Mary (McMillan) Did You Know?

On Tuesday, Clinicient, an EMR and billing software company, released what they deemed as their list of 100 Most Influential People in Physical Therapy using the Little Bird search engine. But here is the kicker...you had to have a a Twitter account to be considered for the honor. Here is a great article on how Little Bird works, including pros and cons to the use of the system. (I strongly recommend scrolling down to the "Tips on Using Little Bird" section.) Hint: it all has to do with visibility on social media. Yes folks, this system does not take into account how many articles you have published, how many committees you've chaired, or the number of terms you have served as APTA president unless you are fervently tweeting/posting about these things.

I will just add the disclaimer that I really don't object with the content of list which was compiled. Many of the names I did recognize and the accomplishments of these fine professionals are absolutely stunning. Everyone of those people on that list deserved to be there; there is no doubt about that. However, I couldn't help but notice that there were several names I would have liked to see on that list that were not present.

Now...let us dissent.

Our digital age has finally come to a point where until you submit your thoughts, accomplishments, and ideas via a service limiting your creativity to 140 characters, you cannot be considered to be influential in our great field. I can easily correct this debacle by changing the title of the article. Had it been printed as "100 Most Influential People in Physical Therapy on Twitter" I could have easily brushed this off as another millennial thing. But because of the way the title is presented, it forms a lattice that is not only deceiving in nature, but extremely misleading to members of the PT community, and those external to it as well. It also pains me that this article was written not by somebody who is a member of the PT community, but by an outsider source who used a single method to determine the importance and value of members within our field. I can see how this might eliminate bias, but the strength of accomplishments isn't usually an objective one to compile. Heck, even as a member of the APTA, and someone who is moderately involved, I feel like I am still trying to navigate the connections between everyone here. So how can an outsider successfully do it with a single subject design?

When I investigated the matter further, I realized that many of the people who I consider to be giants in the field don't actually have social media (mainly Twitter) accounts. Yes, that's right folks. It is possible to be successful in this world without using social media to brag about all your adroitness in real-time. People like Tim Kauffman, who has been calling for renewed focus on Geriatrics years before the latest Mary McMillan lecture; Marilyn Moffat, who has a laundry list of accomplishments such to satisfy any young professional's wet-dream; Joshua Cleland, whose name has been on nearly all the most pertinent literature in orthopedics for the last 15 years; and Shirley Sahrmann, whose entire life has been dedicated to the advancement of physical therapy. Also, where are our original giants in the field? What about Mary McMillan? Catherine Worthingham? We have awards named after them...so why do they appear so obsolete? As this list is mis-titled, I feel that it serves as a giant slap in the face to the professional behemoths who quietly work and continue to impact the field of PT in ways whose significance cannot be contained in a single tweet.

While I believe many of the people on this list deserve to be on it, I must relegate this list to have the strength and relevance of no more than a single subject design/case study. Without more factors, how can you determine a person's worth in such a complex and effervescent field? I have no doubt that with the addition of other factors (research, service, academia positions) many of these individuals would stay on the list...if not rise up in rank!

Nevertheless, I implore you to explore the list, make new connections, and continue to fight for our field. Use this as a tool to assist in guaranteeing the success of the future of physical therapy.

Was there anyone who you thought should have been on the list and wasn't? Leave a comment below and explain why!

The Art of Dissent

Often times, dissent is seen as opposition. Dissent is the antithesis of progress. Dissent is evil and bad and should be eradicated. You're either with us or against us. (Who is "us" anyway?) I believe these paradigms are inaccurate, however. Dissent is an essential component of progress.

One of my favourite quotes came from Lisa Alther in Kinflicks (1975): "The degree of a person's intelligence is directly reflected by the number of conflicting attitudes she [he] can bring to bear on the same topic." Too often, I see people jump on some awesomely-furnished band-wagon whether is be politically, professionally, or otherwise. They will blindly follow directions and complete orders without even questioning if it is right or appropriate to do so. I feel that it is a part of our basic human nature that is difficult to overcome. Let's face it, humans are pack animals. We like to belong and be accepted and feel like we are doing something for the common good. However the common good requires that each individual agree that what they are doing is the best course of action. The common good can't be good if only a select few people are calling the shots and the rest of us blindly follow. This leads me to another obscure literary reference regarding the "Two Minutes Hate" in George Orwell's literary classic, 1984:

Within thirty seconds any pretense was always unnecessary. A hideous ecstasy of fear and vindictiveness, a desire to kill, to torture, to smash faces in with a sledge hammer, seemed to flow through the whole group of people like an electric current, turning one even against one's will into a grimacing, screaming lunatic. And yet the rage that one felt was an abstract, undirected emotion which could be switched from one object to another like the flame of a blowlamp. 

