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PT and the Greater Good

Perceptions of the Nanny

Published February 22, 2011 4:51 PM by Dean Metz

I heard the BBC news report how there is a risk of high numbers of alcohol-related deaths in the future. Incorporated into this story was the idea that government needed to do something to prevent this from happening. Currently this is being done through a "sin" tax and other regulatory steps. The NHS published this account of the information:

The same day, I read this account of how the First Lady, Michelle Obama, is being brought to task by Michelle Bachmann about her endorsement of breast feeding:

The cultural differences really stand out in these two stories. What one country views as sliding towards a "nanny state," the other views as a public service message. What one views as responsible action, the other views as the government imposing its will on the people. When I read the USA Today report to my British colleagues, they were dumbfounded at the response of Michelle Bachmann. I'm sure a few of my United States readers will be amazed to know that most Brits actually do hope and want the government to "do something" about the possibility of an increase in alcohol-related deaths.

What does this have to do with PT? As health practitioners, are we giving comprehensive care if we advise clients to clear clutter out of their homes to prevent a fall or are we being too nanny-like? What if we advise on weight loss to obese patients? Are we interfering with their autonomy or providing necessary intervention? Does it make a difference if Medicare or Medicaid is paying?

I've learned in my public health studies that the U.S. Constitution provides only for the "general welfare" of the public. That is a term that can be interpreted in more ways than Tarot cards.

Where are we as a profession on the "nanny scale?"


Janey, thanks for your response. You are correct in that both examples are the results of legislation. However, there is no penalty for NOT breast feeding, you simply won't have the advantage of a tax benefit.

Also, advice is what friends give. When professionals advise, it can be seen as a treatment which is governed by legislation. If you gave advice outside of your scope of practice, you would indeed suffer a penalty and perhaps loose your license to practice.

I've seen some home care therapists and nurses enter people's homes and start re-arranging furnishings with quasi-consent from the patient. Are they making a safer environment or taking away someone's autonomy? Both?

Health care is inherently paternalistic in that professionals are sought out to provide solutions for people. Public health is a different matter. People may not seek out our help, however they may place the greater population unfairly at risk and therefore intervention may be required. Example, it may be individual choice to not wear a helmet while riding a motorcycle. One thinks, "OK, if you want your head splattered across I-95 who am I to stop you?" However, what about the cost if that person doesn't die? Who pays for the TBI treatment? The lost work? The long-term disability? Ultimately we all do. Is that fair to the rest of us?

As a culture we have a huge value on independence and personal choice. Have we gone too far though? Have we lost sight of the overall cost to our society as a whole for our choices?

I don't have the answer to that as there is no simple one. However as PTs, we see the results of personal choices regarding smoking (COPD and cancer), overeating (CAD and OA), thrill sports (TBI and fractures), distracted driving (TBI and trauma), breast feeding (well developed children). We most definitely have a role in public health! That was my intent in this posting. My apologies if it was originally unclear.

Cheers, Dean

Dean Metz March 3, 2011 12:57 PM


Interesting post.  A point to consider:

These articles both speak of legislation.  

Your medical examples speak of giving advice.  

Legislation requires adherence if penalties are to be avoided.  Advice can be accepted or ignored without a penalty being incurred.  Certainly consequences may result, but no penalties.

In my opinion, this is comparing apples to oranges.  Of course, that is just my opinion :-)

Janey Goude March 3, 2011 1:54 AM

Welcome to my world Dean! A difficult subject to negotiate although one to motivate staff discussion and seek varying opinions. The only approach I can come up with is where you offer as much information as possible appropriate for the patient and then they need to make a decision on the way they want services to work for them. We are, of course, governed by expectations, legal issues, protocols and procedures which usually define what is available and what is not. The goal posts vary according to which government or new 'Director' is in position and whatever finances are available for provision by the local authority. A bit of a minefield don't you think?

Lynne, elderly - social worker, pct March 2, 2011 7:36 AM

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About this Blog

    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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