MARCH 1981 p h y s i o t h e r a p y

e d i t o r i a l
WHITHER PHYSIOTHERAPY?

From recent reports in the medical and physio­
therapy literature, it is clear th at the profession has 
reached a cross roads. Crucial decisions have to be 
taken about the training of future physiotherapists in 
order to determine the direction the profession will take 
in the future (Wyke, 1980). A wide spectrum of practice 
already exists in some countries. In the traditional 
model all patients are referred to the physiotherapist 
by the medical practitioner, often with very precise 
instructions as to the physiotherapy to be administered, 
relegating physiotherapists to the level of technicians. 
However, a new breed of physiotherapists, acting as 
independent professional consultants in their own right, 
have developed. This has engendered feelings of threat 
in medical practitioners who feel that “ colleagues, 
^alued for their skills, respected for their own training, 
fee increasingly transgressing the sacred clinical boun­
dary between doctor and patient” (Pearce, 1980). He 
feels that allowing paramedicals to be directly involved 
in determining a patient’s treatm ent is as unsound as 
it is frankly dangerous and wonders who is responsible 
and answerable in law, should things go wrong.

In a study conducted to explore the physiotherapist/ 
doctor relationship in two aspects, viz. the performance 
of doctors as team leaders, consultants and resource 
personnel; and the physiotherapist’s desire to interact 
with doctors and medical students, some interesting 
findings came to light (Ross et al., 1980). The doctors 
acuse the physiotherapists of a “drive for independence, 
away from medicine and the medical model”. The 
physiotherapists on the other hand felt that the doctors 
were not performing well as team leaders and that 
there was a breakdown in the multidisciplinary team 
and communication, in both directions. The team leader 
should delegate and leave individual team members 
autonomy and authority over details. As doctors receive 
very little instruction in physiotherapy, it was felt they 
are qualified only to give a diagnosis and desired out­
come of therapy when referring patients. It would seem 
reasonable that the physiotherapist should decide on the 
modality of treatment after being given full information 
about the aims of treatment and likely outcome, drugs

being administered and disease characteristics. After all, 
treatm ent should be geared at the individual. The inves­
tigators concluded that physiotherapists wished to be 
members of the team but that it is the proper place of 
the physiotherapist and doctor in the medical team that 
is controversial.

In the midst of all this controversy, the patient, who 
is most concerned as the consumer, appears to have no 
say. Physiotherapists and doctors alike should learn to 
listen to the patient and communicate with him in a 
meaningful way. The doctor/patient relationship is 
often seen as a symbol of the doctor’s independence 
and interference is professionally threatening. Doctors 
feel th at only they should diagnose as it is safer and 
the proper role of the doctor (Bowling, 1980). However, 
as much as patients needs doctors, doctors also need 
patients with problems to solve.

The explosion of new knowledge in areas such as 
biophysics and neurology will undoubtedly lead to 
improved understanding of physiotherapy techniques 
and result in more effective skills developing, but it 
would be a pity if the art of physiotherapy is lost in 
the process. There seems to be a need to develop a 
more consumer-centred health service, where the patient 
and his needs are the most important considerations. 
Until this happens, the anxieties of the various profes­
sional pressure groups may take precedence and impair 
and delay the development of a really caring health­
care system.

References

Bowling, A. (1980). Who is afraid of the paramedic?
World M edicine 15, (June) 48.

Pearce, J. (1980). Whose patient is it anyway? World 
Medicine 15, (February) 70.

Ross, C. A., Roberts, L. W., Olson, L. (1980). The. 
doctor-physiotherapist relationship: the physiothera­
pists perspective. Physiother. Canada 32, 219-223. 

Wyk, B. (1980). Perspectives in physiotherapy. Physio­
ther. Canada 32, 261 -267.

Contents - Inhoud

W ith er Physiotherapy? —  E d ito ria l ...................  3

P.U.V.A.-Photochem otherapy o f Psoriasis w ith 
O ral 8 -M ethoxypsoralen and Long W ave Ultra
V iolet R adiation ....................................................  4

M icrow ave D ia th e r m y ....................................................  7

The Therm al E ffe cts o f Pulsed U ltr a s o u n d ...........  10

T em perature Changes Induced by C ontinuous
U ltra soun d ............................................................. 1 3

M edical O ffic e rs ’ A ttitu d e s  Tow ards P hysiotherapy 15 
The Role o f Physical E ducation and S po rt in a 

C ecrebral Palsy School and the In te ra c tio n  of

T hera pists and Physical E du catio nists ...........  17

C lassified —  Vacancies ............................................  2 2

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