Can we physiotherapist rise above the decades old image to a new image?

[rajulvasa]

Medical Guesswork

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Ian Stevens sent me this link
http://www.businessweek.com/magazine/content/06_22/b3986001.htm?


Medical Guesswork From heart surgery to prostate care, the health industry knows little about which common treatments really work
When I read above material i thought the following,
Role of physiotherapists when the drugs and medicine have no positive role to play but does have a lot of negative side effects, will this century see the role of therapists in pain and in rehab and restoration as most indispensable? And not just one more chance or one more try or one more card? One more feather!
Can we physiotherapist rise above the decades old image to a new image?

[bernard]

Rajul,

Often the link provided by Ian are cut by linefeed. Try to copy the first part and then the part that is in the following line. :lightbulb
I found it!!!

[nari]

Rajul,

I have read that article before and thought the same as you did. The history of physiotherapy is embedded in the principle that the doctor treats first, and when that fails, send 'em to a physio, maybe weeks later. Medication is a hit and miss business, and for ordinary aches and pains, should not be necessary as a 'take up to six a day and come back in a month if necessary' is something of an assault on the system.
We do have to emerge from the belief that the doctor treats "orthopaedic" non-traumatic conditions first; and the best way around that is direct access: patient to physio. To achieve that, physios have to be trained effectively to look for red flags; in many countries that is not so.
We have to learn to 'sell' our skills, and there has to be consistency across the board. In Australia, we have high status but it could be better; we are still known best for sports specialties and exercise regimes. Neurology is a poor cousin of the high profile manipulation/sports image; and many new physios dread their "neurology" rosters and later avoid neurology like the plague.
Until neurophysiology is seen as the driver of most conditions, it won't change.
However there are moves towards that concept being done.

We can live in hope!
Dr Barry Marshall, Nobel prize winner from Aust who discovered gastric ulcers are caused by infections, said today on TV:
I want to treat patients and tell them about helicobacter, but the only way to reach millions of patients is to educate the specialists and GPs.

I think we have to do the same.

Nari

[rajulvasa]

Rajul,

Medication is a hit and miss business, and for ordinary aches and pains, should not be necessary as a 'take up to six a day and come back in a month if necessary' is something of an assault on the system.Nari
Not only it is hit and miss, it can be as threatening as it can be life saving in certain conditions.
from anti bacterial and anti viral, drugs are sold without prescription for simple pain, to even abort the foetus in country like India where female child till date is unwanted.
All these because drug companies sell thenselves thro' ad campaign as well!:embarasse


We do have to emerge from the belief that the doctor treats "orthopaedic" non-traumatic conditions first; and the best way around that is direct access: patient to physio. To achieve that, physios have to be trained effectively to look for red flags; in many countries that is not so.
We have to learn to 'sell' our skills, and there has to be consistency across the board. In Australia, we have high status but it could be better; we are still known best for sports specialties and exercise regimes. Neurology is a poor cousin of the high profile manipulation/sports image; and many new physios dread their "neurology" rosters and later avoid neurology like the plague.
Until neurophysiology is seen as the driver of most conditions, it won't change.
However there are moves towards that concept being done.

We can live in hope!
Dr Barry Marshall, Nobel prize winner from Aust who discovered gastric ulcers are caused by infections, said today on TV:
I want to treat patients and tell them about helicobacter, but the only way to reach millions of patients is to educate the specialists and GPs.

I think we have to do the same.

Nari[/QUOTE]

[rajulvasa]

Rajul,

Medication is a hit and miss business, and for ordinary aches and pains, should not be necessary as a 'take up to six a day and come back in a month if necessary' is something of an assault on the system.Nari Not only it is hit and miss, it can be as threatening as it can be life saving in certain conditions.
from anti bacterial and anti viral, drugs are sold without prescription for simple pain, to even abort the foetus in country like India where female child till date is unwanted.
All these because drug companies sell thenselves thro' ad campaign as well!:embarasse

Neurology is a poor cousin of the high profile manipulation/sports image; and many new physios dread their "neurology" rosters and later avoid neurology like the plague.
Until neurophysiology is seen as the driver of most conditions, it won't change.

To bring the core change, our education standard must rise further at undergraduate level and as the radiologist, pathologist, work in team with diagnostic physicians, and surgeons, we physiotherapist concerned with motion movement must work and gel closely with neuro physiologist who work secluded in a lab with animal or sometimes with humans without any clinical experience at all.The day we work in team and in complete co operation with them we will rise our standard above those diagnostic physicians who actually have become pharma representatives.


Dr Barry Marshall, Nobel prize winner from Aust who discovered gastric ulcers are caused by infections, said today on TV:
I want to treat patients and tell them about helicobacter, but the only way to reach millions of patients is to educate the specialists and GPs.
I think we have to do the same.
Nari Yes we need to educate these specialists, and GPs but my feel is that these are the people who estimate physio services as by the way trials when nothing that they do work, and a lot of time is wasted in trying & waiting till one or the other drug may help!

