentials of the person treating me. If I'm in a chair at the dentist's office, there's no chance of confusing that guy with my oncologist!  So place and context are important parts of the identity puzzle.  Where I imagine it matters is when the title 'doctor' can legitimately apply to a range of credentials in the same clinical setting.  A nurse with a PhD who has any kind of clinical role could certainly add to the confusion if referring to him/herself as 'doctor' in clinic, but if managing a research program at a university --think the wonderful Dr. Jane Armer--the title is certainly appropriate and isn't likely to confuse anyone.

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  • kira66715
    kira66715 Member Posts: 4,681
    edited March 2013

    My husband is a dentist, and the program is an undergraduate degree, 4 years of dental school--where the education the first two years is similiar to medical school, and clinical experience is the primary focus of the last two years. And my husband did a post-doctoral hospital based residency, which was unusual at the time, but is more typical now--like a medical school experience where you do undergrad, med school then residency.

    I agree with Carol, the audiologist today introduced herself as Doctor X, within the context of a medical office. Now I know she's an audiologist, but someone who didn't know the office could be confused.

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