When Katie Doucette sustained an injury to her back after a half-marathon, she was referred to Alex Neal, PT, DPT, of Brigham and Women’s Outpatient Rehabilitation Services, for physical therapy. Neal worked closely with Doucette, a triathlete, and began to understand the complex musculoskeletal issues she was experiencing. He recommended that she also see Rebecca Breslow, MD, of Sports Medicine, and that the three of them meet for an evaluation at the Multidisciplinary Sports Clinic.
“It was such a luxury to have two experts working together in a systemic way for my success,” Doucette said. “They clearly are a team, and they treated me as the most important member because I’m the one who is implementing the plan. What I found unique was that they were focused on treating the whole person, not just one body part.”
Helping athletes like Doucette recover and return to their training is the reason that Breslow and Neal established the Multidisciplinary Sports Clinic earlier this year. They evaluate patients together with a physical examination and discuss the patient’s needs, goals and plan of care. Then, patients see Neal for therapy and have another joint appointment if their progress plateaus or they require additional treatment.
“Patients feel like they have a team and that we’re all working together and on the same page about the plan of care,” Neal said.
Breslow agreed. “Communication is enhanced when you have two providers and vantage points participating in the same patient visit,” she said. “We’re communicating with each other and with the patient, and that results in ideas about how to progress.”
For Doucette to be successful in her recovery, she needed a realistic plan that fit her busy lifestyle, which includes frequent travel. “I’ve had really good results,” she said, adding that she plans to return to triathlons soon. “It’s great to have two experts working together who also happen to be very nice people.”
Increasing Communication, Collaboration
Typically, when a physician refers a patient for physical therapy, communication between the two providers occurs in notes entered in the patient’s medical record or via email, but there isn’t real-time interaction.
Neal came to the Brigham almost two years ago from a private physical therapy practice, hoping for the opportunity to work more closely with physicians. He introduced himself to Breslow, whose understanding of rehabilitation, sports medicine and athletes is not only her profession but also her passion. A runner, certified personal trainer and USA Track and Field Coach, Breslow is deeply committed to helping patients achieve their goals.
“As we talked more about our shared patients, we started thinking about what it would be like to do a co-evaluation of a patient and how that could really benefit some of our more challenging patients,” Neal said.
That idea evolved into a weekly sports clinic, where they meet with patients together. Most patients have knee, hip or back injuries, and many have undergone physical therapy previously.
That was the case for Melissa Horowitz, who was referred to the clinic by her primary care physician, Christina Iacobo, MD, of the Brigham and Women’s Physician Group. Horowitz had received physical therapy once before after sustaining a partially torn tendon in her leg. Now, she was experiencing muscle pain in both quadriceps tendons (located just above the kneecaps), which disrupted her rigorous exercise regimen of weight-training and cardio.
“I felt more at ease meeting with the doctor and physical therapist together, and having their joint perspective was really helpful,” said Horowitz. “I was able to get back to a modified plan quickly this time, within two months.”
The model is also beneficial for Neal and Breslow.
“I learn a lot from Rebecca and have always wanted to work with a doctor in this way,” Neal said. “It gives me an opportunity to ask questions about what she’s doing, like why she may choose an injection for a certain patient or what she sees in an X-Ray or MRI that may be pertinent to treatment.”
Breslow said the feeling is mutual. “Alex has a lot of knowledge about different kinds of therapies and modalities that help shape the plan for rehabilitation,” she said.
Since teaming up with Neal, Breslow says she has a better understanding of how rehabilitation is going for their shared patients, which helps her troubleshoot if the patient’s recovery is not progressing.
That’s key to helping patients achieve the most important goal – staying out of the clinic.
“I want to give patients the tools to be in control of their musculoskeletal health, such as techniques and exercises that help them get out of pain and recover, and this clinic gives me the opportunity to do that,” she said. “Allowing patients to take control is important to their evolution as athletes so they can achieve consistent training.”