"Every American is our patient…" Really?!!!
Or, I could have entitled this blog post:
I went to school for a lot of years, got a doctorate degree, learned your anatomy inside and out and for that, I can tell you "Go out and play an hour a day."
It just seemed a little wordy.
These were the words of Rear Admiral Penelope Slade Royall, PT, MSW, as part of her keynote address Wednesday night at PT 2007, the annual conference of the APTA. The headline of the speech was her "telling the considerable crowd that physical therapists are public health’s "first responders" for fitness." Royall is the US Deputy Assistant Secretary for Health in the US Department of Health and Human Services.
Well, is EVERY American our patient? Is physical fitness our specialty? Will Physical Therapists speaking as one voice about physical activity guidelines really help our profession and our patients? I’m not so sure.
Or, is the ideal set forth by the Evidence in Motion working group, "that to improve our caliber as a profession, we have to shrink our role and be identified as experts in neuromusculoskeletal medicine" one that will help our profession and our patients?
Reading headlines such as "PTs: First Responders to Physical Fitness" seems to me to be suggesting our role to Americans is really one of a personal trainer. Personal trainers do physical fitness better than Physical Therapists. Perhaps this is because they specialize in it.
This goes back to an old question of strategy: Should one try to do everything well, or should one do just a few things expertly?
You know, thinking more about the contents of the keynote address, I really feel like Royall is speaking about Physical Therapists in a light that will further her own agenda (and here) rather than our profession’s agenda. I would do the same in her position; so would most. If a government representative like Royall views Physical Therapists as Physical Fitness Responders, then what are we really?
This post is more questions than answers. This is deliberate, as I think a public debate about how PT’s are marketing their profession is required. We should all spend some time asking ourselves some questions about this issue.
Labels: APTA, physical therapy, PT Publicity Project
How do you get your evidence?
I am employed by an academic institution with a fine health science library. I belong to several sections of the APTA as well as the AAOMPT. Through these affiliations I am able to get my hands on quite a few journals and read full text articles when I like.
I was thinking the other day, about how many allied health professionals do not have access to such a library of content. This would include those working in private practice, non-academic hospitals, rehab centers, local school systems, etc. How do these folks get their dose of evidence? How difficult is it to get access to an important new article?
There is PEDRO, and the Cochrane Database, and the APTA resources such as Open Door, but these are far reduced from what I use. They also suffer from lack of use among therapists. A scattering of journals offer free text, but usually there is a time delay or restriction with this. A service like InfoPOEMs is kind of expensive and not rehab focused even if it is useful in theory.
A colleague recently left the hospital system that I’m in and now works at a corporately owned outpatient clinic. She has no access to journals.
Barriers lead to inactivity. Inactivity leads to the failure of the principles surrounding Evidence-Based Practice. How much of a professional duty is it for health care providers to pay their own $$ for access to evidence? How much of that burden should fall on the employer?
I will assume that a majority of the Physical Therapy work force is in practice settings with limited access to rehab/ortho journals. Does this mean that the majority of the profession does not keep up with new evidence? Regardless of that being true or not, I think these barriers need to come down somehow.
Any thoughts on access to literature among Physical Therapists?
Image: Arnold Bernhard Library, Quinnipiac UniversityHamden, Connecticut
Labels: physical therapy, Research
Spotted Owls, Take II
Famously in 1990, the Spotted Owl was declared an endangered species. It is generally assumed by some that this ruling and the subsequent ban on logging old growth public forests contributed to a decline of the entire northwest logging industry.
6/27/07: Update: Today’s CSM has a great article on this issue. They obviously read my blog and considered it big news!
Labels: environment, Questionable Practices
What should we do with this window?
Rockefeller Plaza is some pretty valuable real estate. It looks like the APTA has got their hands on 115 square feet of it for the month of June in the form of a picture window. The window’s content is about Physical Therapists’ ability to help prevent diabetes:
"The oversized panels also explain how physical therapists can help people with type 2 diabetes by designing a safe and thorough physical activity regimen that meets individual needs. The centerpiece of the window display is a life-sized female mannequin, who demonstrates the proper "fit walking," technique. She is standing in front of a video illustrating the various ways people incorporate physical activity into their daily lives."
Fit Walking Technique??? Well, at least my membership dues didn’t pay for this. The window space was donated by Executive Health Exams International. Which is also interesting.
