Our identity and the power of touch.

Voices heard through a doorway are often unwelcome intrusions. But such was not the case recently when I overheard one of my former students interacting with her patients. I found the sound soothing, reaffirming, and a source of remarkable pride. As the recession threatens our ability to provide care for patients and to educate new generations of therapists, and as DRGs, CPT codes, and shortages haunt our working days, it is easy in our own working environments to become alienated from the sources of our profession's strength. The grass may not be greener in your neighbor's yard, but often it seems that way because you can view it for what it is, not for the problems that it presents. Thus, the voice of my student was a welcome reminder of a reality that defines us as a profession and provides us with the spirit that has made us grow and prosper.

The therapist I overheard while I worked at my computer was using a variety of orthopedic techniques on a series of patients, but what I remember most vividly was not the techniques themselves, but bearing the way she touched her patients.

There can be no doubt that physical therapy is a profession heavily dependent on our manual skills and our abilities to invoke proper techniques, but what has always set us apart from most other professions are the interactions we have with our patients, the partnerships in which we join when we work together with our patients. In an era when the word "touch" has been co-opted to describe the dexterity of manual therapists or the mystical therapist-patient interactions that are supposed to occur with fringe treatments, we have lost sight of the word's simplest and most beautiful meaning. To be touched does not require a physical interaction. When the Berlin Wall fell, we were all touched, and I for one am deeply touched when I hear Beethoven's Ninth Symphony or when I see a child reassuringly reach for a parent's hand.

We touch when we take the time to relate and to use all of our skills. When orthopedic therapy becomes relegated to the isolated uses of manual therapy techniques, with emphasis on snaps, crackles, and pops, we are not touching. But when we teach our patients and use our skills as movement specialists by relating to our patients, we are touching. Similarly, when we work with children or adults with neurological injuries and see them merely as collections of neurological signs and symptoms, we lose our unique essence as professionals, professionals who even in the presence of neurological deficits can somehow touch something within our patients to make them more a part of the world they live in. And although we cannot return patients with terminal illness to the lives they led before, we can aid them with compassion along their fearful journeys.

There is a false dichotomy that is created when people talk about the art and science of physical therapy. Science takes no position on the issue of human interaction and neither does art, but physical therapy should. The real issue is that we owe our patients the best possible care, and who can argue against the use of science and research as the most plausible means to this end? But that does not and never will preclude the need for us to touch our patients and to be touched by them, to share with them our common humanity as well as our professionalism. How fortunate we are to be in a profession that calls upon science to express the best in human values and to achieve beneficial human interaction for the purpose of bettering lives.

Like many therapists struggling to start their own practices and to maintain a high quality of care, the therapist I overheard the other day has doubts about whether her enterprise will be a success. The bottom line is a real issue in business, and health care is a business. But there is something beyond the bottom line on a ledger sheet. In all practices, be they private, institutional, public, or what have you, we should never lose sight of our roles as caregivers who touch more than the bodies of our patients. Surrounded by the financial exigencies of our daily lives and the bureaucratic nightmares, we sometimes need to hear voices through doorways to remind us of the beauty that is practice and the joy that can be realized through service.