Critical of Quality: What Kind of Physical Therapist are You?

Several years ago I read an article on the incidence of lower back pain.  In the article, the author stated that symptoms of 80% of people with lower back pain will resolve without any intervention.  I found that very interesting, because in essence in this group of patients, it suggests that it doesn't really matter what type of treatment the patient receives.  Practitioners who work with these clients, we can assume, will enjoy an 80% success rate!  That sounds pretty good.

I extrapolate this natural recovery reported in lower back pain to most other orthopedic diagnosis.  Again, the body being designed to heal, many pratitioners can enjoy a relatively high degree of success, but not necessarily as a result of their skill or intervention choices.  If you are happy with that, then there is no need to read further.  As a physical therapist, I am drawn to the 20% who don't fit into protocols or cook book approaches to therapy.  These patients truly challenge our understanding of the body and the complex interactions of all structures from head to toe.  These are also the patients I see, time and time again, who have been redirected from failed rehab that is often of poor quality.  Whether the approach is inappropriate (no foundation in evidence), passive (modality laden), or too brief a session to effect any therapeutic change (multiple patients scheduled per hour), these patients have often had their time wasted, while their therapist has waited for them to heal...despite their treatment interventions.

I am sure this sounds harsh and perhaps egotistical.  But frankly, I believe that these types of practice patterns are truly harmful to the profession and role of physical therapists.  I am often embarrassed for the field of physical therapy by the work that some of my peers are and in more cases are not doing.  I ask "What types of things were you previously doing in Physical Therapy?"  Often these answers surprise me, but more often they frustrate me immensely as patients have put their faith in their providers and often exhausted financial resources to recover.  I am often surprised they have any faith left to try physical therapy again.

At our clinic we are critical of what we do.  We practice evidence based medicine, yes, but we also practice patient centered medicine.  In one manual therapy course years ago, we were asked as a group to come up with as many causes of lower back pain as we could.  In a few minutes of discussion we came up with over 300 (when you consider all of the different levels).  How could a protocol or an e-stim unit possibly ever account for that degree of possibility or variability?  Do we really ask ourselves after each session, have I done the best by this patient or is what I am offering effective? 

Sadly many of these therapists enjoy an 80% success rate, and have decided that is good enough.  Learning has ceased, critical analysis is no longer practiced and minds are closed to new techniques or ideas.  That is not good enough for a profession that desires increased autonomy and expanded roles in health care delivery. 

My hope would be that each of us pursues the goal of being the best Physical Therapist we can be.  Learning never stops, and none of us ever has it mastered.  The true master realizes that the more she learns the less is known.  Those who sit on their heels and stick with status quo will quickly be left behind by their profession, and that same profession, left behind by their patients.