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I went to the local clinic for a problem with low back pain. I saw a physical therapist who examined and treated me. I did get better but I'm just wondering: shouldn't a doctor have seen me first before sending me to therapy? What if I had something seriously wrong?

National and even international experts agree that competent healthcare professionals who are not doctors can evaluate patients with low back pain. This is called first contact or direct access.

Physical therapists and nurse practitioners are the most common healthcare providers to fulfill this diagnostic role. By asking a series of questions and conducting a standard set of physical exams, they can quickly and efficiently triage a patient. Triage means to sort patients into different groups or categories.

During this process, the healthcare provider will be looking for yellow or red flags. Yellow flags point to the possibility of psychosocial risk factors. Red flags suggest a more serious underlying problem such as fracture, infection, or tumor.

Only a small number of patients (probably less than one per cent) have a serious enough problem to need a medical doctor. Most patient respond quite well to a program of supervised activity, exercises, and postural changes.

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