WHEN IS A PHYSIOTHERAPIST NOT A PHYSIOTHERAPIST?

WHEN IS A PHYSIOTHERAPIST NOT A PHYSIOTHERAPIST?

331 July 1997 Volume 83, No 7 SSN0031 9406 Physiotherapy Journal of The Chartered Society of Physiotherapy CSP telephone 0171 306 6666 Journal tele...

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July 1997 Volume 83, No 7

SSN0031 9406

Physiotherapy Journal of The Chartered Society of Physiotherapy CSP telephone 0171 306 6666 Journal telephone 0171 306 6662 Journal fax 0171 306 6667

WHEN IS A PHYSIOTHERAPIST NOT A PHYSIOTHERAPIST? In the debate over t h e future of physiotherapy provision three words appear frequently: generic, holistic and m u l t i - (or inter-) disciplinary. These a r e used in a variety of settings, suggesting that their meaning is clear and their definition precise. However, although we intuitively understand them in context, their definitions seem to lack the clarity we assume. Perhaps the difficulty lies in that by defining them we are inevitably limiting something t h a t essentially has no demarcation. Nor can we be precise about each word while accepting that they are all interrelated. The clinical arguments for generically provided care or therapy initially appear to be sound: 0 There are some key, core skills and treatment techniques shared

between therapies. 0 Multi-disciplinary working is a recognised effective method of

providing patient care in both the primary and acute sectors. 0 Staff shortages are a major limiting factor on the effectiveness

of these teams. 0 By enabling all members of a team to perform any role within it, not only would staff shortages be less of a threat to the variety of care available; but there would also be more continuity of care, with fewer professionals looking after individual clients.

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When examined in closer detail, however, several major problems arise: 0 Although there may be some areas of common undergraduate education, even if a syllabus addressed only physiotherapy, occupational therapy, and speech and language therapy, it would require at least six years’ study to cover all three professions adequately. 0 To gain a level of experience similar to that of a

physiotherapist with three years’ experience would take three times as long - nine years of clinical work! 0 With a multi-disciplinary approach clients meet a variety of professionals with many different approaches apd personalities. Ideally, the most appropriate can be identified and used, so far as possible, consistently.

0 Brain-storming between professionals is often a useful tool in solving complex problems which may seem daunting to anyone alone.

With these major difficulties identified, should we then avoid methods of working which may encourage a move towards genericism? Should common areas of treatment be allowed to become dominated by a single profession, because the opposite highlights areas as already common territory? The concept of generic carers or generic therapists seems t o be viewed by the majority of clinicians with disdain; yet if they were called holistic therapists or multi-disciplinary therapists would the same feelings of aversion prevail? Where do we draw the line?

Case Study One A physiotherapist working on a community multidisciplinary team is responsible for the initial team assessments of all clients whose major need appears to be physiotherapy. In undertaking these assessments the physiotherapist has to identify any other problems which may require nursing, occupational therapy, speech therapy or psychology input, and arrange this with colleagues.

Is this physiotherapist working generically or merely taking part in a multi-disciplinary team approach?

On assessment a client also has some financial worries for which the physiotherapist refers him to the local Disability Income Group.

Is this part of a holistic approach or outside our scope ofpractice?

Case Study Two An out-patient physiotherapist advises a patient with chronic low back pain t o lose weight as this would reduce stress on the spine.

Should the patient also have been assessed by a psychologist or a dietitian before being given advice based solely on a physiotherapy approach which may take no account of the familial, physical and psychosocial aspects of weight, or was the physiotherapist simply acting holistically?

Case Study Three Physiotherapists working on a care of the elderly ward often help nurses to ensure that patients get out of bed into a chair as soon as possible. They can help to change the beds, reasoning that this makes it less likely that the patients will get straight back in, while also promoting their ‘well’ self-image and, through this, functional independence.

Do these physiotherapists treat the elderly patients holistically, generically or as part of the multidisciplinary team, or are they wasting professional resources by doing menial work?

Where Do We Stand? Taking all these into account can we ever work holistically without being to some extent generic? How far will multi-disciplinary working fuel the fire of genericism?

I offer no answers and provide no advice. This leading article is intended solely to stimulate debate; to pose questions that no individual physiotherapist can answer, but that we must all address, and then chartered physiotherapists must work together to solve.

Where is the line? How wide? And how blurred?

Daniel Yates MCSP Senior Physiotherapist, Worthing and Southlands Hospitals NHS Trust Member, CSP Communications Committee

Physiotherapy, July 1997, vol 83,no 7