physiotherapist & physical medicine/rehab physicians

[gcoe]

Thanks Fyzzio

Some good points you are making.

Professional autonomy does come at a cost - rights come with responsibilities. In gaining autonomy we need to be very prepared so that we do no harm to patients who are vulnerable or need care beyond our scope of practice. It only takes one sensational case of malpractice to taint the profession in the eyes of society and can send the profession back decades. I recall in Australia we were lucky not to have a serious adverse effect from a neck manipulation while other professions got tainted with unsafe practice over a couple of adverse events.

Entry level courses, regardless of whether they are Bachelors, Masters or Doctorate must have the appropriate content. such as pathology of a wide variety of medical conditions (beyond the types of conditions we treat) so we can understand what we are seeing, pharmacology so we know when we are seeing side effects or adverse effects and know we are safe to treat the patient a certain way, and skill in triage for non physiotherapy - problems so we quickly refer on when there is a problem - these are all basic skills for primary care practice.

Standards do vary all around the world and what is considered a physio's scope also may vary somewhat. However hopefully the WHOLE world wide profession is moving in the same direction towards autonomy. This is important for the international standing of the profession. It doesn't matter if it takes some countries a little longer to reach autonomy as long as we are all moving that way.

It wasn't that long ago that NZ didn't offer baccalaureate education. even in the early 90's We just had a 3 year diploma from a technical institute and we were then definitely under the wing the medical profession then. So it is possible for things to change quite quickly.

Entry into the universities and having a research capability seem particularly important steps for raising the professions standing

[quorthon]

reply to phyzzio:
U right about the training programmes in europe...To be more specific in Greece is 7 semesters (3 and a half duration) and 1 semester of clinical practice as applicant in a public hospital.Also it is true that as far as Greece concerned, the educational programme in physio school in Greece is of a low-level because we dont study the most recent scientific evidence in our profession..For example is almost ridicilous that when i was in physio scholl we get stuck on passive modalities so much, when in the meantime its clinical value and validity has discarded in a huge percent!! U got the point??? We never get through of the most recent evolutions and as far as i know from people who study THIS TIME physio in Greece, they are been taught the same stuff!!!!
But from my personal view this situation does not have to limit us in a passive role in practicing...When i graduated and start working as employee in other clinics and rehab centers i was just applying treatment without evaluate and assess what i was doing to patient...By taking McKenzie courses and finally the certificate on the Method (Cert.MDT) a new horizon had opened in front of me....I first learned the word "DIAGNOSIS" in my clinical context...And if u can diagnosed (of course i dont mean diagnosis as a physician can do, but diagnosis in MECHANICAL problems which are the majority in what we see in clinical practice) of course u can be more effective in TREATMENT....U can know what the prognosis will be, u can even know when u will come to a "plateau" in your treatment...And the most important is to recognize early which patients are CONTRAINDICATED for physical therapy....The so called "red-flags"....I ve seen that many times, when a patient comes to my clinic, he is "misdiagnosed" by his physician, and through the evaluation procedures we can see that a serious pathology is beyond his "mechanical" pain....Its not my duty to SPECIFY the patholgy but it is my duty to refer the patient to a specialist physician for further evaluation...
We are not here to play doctors but i think that each physio can take the RESPONIBILITY of a patient from the start (provided that he has a proper scientific base)...If we insist on just executing physician referrals whithout knowledge of what we especially doing with the treatment that they have described, then we take our profession many decades ago as gcoe said....We OURSELVES,through proper practice can firstly get the profession many levels higher and then comes the rest!!