[rajulvasa]

Following is the e mail I received from a stroke patient in canada, I will not reveal his name, his letter and many more of such stroke patients are signalling the physiotherapist to find solution for them as they are upset about the rehab physiatrists, and neurologists, and the real truth is that these physiatrists and poor neurologists have no role beyond the diagnosis and early critical care, and we therapists must soon rise to a level that patients do not have to out cry.
How does one eliminate severe muscle spasticity after acute thrombo embolic stroke without medication.

I have tried every muscle relaxant on the market, nothing works. I have
asked to be evaluated for Botox injections and I was told not to expext any
help from Botox. The distinct feeling that I get from health professionals
is to simply accept the condition as permanent and not hope for any motor
function recovery. My stroke also afflicted me with epilepsy and it is
simply to dangerous to perform unsupervised physical theraphy with that
neurological condition, I had a mild seizure on June 13 after nearly 18
months of normality. In any case I have a very serious drop foot problem
where I must drag my lower limb by raising my hip in a completely unnatural
manner.When health specialists demonstrate such pessimistic attitudes how
can a stroke survivor demonstrate optimism. It is like someone telling me
dont worry and be happy you are still alive after all.I am really starting
to beleive that in my case no amount of hard work will ever pay dividends
and provide some quality of life improvement. Post stroke depression is a
real bitch and a serious bladder control issue does not help at all. I dont
beleive in miracles and nothing I have seen in post stroke rehabilitation to
date will change my mind on the possibility of performing meaningfull post
acute stroke recovery. How can you succeed were thousands have failed
before. If the Vasa Concept is as effective as you claim why is it not in
use in all reputable stroke rehab facilities. You seem to promote healing
principles that are more associated with the treatment of the energy centers
of the human body. Building new neuro muscular pathways to healthy parts of
the brain implies teaching the brain skills that have been dormant for
decades or have never been used at all. What is the trigger mechanism
capable of performing such a reorganization of the brain. Triggered electro
myography was invented with the promise of helping stroke survivors rebuild
new neuro muscular pathways, it has proven nearly useless with acute stroke
survivors. Victims wishing to use E.M.G. must do so at their own expense
since insurance companies do not recognize it's benefit as a therapeuthic
apparatus. Most stroke victims are already affected by loss of revenue and
must incur additional debt burden to seek new rehabilitation therapies.
Since money does not grow on trees, very few have the possibility of seeking
truly beneficial therapies that might help to restore lost motor control
functions. It really comes down to how bad do you want to obtain medical
treatment and how much are you willing to spend to get rid of the wheelchair
permanently.

In western society, stroke rehabilitation is the domain of physiatrists and
they operate within a very rigid frame of medical teaching in which holistic
medicine as no foundation or merit. We are not in a position to challenge
what the medical field considers to be it's imminent domain. We are the
patients and must often accept medical prognostics at face value. If the
physiatrists were the individuals afflicted by brain attacks, I suspect that
many of them would question traditional teaching and seek help in uncharted
territory.In a society where healhcare is provided by the state. The state
prefers to keep medical expenditure per capita to a minimal.


Sincerely.

xxxxxxxx

[nari]

Rajul,

An excellent letter. Thank you for posting it. This Canadian person is one of countless people whose medical personnel believe medication and palliative management is the only way.
In Australia, the issue is money, because after discharge from hospital at so-called "optimal recovery" a stroke patient is rarely followed up because of the cost. Medicare-based PTs are few and far between; the emphasis is always on the fast recovering patients, where we aren't really needed. If the powers that be (including the physiotherapy hierarchy) recognised that the time and money spent on minor orthopaedic issues, including sporting injuries could be better spent on strokes in the early phase, up to twelve months, say, then the world would be a little different.
I think it comes down to outcomes and money; a LBP patient will get better in 80% of cases, a stroke patient's odds aren't near that. Besides, the stroke rehab is longer, and with uncertain outcomes.

I clearly remember a neuro PT pleading in an address to us, long ago:
What is the point of pouring money into the ICUs to save someone's life when there are not the resources to enable many patients to lead a decent, dignified life afterwards, after survival?
Saving a life is worthwhile, but commiting suicide 2 years later because of dysfunction, acopia and depression, makes you wonder about priorities. Certainly some people will NOT recover if half their brain is blown out of the water, but most have a chance.

When I see PTs spending weeks retraining and following-up someone's sprained ankle....well, it annoys me. (A profound understatement) Someone else can do that, with the high level of fitness trainers and exercise physiologists around. Why aren't we where we should be, in neurology, where we are unique in what we can do?

Your post got me going again.....:D

Nari

[rajulvasa]

Rajul,
When I see PTs spending weeks retraining and following-up someone's sprained ankle....well, it annoys me. (A profound understatement) Someone else can do that, with the high level of fitness trainers and exercise physiologists around. Why aren't we where we should be, in neurology, where we are unique in what we can do?

Your post got me going again.....:D

Nari
I tell u Nari, we sail in the same boat. For skeleto muscular problems there are plenty of chiropractors, exercise physiologists, fitness trainers even massues who I have seen sometimes do better job, and are better trained at such problems and are giving tough competition to orthopaedic physios, in such case only if the young up coming physio students are not frightened from the world of neuro rehab which still remains unchartered waters. we can really rise above all in rehab fraternity and take pride that we physios are the only problem solvers in true sense and are indispensible, no one can replace us.