Restricted Thoughts



Say a child doesn’t have the legal right to drive (we’re talking about an 8 year old). Ask the kid what they want to do, most of the time that task or activity will be restricted to their home. Some people may argue differently,and say, “that’s not true, my kid always wants to go the park.” (or fill in the blank with something else). Maybe that’s true. Maybe that child’s thought process involves things that are outside of his or her control, but maybe that child has an active and willing participant (i.e. the parent) who has made this thinking possible. The parent is actually asking the child what they want to do, taking into consideration the child’s opinion/desires for the best possible outcome for everyone.

What happens, however, when we turn this scenario? What if this is the parent who does not cooperate with the child’s desires? What if the parent is actually a really bad individual, who doesn’t really value what the child thinks? What if the parent has had a long day of driving and doesn’t feel like going back into the car? What if the parent doesn’t have a vehicle? And the biggest question of all, what if the parent does this consistently? Day after day, week after week, year after year? The child’s desires and thought processes are likely to change. They are likely to become narrowed. Instead of going to the movies, or going to get ice cream, or for a day at the park; the child will start only thinking of things to do at home. Like play outside, watch a movie, or read a book (…maybe that’s a stretch).

You can see this happening in real life. I wouldn’t be surprised if there was some bit of academic research on the topic. How children’s minds are shaped, and likewise their thought patterns, by the constraints or liberties placed on their actions. Some people may say, well that’s not a huge issue, especially if the child has a good home. They can stay and play at home all they want! Which might actually be true, but what happens if this scenario is turned into the healthcare field? Lets swap the child for a physical therapist/physio and the parent for the physician, and let’s say that instead of figuring out something fun to do, the PT is trying to determine a diagnosis for a patient. The fun activity or task may be a means of diagnosis, say an x-ray or blood values, or an EMG, or even a referral to another type of doctor.

There’s a lot of talk these days about extending privileges and roles of physical therapists and physios. Different groups are asking about and for direct access to patients. Wisconsin physical therapist just this year were given the legal right to order radiographs, with certain fairly un-restricting provisos. U.S. military PT’s have been given this privilege since the 1970’s. Physiotherapists in the UK have the ability to undergo training to become extended role physiotherapists, therefore allowing the ability to order imaging studies, perform injections, and even order blood tests.

I think this is an awesome time to be in the profession, and I look forward to more success for us and our colleagues in the future. I do feel, however, that trends will only remain the same so long as we continue to push for the right legislation and public demand.

I was recently listening to an episode of the Physio Matters podcast which prompted some thoughts about the topic of . They were discussing spondyloarthropathy in general and, among other things, the average delay to diagnosis for ankylosing spondylitis. The expert for the topic, Karl Gaffney MD, reported the average delay to diagnosis for ankylosing spondylitis to be eight years…for a condition with a normal age of onset between 20 and 30 years of age. Which means a person with this condition is typically putting his life together, starting a career, perhaps marrying, or at the very least choosing a path in life. During this time, that same man (or woman) is dealing with back pain, and if not in reality at least will feel dismissed and misunderstood – at first by the healthcare community, but potentially his friends and family.

I have been practicing for a short time overall. In this time I have met enough resistance and difficulty in attempting to refer patients back or politely suggest further testing to tempt me into other routes of action. The temptation has been real at times to simply “put it off.” Let someone else deal with that weird symptom that the patient is complaining about,’ll take me two weeks to hear back from someone anyway.* I’ve dealt with these difficulties before, and even written about them. It’s not hard to see how such crazy things as a “PT diagnosis” came to be in the first place.

Physical therapists and physios alike are poised to be a huge asset to the healthcare community at large with our training in musculoskeletal medicine, however, we are debilitated by our limited privileges as practitioners. My fear is that these limitations not only limit our actions, but also our thoughts. Restricting actions eventually leads to restricted thoughts and restricted thought patterns. Humans are adaptable. We seek to make our lives easier each day. Facing difficulty, poor communication, uncooperativeness, and friction daily for months (let alone years) is enough to start changing any persons habits and thought patterns. If we don’t continue to push for these privileges to better aid our patients, we will continue to be stuck playing in the sand box…and our patients will continue to suffer the consequences.


Thanks to Neil Maltby for answering some questions about UK physio rights/scope of practice. Check out his excellent writing at Becoming More Human.


*Since I started writing this post several weeks ago, I have had a patient I was attempting to refer onto and specialist for a consult. It has been roughly two weeks without any response from the referring PCP with regard to my suggestions.

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