Autonomy or isolationism? (Letters to the Editor).

To the Editor:

I have read your Editor's Notes in the February and March 2003 issues of the Journal. In the March issue, you state that many practitioners in academic health centers are unable to use the literature or to engage in dialogue that would demonstrate excellence.

Are you saying that they are incapable of doing so because they are educationally unprepared to do so? In some cases, that is probably true. It is also true, however, that in many of these centers, the physical therapists are not "invited," just as women are not invited to be members of certain country clubs. The physical therapists in those settings are the "worker bees." They could produce excellent research and be totally ignored or discounted. The environment does not support the worker bees doing research. It is a cultural thing. If a knowledgeable physical therapist happens to live in a community, but does not work for an institution with an academic health center, competition will prevent that physical therapist from being involved in research.

I agree with you that "autonomy" is not the most appropriate word for our goal as a profession. "Direct access" is, because when physical therapists can demonstrate their value and professionalism to the health care consumer, we will be able to overcome the cultural barriers maintained by some of our medical colleagues. I believe that some physical therapists use the term "autonomy" because they are tired of "asking for permission" and not being invited to join the country club. I do agree with Jette (1) that academic and clinical physical therapists are too isolated. Each group is doing their own thing.

Tony Oliveri, PT, MS, OCS 

References

(1) Jette AM. Invited commentary on "A Quantitative Analysis of Research Publications in Physical Therapy Journals." Phys Ther. 2003;83:131-132.

Editor's Response:

If physical therapists are unable to use literature, that would mean that they would have no idea about what constitutes contemporary practice, and they would also lack the ability to use evidence and the literature to better serve their patients. In other words, they would be practicing in violation of APTA's Code of Ethics because they would have no idea about what interventions have been shown to be effective or ineffective. These therapists--who were not the subject of my remarks--should be considered incompetent and unworthy of employment or licensure. For physical therapists who choose not to use, know, and cite the current literature, but have all the cognitive skills necessary for these tasks, the same may be true.

A failure of will represents a choice on the part of the physical therapist. In some ways, that is even sadder, and therapists who do not live up to expectations were the focus of my remarks. Your metaphor, I believe, misses the point. Worker bees are born into a hive and are genetically predetermined to carry out a task. Humans--and, most important, professionals--have choices. Therapists can leave their jobs! Therapists are obligated to not function in an inappropriate manner, and they are obligated to find employment where their professionalism is not compromised.

You appear to suggest that physical therapists need to be invited to behave properly, that is, to use and, you contend, to generate literature. Your analogy to women not being invited to join country clubs is interesting. Since World War II, there has been radical change in the way our society treats African Americans and women, and although I would not contend that they have the same free and open access to all aspects of our society, I would also note that neither of these groups waited for an invitation. If you want something that is proper and necessary, you work to achieve the goal and do not, in my view, wait for the invitation.

If physical therapists behave in a way that brings credit upon the profession, they assist not only themselves but their colleagues. Once again, I believe that this must be done where members of the healthcare team are educated, and, more likely than not, that is in academic health centers.

Jules M Rothstein, PT, PhD, FAPTA Editor in Chief