Did Physical Therapy Follow the Wrong Leader?

Well, after twenty years of some insomnia wondering why my PT training forgot about the mind of the person behind the pain and ridiculed our innate gift in supporting our own healing , I can now celebrate that I sleep like a baby . Due to the recent media covering everything from yoga for healing to physician's committing suicide, we are almost there. Sad it took these statistics but that is what happens when the monkey mind clouds the C.A.L.M. of the mind.  We just got distracted by the promises of the bells and whistles within the medical system

Promise #1:

IF YOU WORK HARD, YOU WILL GET PAID FOR THE VALUE YOU BRING

Umm, not quite.  Physical Therapy was not designed for that and we are taking forever to practice the primary care we preach.  We need it to stop reaping the seeds of watching that greedy mid 80's to 90's hotpack, estim and Ultrasound POPTS show. Like I tell every persistent pain patient, staying in the mindset of the victim is not going to foster the healing glow.  WE allowed ourselves to remain too long as a secondary model of care because the payout was easy.  For a good decade, following a written protocol with a four year college degree in PT, was acceptable to those getting paid the big bucks to bill a ton of modalities and send the client off to the tech down in the shared fitness gym. So now why are we surprised to find the jig is up? 

It is more like...

IF you work compulsively robotic, figure out creative ways to use your staff or find a loophole ...
— The payors

 

AND...

  • patients make it to your service instead of being lead right down the hall
  • you bill well and kiss butt to referral partners
  • are volunteering in enough free 5Ks and post wellness posts to be seen as more than sick care service
  • let the most loved orthopedic group in town use you to own a rehabilitative revenue stream by your labor
  • find AND train the right front desk staff to sell upsell packages for you
  • then train everyone from clinician to tech to cleaning help to subliminally get your patients to rate your clinic as excellent ...

You MIGHT rank high on SEO and reimbursement enough to get the number of patient visits you need to get paid.  The target is at least enough to rationalize the value of spending 100K + on school, hiring a business maverick, continuing to pay more on a specialization , spending unpaid overtime to make sure the notes are clinically relevant for the point of getting paid ( accepting the fact that no one but your clinical staff will actually respectfully read them for a professional opinion).  Only then, if you are not bald from pulling out your hair every time insurance coverage bundles gets changed and/ or burnt out from how mentally exhaustive just reading that last paragraph sounds, will you probably get paid enough to come back or want to own your clinic another day. 

Promise #2)

IF YOU WEAR A WHITE COAT IN A HOSPITAL, THE ESTABLISHED HIERARCHY AND PAYOR MODEL WITH ACCEPT YOU AS THE PRIMARY DECISION MAKER ON INDEPENDENT MOBILITY NEEDS
— The APTA circa 2000

 

Oh that lie is both sad and funny, considering the importance of our role to payors when filling out an OASIS form.  Maybe the APTA and FBPTE followed the wrong leader or guru back in the day?  Maybe we should have wanted to align ourselves in support of the DO's vision of holistic health and circulatory assessment vs attempt to mold ourselves along the linear path of the physical cause and effect MDs? After all, it helped Chiropractic tremendously as a foundational tenant saving their profession the cost of getting more than a four year and 2+ professional studies degree.  

“Osteopathy was discovered by Dr. A. T. Still, of Baldwin, Kan., 1874. Dr. Still reasoned that “a natural flow of blood is health ; and disease is the effect of local or general disturbance of blood—that to excite the nerves causes muscles to contract and compress venous flow of blood to the heart; and the bones could be used as levers to relieve pressure on nerves, veins, and arteries.’
— Taken from Auto Biography of Andrew T. Still

Interestingly, while researching the philosophies behind medicine for one of two books I am writing,  I came across the mindset of Andrew Taylor Still, the father of osteopathic medicine. 

Anyone else think our underlying binding health philosophy of "movement is life" is conceptually a bit more aligned as a profession with the original intention of osteopathy more than anything else we promote ?

As you can see, the original intention of being an osteopath is in alignment with all the wellness talk we only more recently do. The difference now is that we have the "evidence" so all of a sudden it is actually cool to be using the same techniques as a DC , mobilizing scar tissues or helping a woman address her holistic health vs "fixing" her vaginal disability.

