Influences on Autonomy

autonomousAmerican Physical Therapy Association (APTA) President, Scott Ward, posed an interesting question in his latest blog post. Dr. Ward wondered, based on feedback from a group of stakeholders, if the inclusion of the term “autonomous practice” in the APTA’s Vision 2020 was the right word. Is it non-collaborative? Does it reflect a patient-first approach or a provider-first approach?

Wanted: Wordsmith, No Experience Needed

Well, before we word-smith “autonomous” and label it as bad, it’s probably helpful to be clear about why the concept is part of the vision in the first place. To me, this centers around the “self-governing” aspect of the profession. Too long, have physical therapists been positioned under the direction of other professionals. This doesn’t make much sense to me.

Consumers would be surprised to know that even if I know a better, evidence-based intervention for their condition, I’m legally bound to follow the direction of the physician’s prescription. Is it correct for me to have to follow a prescription written by a doctor for treatment interventions that are ineffective, not evidence-based, and a product of the 3 hours of rehabilitative education that person received in medical school? What about working as an employee of a physician referral source, who profits from every referral he makes to his employee? Is that a good idea? What about having the inability to perform certain techniques based solely on the strengths of oppositional lobbies, regardless of scientific support in our favor? Is that fair?

Autonomous is Patient-First, (sort of…)

Are these situations of limited autonomy good for healthcare costs or patient outcomes? NO! Being autonomous, having the ability to self-govern, is about putting the decision making ability of physical therapists in the hands of physical therapists, not people who don’t know the particulars and science supporting our profession. Is “autonomous” patient-first? Of course not. This is about the internal management of the profession. Do patients benefit from physical therapist autonomy? Of course they do. When I can follow my own treatment protocol for your chronic foot pain, for example, instead of a podiatrist’s order for anti-inflammatory transdermal medication…the patient benefits. When self-referral is eliminated, costs go down. This helps everyone. When physical therapists are allowed to see patients with back pain first, needless imaging, tests and procedures can be avoided, and the risk of surgery may be reduced.

That said, I don’t like the word autonomous practice. It has bad connotations and the potential to provoke needless defensiveness by other parties. What we’re really talking about is the profession’s ability to self-govern. Gaining the rights and privileges associated with being a licensed professional with a doctorate-level education. No one is ever “autonomous” in healthcare…or in today’s flat world, for that matter! And, who can fault someone for wanting the ability to self-govern your own profession?

So Now What?

Revise the autonomous practice statement. Be clear about what we’re talking about. The current statement for autonomy is too broad. It needs only be one sentence:

Vision for Physical Therapist Practice

Physical Therapists will have the ability to self-govern the profession and practice of physical therapy in all clinical settings, including self determined professional judgment within one’s scope of practice, consistent with the profession’s Codes and Standards and in the patient’s/client’s best interest.

That leaves me with a better taste in my mouth, and leaves out a word I have to continually explain to folks.

In my humble opinion…