In other news, an angry mob of internists was seen accosting a group of APTA members near Alexandria, VA. As the attack was taking place, the internists could be heard chanting, "You’re experts in muscles and bones, leave the diabetes to us…"
Labels: physical therapy, PT Publicity Project
Unfortunate Weekend News Roundup
Browsing through my various news feeds this weekend lead me to the following two instances of Physical Therapists making news headlines:
This is about a new facility in Summit County, CO now offering Primal Reflex Release Technique. Click here for a somewhat disturbing video and an opportunity to sign up for a home study course in this technique.
Three individuals, including two Physical Therapists, were arrested and charged with health care fraud, allegedly billing for services not performed and billing for Physical Therapy performed by a massage therapist. At least the FBI knows all about our profession. That’s good, right?
How are we doing policing ourselves as a profession? When instances like these happen, the concept of professional autonomy is undermined as the trust we demand from society is eroded. These are fairly extreme instances (and in one case, criminal,) but how do we do in situations that are not so obviously concerning? Such as: Treating too many people simultaneously to bolster a bottom line, over or misuse of modalities, not keeping up with current evidence on a particular condition or patient type? Do Physical Therapists, or any health care profession for that matter, really have a good system in place to help police the rank and file?
Anyway, perhaps that is too much philosophy. All I really want is some Good Press!
Labels: current press, physical therapy, PT Publicity Project
Some Friday Humor
The Onion is always good for a laugh!
Labels: misc.
Smoked Ligaments Not A Good Idea
Labels: public health
An Economist Checks In on Health Care
I like to keep a lookout for when the smart economists provide some of their thoughts on health care. Ultimately, it is these economists that the government consults with to initiate ideas about how to manage our health care system.
Tyler Cowen, a well respected economist, checks in with a piece called, Smart thoughts on health care. He doesn’t say too much, but it sure sparked a conversation in the comments!
When I read this, I try to read between the lines about what people are saying and see how Physical Therapists might act to fill a need economically.
My favorite line from the comments:
"90% of the time I see a doctor it’s to tell them, "I have X, and I need a prescription for Y." After reviewing my symptoms and medical history they always agree with me and write me the prescription. So why am I paying an extra ~$100 just to get a medication I already knew I needed, for a condition I already knew I had, before seeing the doctor? It’s just a waste of my time and money."
Perhaps it is this lack of perceived value in routine care which prohibits a move to a retail-like system.
Labels: health policy
Some News and a Thought
I have been writing my blog, NPA Think Tank for less than one year. In that short time, I have been fortunate enough to get some good exposure and a fairly loyal audience. The Evidence in Motion Group has been very helpful in support of my pursuit.
To them, and my readers, I ‘d like to say, "Thank You!"
Today, I’m happy to announce that my blog posts about Physical Therapy will begin co-appearing directly on the Evidence in Motion Blog at MyPhysicalTherapySpace.com. I’m excited for a new level of exposure and for a new audience. NPA Think Tank will still have some posts unique to it, which will help fulfill the "healthy living… and a vast array of seemingly random topics" part of my tag line.
I have also begun helping out with the Physiospot Musculoskeletal Blog, which is working to be a resource to deliver updates of new research as it breaks. This is part of a collection of sites worth a visit for Physical Therapists. Their tag line: "Assisting health practitioners with evidence based practice and continued professional development." Physio implying a Canadian-based site in this case.
Finally, and hopefully your still with me, I will direct you to an interesting editorial that appeared in this month’s issue of Contraception, An International Reproductive Health Journal. (Please, do not read into this…visiting just by chance!) Anyway, the editorial entitled, "Why We Need to Truly Understand the Medical Literature", lets the audience in on "One of the best kept secrets among health care providers…"
The secret: Many healthcare providers— especially medical doctors — do not have the ability to understand and interpret the medical literature. I liked the article because it brings up some good questions about training future providers in topics of critical appraisal and evidence-based practice principles.
Eric
Labels: physical therapy, Research, Science Literacy
Oh Brother! "PT's Do Research?"
Teaser: Find out what one MD thinks of Physical Therapy! Please read the whole story: Kind of longish, but entertaining never-the-less.
Labels: physical therapy, PT Publicity Project, Research
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