Turf Wars

The world of health and health care has become a turf war - and a rather aggressive one at that. It's a significant problem on many levels - some more obvious than others. After you've been a part of it for 20+ years, you see some rather ugly scenarios underlying all of it.

Start out on the political level. "Health care" has become a battle between Republicans and Democrats. Who will provide us with a universal health care plan that is feasible and can gain bipartisan support? Or do any of the politicians really care to see this occur anyways? Will the lobbyists manage to coerce the politicians yet again? Will they convince them that universal health care "can't be accomplished" and "isn't a feasible solution" yet, strangely enough, it seems to provide pretty darn good results in many nations around the world?

It's become a battle of professions. Athletic trainers say they are more capable than physical therapists - and have gone to the point of filing lawsuits to attempt to confirm their legal role in the care of patients. Physical therapists bark at the chiropractors, saying that they (chiropractors) are the ones that will try to convince you that you need more visits, more modalities, more everything - but as they say, those who live in glass houses shouldn't throw stones. There are plenty of physical therapists who complain about one thing, and then go right back to doing something similar. The chiropractors battle the physicians, because dang it, they're doctors too and you are going to have to realize it. Doctors want to maintain their piece of the pie because if a patient has access to all these other health professions, then how will they earn a living? Massage therapists can see patients right off the street, use just about any hands-on (and even hands-off) technique imaginable, and fly under the radar to the point of literally prescribing exercise programs with little or no educational background in exercise. Personal trainers aren't truly considered part of the "health care" system, but they too feel they are entitled to the "post-rehabilitation" or "post-surgical" activities.

It's also become a turf war of ideologies. This is perhaps one of the biggest battles that is waged - all under the premise of the mighty "evidence-based practice". As a clinician, what do you see your role is in the care of the patient? Educator? Healer? Entertainer - while nature runs it's course? Problem-solver? Diagnostician? Guru? Or can the patient be educated with the tools for competent self-care? I truly believe that the roots of this lie in the self-image of the clinician themselves. What does your belief system tell you?

And last but certainly not least it's become a territorial battle for the almighty dollar. When the goal is "the benefit of the client" and "the client's well-being", it's amazing how clinicians are afraid to "do the right thing" and refer the patient on to someone that might help them if they aren't doing so themselves. That sends dollars out the door now doesn't it?

Yes, it's one big turf war mess.

We can't forget that it's the patient that is at the center of all of this. The patient is trying to make informed decisions in a world of information, hearsay, "evidence-based" practice, and public perception. There are as many opinions as there are web pages. And here are all the professions, clamoring for their little piece of the pie, trying to sell their wares as "the next great thing".

If only "health" and "health care" truly mattered for what it really means.

The battle wages on.