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Toni Talks about PT Today

There’s More to PT than Outpatient Ortho

Published December 10, 2009 10:25 AM by Toni Patt
There seems to be a misconception in the general public around what physical therapists actually do.  So far I've been to two Christmas parties.  Both times I had almost the exact conversation about what I do.  When I said I'm a PT   I immediately heard one of two things.  Do you work with athletes?  What can I do about my back?  Naturally someone else wanted a massage.  I think I spent more time explaining what I work with neuro patients then talking about anything else. 

Last week the local PT school had its annual research day when the PhD candidates present some of their research and the third-year DPT students display their posters.  This year there were four PhD presentations and 17 posters.  Three of the PhD topics were orthopedic outpatient oriented.  The other dealt with pain during therapy with pediatric patients.  Ten of the posters were orthopedic in nature.  Two of them were neuro related.  Two were pediatric in nature. The remaining three dealt with topics relating to PT education.  I found myself wondering why I was there. 

This is disturbing to me.  There is so much more to PT than outpatient orthopedics.  You wouldn't think that if your opinion was based on the above two examples.  I got the impression that's what the general population thinks.  That also seems to be the areas PTs have the most perceived value.  I doubt an OP ortho therapist is ever asked why she doesn't want to work with stroke patients instead. 

The APTA might want to step back and think about this.  PTs are being packaged as movement professionals with unique knowledge about the neuromuscular system.  If the emphasis is only on OP ortho, the APTA and everyone else, is selling the profession short.  If we want to talk about relative value let's consider pediatrics.  Many of those patients have developmental issues. Without PT intervention, those children will never reach their potential and may be confined to a wheelchair the rest of their lives.  How is that less important than treating total joint patients?

Physical therapy needs an image update.  Not only are we a doctoring profession but we are a varied one.  No one questions the value of one medical specialty over another. We just assume that person preferred to work with those patients.  So why am I explaining why I like to work with stroke patients?  This needs to be addressed on the national level. 

They might also want to look at the transitional DPT programs.  They seem to be oriented solely to those who work in OP ortho.  I've been the only neuro person in every class I've taken.  All of the assignments have been geared to the OP setting.  The radiology class only covered the spine and peripheral joints.  The only mention of neuro imaging was a mention that MRIs and CTs are used for brain scans.   Well, doh.  Here I thought I was going to learn something about reading them.  That was just sad. I realize reading a brain MRI was beyond the scope of the class but infarct and ICHs show up completely different from each other on both scans.  A discussion about what they look like and why it happens would have been nice.

I'm not putting down OP ortho.  I just don't want to do it.  I also don't want to do pedi, women's health or cardiovascular.  Even so, I recognize the necessity of each and would never ask a pediatric therapist why she doesn't want to treat adults.  Once again there needs to be some unity of the profession.  How can we be considered a doctoring profession if we act as though we believe only one aspect of what we do is really doctoring? 


I really enjoy your down to real earth comments, Toni!

About PT not knowing or respecting - never mind promoting - itself effectively as a profession, it is true, and it is aggravating. Being called "doctor" while never being a "real one", I think backfires and adds comedy to the hospital ward when someone calls a doctor and four people turn their head with only one (hopefully) having the skills  needed.

OT seems to do a much better job of taking pride in what they do and can all but pretend they do gross motor stuff in their stride, as prep, for the real involved therapy regarding fine motor function, visual motor, hand eye coordination and - wait for it - all of sensory-motor integration issues.  As if all we PTs knew was how to lift a leg or tighten a quadriceps.  How did we PT's as a group concede the whole afferent side of things, at least in developmental therapy!?! Personally, I have not and I study what I want to know and apply what I know.

If it was up to me, there would simply be a "developmental therapist" working with the 0-12 year olds, a specialty either OT or PT could go into, because there is plenty overlap in knowledge and skill.

The other point I wanted to make is that working with little kids is working on a person's  whole lifetime of issues they may or may not need to have. It is not just a niche, or cute, it is BIG.

I notice the opening and closing of the cycle of human development is very much related: the motor skill you never learned as a child, will not support you through life. Older kids and adults will compensate, at great energy expense, which wears thin around 50 or 60. Some of "old age is extremely preventable!. If you never played vigorously outside or with others, you most likely will be an increased risk for falling, overweight, depression etc as an elder.

In my persistent quest to make a difference with my work, I have have worked in just about every setting, including competitive outpatient clinics, which tend to be filled to the ceiling with inflated EGO's! Once you understand the emotional and psychological undercurrents related to  posture as well as chronic and acute injury, you get a bit less excited about manual therapy techniques. I ended up working with the youngest ones, in early intervention and school, most of whom really want to move and explore and live life on this planet! And while I don't work to be loved, they do give you hugs without agenda and make you laugh out loud, not all of them all the time, but enough to lighten the day. I share your fascination with Neurology, and it is very much at work in this group, only it is still much easier to facilitate :(

Siglinde, Early intervention/scbool - PT June 21, 2014 7:28 PM
Santa Fe NM

For a change I'll be brief...Bravo!

Dean Metz December 10, 2009 12:26 PM

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