So what went wrong? Why are we still, after decades of use, still addressing body parts for pain and fighting to validate the value of a PT, I mean a DPT?  Cut #1: The medical profession's decision to take the role of healer out of the patient's hands (and into his or her own orders) set the karma by disrespecting who actually owns her health. Cut #2:  It is blatantly obvious hospitals of the past were for a little more nurturing or only for emergencies.  We need to get back to that instead of deciding to broaden our "surgical techniques" and make a rationale on "needing" surgical procedures.   So I ask again, did we follow the wrong leaders? Could we have valued the persons power in their pain sooner based upon ancient and still used eastern models of care?

History Has the Evidence of Repetition

In 1921, at the first APTA meeting we were right there, giving the polio kids our presence and coaching the war casualties by empowering their hero attitude to heal. Having practiced in such a successful integrative way for so many years myself, it makes me cringe thinking of the possibilities.  Could more belief in our specialness, vs specialty, could have allowed us to kept our authenticity instead of chance functional diagnosis as a skill? Would we not have the DC/PT debate had we persisted on the holistic health management road less traveled? 

I Can Smell the Sweat of Hard Fought Victory

Oh it stinks but I am enjoying the hints of that battle's aroma.  Sound's gross, but again, I was an ATC and the athletic trainer spirit in me knows that blood, sweat and tears are needed to win in this game.  There are still many points of resistance.  

  1. Most of what is now valid requires a radical mind hack to implement the shift to coaching verse treating our pains. 
  2. God like conversations are no longer functional
  3. The money is in the illness of the status quo.  There needs to be a new level of acceptance in paying the provider and in the provider bringing their A game. 

Still, this game to integrate common sense observation, the desire of the client to be healed verses soothed and be charged fairly to pay, and a need for getting humanity back into healthcare,  is only starting this game's third quarter.  There is plenty of time to get over confident on gains made against the opioid epidemic and detriment of repeated cortisone shots and early MRIs.  Those that are pushing radical change, have to also prepare themselves on the sidelines to score that winning goal. We need to remain steady on the offensive line and get hit over and over as we are.   Believe me, there will again be a moment, we want to run. There will be plenty of people who do not see a reason to pay for change even if what they paid for  is not producing statistical results. As Simon Sineck said "People pay for the Why and not the What" (2009).

Hindsight's 20/20....

And ignorance is bliss but you need to acknowledge, in 1897, this dude was ahead of his time.  He was a bridge builder between the old and the newbie ideas about cells.  He valued the systems model of old school 4 humors philosophy but he now had the idea of why we need movement and the intra-systemic relationships by understanding the habits of the cell. So out came osteopathy because he valued the integrity of the human structure as a player in the game.  I can only hypothesize by his autobiography that he was not afraid to be a change maker. He realized getting physically stuck would limit the ability to nourish our cells with nutrition, blood gases, clear toxins and seemed to value a subtle communication system between the cells and our physical form. 

Given this, it is interesting( but predictable )the way we went in following the MD. Even DOs did not have the perseverance to believe in themselves and followed their lead but they made the same mistake.   As we DPTs continue our ever elusive need for more PT focused specializations we deny the integrative expansion into other compliments of care like nutrition or health coaching or even the value of adding an MBA instead. Please let us not spend the 2020's complaining when we reap what we now sow.  

But then again, I am an optimist.

There is always the human strength in witnessing our vulnerability as a catalyst for being receptive to change . There is always the heroine of learning to clean up our crap, put on our clean big girl undies and step up to being radical,  courageous and risky.  Could we possibly do that? Could we collectively share the vibe and lead our #ladyBiz self into witnessing the ignorant or narcissistic mistakes of the past most popular leadership models and use that hindsight to actually motivate a radical move by the profession back onto that original road less traveled? 

References

Sineck, S. (2009). Start with Why: How Great Leaders Inspire Action . TEDx Puget Sound -https://www.youtube.com/watch?v=u4ZoJKF_VuA

Still, A. T. (Andrew Taylor), 1828-1917. Autobiography of Andrew T. Still, with a history of the discovery and development of the science of osteopathy, together with an account of the founding of the American school of osteopathy (Kindle Locations 14-17). Kirksville, Mo. : The author.