April, 1957. P H Y S I O T H E R A P Y Page Seven

THE PHYSIOTHERAPIST'S RESPONSIBILITY
B y  W. WOODGATE, M.C.S.P.

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H O SPITA L L IA IS O N  O F F IC E R , W E STE R N  P R O V IN C E  B R A N C H .

TH E  physiotherapist's responsibilities are ingrained from the comm encement o f his education. The word educa­
tion is used rather than the word training because he does 
not only need practical training in specific skills. H e is 
given the theory o f his subjects to  develop an understanding 
o f his work, the crucial test o f this understanding being his 
ability to  advance it.

His profession is n o t learned in three m onths or even 
three years, but to  m aster its activities requires a perm anent 
study. It requires constant critical analysis and then m odi­
fication by the results o f this analysis. It is required to 
appreciate the things o f intrinsic im portance and then 
decide w hether their attainm ent is a practical possibility. 
The surgeon o r physician is concerned with getting the 
required physiotherapeutic result. The physiotherapist 
working under their guidance has the responsibility o f 
deciding the best m ethod o f achieving this result.

The Patient — Physiotherapist relationship
A lthough emphasis has recently fallen on the need to 

treat patients as an entity and no t a condition, physiotherapy 
is one o f the medical services which has always done this, 
and is one o f the last rem aining services to do so. Once a 
patient feels he is being treated, o r regarded, as a thing, 
a case, a condition, all hope o f a professional.relationship 
is lost and with it all hope o f the co-operation necessary 
to achieve a perfect result.

As our field is prim arily one o f rehabilitation the fact 
that behind the case papers there is not an abstraction but 
a hum an being with his own characteristics, home, back­
ground work and family requires an acceptance o f an 
individual and a personal sense o f responsibility tow ards 
him. Therefore the physiotherapist m ust study the whole 
patient, m ust establish a personal contact, and may do more 
good by understanding personal difficulties, th an  by the 
operation o f all his im pedimenta.

W hen such personal relationships develop and the con­
fidence thus established leads to  im provem ent the physio­
therapist is praised for exceptionally fine work. T he reason 
lies beyond the m anipulations o f a technician  ̂but in a 
person exercising his initiative and respsnsibility.

Selection of P atient and Treatment
Owing to  the understaffed and overcrowded hospital 

departm ent an additional responsibility is throw n on the 
physiotherapist. H e m ust not only select the treatm ent 
m ost suitable for the patient, which arises in many cases; 
but he m ust also select the patients m ost suitable to  benefit 
from  treatm ent. In selecting the treatm ent the tem ptation 
arises always to  choose one treatm ent for the same diag­
nosis.

While the classroom  sequence o f Diagnosis, Signs, 
Symptoms, Aims o f T reatm ent, M ethod o f T reatm ent 
need not be followed lavishly for every patient, it would 
be unfortunate to  progress from  D iagnosis to  m ethod of 
treatm ent, w ithout considering Aims o f T reatm ent in the 
light o f individual requirements.

T he methods o f treatm ent are wide including massage, 
movements, remedial exercises, and the m any forms o f 
electrotherapy, but the aims are o f great im portance. F o r 
example a typist with a wrist injury would be rehabilitated 
quicker, from  a point o f view o f work if pronation was 
concentrated on, and not an equal time in pro- and supina­
tion. A violinist with stiffness of the joints o f the left upper 
limb w ould not need a great range o f elbow movement 
but w ould require wrist extension and supple fingers. H ad 
the right upper limb been involved the elbow movements 
would assume m ore im portance.

In selecting th e patients most suitable to  benefit from 
treatm ent the problem  arises from  the state of affairs 
where an average o f thirty and on occasions as many as 
forty o r fifty patients have to be treated in a space o f time 
originally recommended for the treatm ent o f twenty. In  
addition many non-professional demands are made on the 
physiotherapist’s time, varying from  as low as 10% to as 
high as 30% . It is accepted that the quality o f the physio­
therapist’s treatm ent shall be ‘his best’. B ut what o f the 
quantity. The am ount o f time given to a case may not 
only determ ine the rate o f progress, but w hether there will 
be any progress at all. O n what grounds can this time be 
allocated. Equality o f time cannot be considered as it is 
ridiculous to propose spending as much time on a Colies 
fracture as a spastic child.

The Tim e Factor
Two means o f allocating time unequally can be discussed; 

the severity o f the condition, and the usefulness o f the 
patient to the comm unity. The form er receiving priority 
coincides with the traditional point o f view, but are we 
justified in spending additional tim e on a patient whose 
value to the com m unity in terms o f productive work is very 
low or n il? I f  the latter receives maximum treatm ent to 
ensure an early and efficient retu rn  to production the 
traditional view m ust be flaunted. This m oral issue con­
tinually arises in a busy departm ent and may be one of 
the hospital w orkers heavier responsibilities.

Technique o f Treatment
This m oral responsibility adds to the physiotherapist’s 

personal responsibility o f using certain acquired skills to 
the limit of his ability and knowledge, in the service of 
another individual.

A further responsibility lies in the very real danger o f 
injury. The unskilful application o f ultra violet light, 
sh o rt wave diatherm y, ionisation, and remedial exercises 
in recent fractures, antenatal and cardiac conditions, can 
result in serious injury to the patient.

Conclusion.
It m ust be realised then, that th e physiotherapist’s re­

sponsibilities are not light. W hen all these decisions have 
to be m ade by an individual w ithout the chance o f con­
sulting a m ore senior m em ber o f staff, such as in the case o f 

' one w orking single handed then the responsibilities' are 
even heavier.

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