I was recently at a company-wide meeting with all the PTs and as I looked around I got thinking…
An entire room of people who think differently, have different algorithms and thought processes, and are all going to be treating people who are seeking one thing: Physical Therapy.
It was a very crazy thought. How can this ALL be Physical Therapy? Certified Manual Trigger Point Therapists, Certified Mechanical Diagnostic Therapists, Certified Othopedic Manual Therapists. At first it is a bothersome idea, as in, they can’t all represent PT, or the PT that I envision. But perhaps that is short sighted. Isn’t that one of our greatest assets? Isn’t that a selling point right there? We are extremely varied in our approach… there is a therapist for every patient. There’s a PT for every pt.
We, in PT, are evidenced-based and research driven. We look for the best methods to treat people and we have a wide variety of practitioners with different thought processes. It’s all underneath the umbrella of research and best evidence in treating the human body’s neurological and musculoskeletal conditions through movement, education and manual techniques.
(*Disclaimer: Diverse is cool. Craniosacral therapy and visceral liver manipulation, etc doesn’t count…)
The 3rd pillar (patient preference) is multi-faceted. As opposed to our varied approaches being a negative thing and wishing we all did exercise only, or TrPs only, or manips and DN, etc… How about: it’s OK that some PTs do and some don’t…some patients want it, some won’t.
And what a benefit we provide to the community by being diverse.
We need to understand where other PT’s roles are. Now I’m still OK with saying mine is better. Everyone thinks their own way is the best. (cue discussion about Religion if you want…) I’m OK with all that, because that’s how the community thinks as well. My point is about matching belief models as close as we can to get better outcomes.
If I were to own a practice, I’d like to have a muscle-centric, a neuro-centric, and joint-centric PT, etc… all using best evidence, but looking at things through their own lens (as patients do). Perhaps have a pre-intake form that can help schedule the patient with a similar thinking PT?
Let’s say I’m a big McKenzie, hands-off, internal locus of control-type PT and a patient is very focused on telling me about his muscle knot in his traps. Will that patient take 2 more weeks to get better because I don’t view his neck issue in the same way and don’t feel like rubbing that spot?
Of course our thoughts and interventions need some level of evidence… we are not providing every and all treatment under the sun. I’m not saying get rid of evidence for crap treatment, by any means. Vigilance for the truth is required.
Well, let me back that up a bit. I do personally have an opinion on what should be included in PT, and I, like you, spend a lot of time discussing the finer points of treatment, efficacy and robustness of our profession. I suppose I would have to be OK with the whole spectrum being called PT. There in lies the problem. What are you OK with being called PT? (dang, I thought I was going to make a point!) Well, I guess that can be a different discussion: but I do think some celebration or embracement of the diversity of treatment philosophies is beneficial to the patients because it brings a varied approach.
Side Note: I remember listening to Karen Litzy’s Healthy Wealthy & Smart 2013 conference and she interviewed Barrett Dorko and Jason Silvernail about how to treat a “patient’s” chronic neck pain. They both had different thought processes and took different paths… but ended up in the same place. That’s not exactly the same (they ended up with a similar treatment, not a majorly diverse one) but the point is that there is value in different lenses, even though that variability is hard to manage, guide and sell to the public.
All PTs need to stay up on the concepts of behavior modification, healing environmental context, Therapeutic Alliance, customer service, avoiding nocebo and negative imagery, etc… but past that, lets work on finding interactive fit. Maximizing our existing diversity. What better way to engage society?
I suppose what I’m saying is: some of this variability and diversity should be played as an asset.