It may have been one of the worst value propositions ever made. I know you've heard it before -
"Hands-on care is quality care".
I have heard it more than once, be it in a clinical environment, educational program, or on social media. What makes this scenario even worse is how the public has been snowed into believing it. Clinicians have, over time, skillfully trained the public to believe this. While doing so, clinicians continue to perpetuate a myth - that quality care is inherently related to the laying-on off hands.
Clinicians like to think they know what is best for the patient. And oftentimes, that is true. I mean, isn't that why patients come to see us?
But there is a fine, yet distinct, line between patient-centered care and paternalism. You know, the "father knows best" mentality that pervades our health care system right now. It might have been fine in the 1950's, but patients of the 2000's are becoming consumers when it comes to their health care. And rightfully so.
If we don't start paying attention, paternalism will be the demise of health care as we know it. And maybe that's a good thing.
Physical therapist education is something that I have been involved with for many years. I have seen both sides of the coin - the didactic educational side, and the clinical instructional side. I have also experienced the process of accreditation, albeit with a physical therapist assistant program.
There is always talk of "preparing students to take the licensure exam". However, the sad reality is that accreditation and licensing exam standards don't always reflect the current status of research and/or clinical guidelines in the profession.
So here's the question: is the goal of physical therapy education to get graduates to pass an exam, or is it to train competent clinicians - or both?
This past weekend, the city of Denver hosted the McKenzie Institute Americas Conference. I made the trek to Denver to take part in what was, according to my calculations, my 14th McKenzie conference. Where has all the time gone?
As has become the norm over all of those years, the conference was chock full of current research and insightful presentations. Add to that the thought-provoking and insightful discussions after hours with colleagues from around the world.
Sadly, the 2013 edition was the first conference since the passing of Robin McKenzie. Though the conference began with a moment of silence and tribute to Robin McKenzie, it ended with a powerful reminder that there are a dedicated group of clinicians poised to forge ahead with his legacy.
When clinicians bring up the phrase "Mechanical Diagnosis And Therapy" (MDT), they will often mention things like diagnostic classification, centralization, and directional preference. You might even hear mention of self treatment.
I would suggest that we can add one more phrase to the mix: public health.
MDT clinicians are uniquely qualified to contribute favorably to a public health initiative. Though that may sound like a pretty significant value proposition for the future of health care, it comes with some substantial rationale to support it. There are a number of reasons why MDT can provide the foundation for a public health initiative that could truly be a game-changer.
The logical fallacy exists on a daily basis in the orthopedic world. Perhaps more importantly, it costs the health care world millions of dollars and a tremendous unnecessary burden psychologically.
Orthopedic patients are referred for countless imaging studies as a first line of assessment. An MRI is a detailed image which patients are told will provide all the answers to the diagnosis of their problem.
Technology is a wonderful thing, right?
But there are some significant problems with this that begin with the initial line of thinking.
Should we trust pathoanatomy?
It is a simple decision that stands in our way to the promised land of health care reform. When do we finally get to the point in which health care consumers just say no?
Imagine, if you will, a world without Big Medicine, Big Pharma, Big Insurance, and Big Hospitals. Imagine, again, that same world with legislators who made decisions based on the needs of their constituents, and not the needs of the Bigs. I know, I am creating a world of science fiction here, but work with me for a moment.
When do consumers finally decide that the status quo - and its currently accepted "standards" of health care - is no longer acceptable? And when will consumers finally choose to take back their health care system once and for all?
Allan Besselink, PT, DPT, Ph.D., Dip.MDT has a unique voice in the world of sports, education, and health care. Read more about Allan here.