The "abstract rage" that the crowd experienced was because they didn't have a personal connection to the topic. By dedicating time from your lives to really explore a topic, you become more vested in it. This is evident by those of us who are passionate about sports (can't watch one game and be a fan), literature (can't judge a book by its cover...or associated English assignment), or fandom (can't say you're a fan before you've watched it until your eyes bleed and your heart hurts). 

With this upcoming November being a major election season, I think that it is even more important now to educate ourselves on what is means to dissent and think critically. Now, I am not encouraging anarchy. I am simply encouraging you to take a step back and think on an issue from all sides. When you are able to not only think as your audience would, but also your enemies and allies, I believe that it strengthens communication as you can at least understand the opposing view, even if you don't agree with it. 

I don't dissent to stunt growth, I dissent to foster it. And I intend to apply these principles within this blog and throughout my professional life. 

PT vs. Opioid Use: Missing the Mark(-eting)

Image from www.moveforwardpt.com 

Currently, the APTA is on a campaign against Opioid addiction and the over-prescription of medication in the treatment of chronic pain. The APTA has long-advocated for involvement in pain management of its community. The CDC has even issued a statement that physical therapy and other non-pharmacological avenues should be the first line of defense when treating chronic pain.

Pros

Now, there are several elements that I agree with in this message:

First, do I think that physical therapy should be advocated for by both PTs/PTAs as well as other health care professionals in terms of managing pain?

Yes.

Second, do I think that medications are over-prescribed or improperly prescribed for issues that physical therapy can treat?

In some cases, yes. 

Third, do I think that patients tend to rely heavily on their medications for pain management? 

Sometimes! In one of my clinical rotations for school, I worked with a chronic pain population, and some of them did use prescription medications to manage their pain...but a large number of them did not and outright refused to use them.  Those that did largely used them as an adjunct or last-resort when symptoms got out of control. 

I think that in today's society, we look for the quick fix. How can we do this faster so we can get on with the fun parts of our day? Physical therapy typically isn't the quick fix, especially when it comes to managing chronic pain. We can implement techniques to assist in pain control, but until the patient is able to master these techniques (such as reduce their stressors...which...let's face it, isn't always possible), our methods might need supplementation.

Cons

Now I would like to start the dissenting portion of this review by stating that I truly have no qualms with the message that the APTA is attempting to convey. I actually agree with it wholeheartedly. Why cause more problems (such as drug abuse and addiction) when there are alternative methods to approach the original issue? My true dissent actually lies with the marketing of this idea.

From the moment I laid eyes on the image you see above, I was appalled. I found several flaws in this marketing campaign, and I will list them out below.

1) Over-simplicity. The paradigm this picture is presenting is too simplistic. The inclusion of the word "versus" is the real downfall here. In Latin, the word versus means "against." It can also be translated "as opposed to." That makes the two options mutually exclusive from one another, relegating the observer to a choice between one or the other. If I were an average Jane off the street, I might take one look at this picture and think "great, once I start therapy, I don't have to take my medications anymore." Now, while we did not directly instruct them on this, our marketing led them to believe that they can have drugs OR therapy, but NOT both. This can be inherently dangerous with some medications such as mood stabilizers or those used for controlling blood pressure. Additionally, patients in the acute stages of injury might require pain medications to participate in therapy services. I haven't seen many patients in the acute care setting who can participate in PT without medication before hand. Now while this campaign was created in relation to chronic pain, the word "chronic" is no where to be found, feeding into the continued theme of over-simplistic delivery. This simplicity delivers an unknowing ultimatum to the community, which I don't quite think was the intention of the APTA.

2) Scope of Practice Issues. It insinuates that PT somehow manages addiction. Quite a bold move from a group of people that can't even suggest an NSAID. Now, while we can assist in the process and recovery of substance abuse and addiction (PTs do work in behavioral health hospitals), we don't actually assist in the detox process. Last time I checked, prescribing medications is out of our scope of practice. We can't give drugs, change the dose, or even suggest that they stop taking a medication (unless a medical emergency is occurring in which we call 911 to get an ER doc to make that call).  What we can do is call the doctor on the patient's behalf and discuss our findings, encourage honest communication in the patient/physician relationship, or offer resources to our patients. This picture suggests that we can do much more than that due to its facile nature. I can't think of many other ways to get the AMA riled up faster.

3) Demonization of Medication Use. Now I understand that this poster is related to Opioids, which are highly addictive and dangerous. They are considered to be a Schedule II narcotic, which is the second to most dangerous class of controlled substances. (For Reference: Schedule I are drugs that have no medicinal purpose, such as LSD, and are used only in strictly-regulated lab research.) It's super nasty stuff. However, I would like to point out that there is no mention of opioids in this picture. For all the common person knows, these could be Tylenol or Aspirin. Does that mean that our patients shouldn't take their daily aspirin and that some stretching could prevent their impending heart attack? Obviously not, but do I want to be the person in charge of this marketing when the APTA is taken to court and sued over false advertisement? Obviously not! Again, we are led back to the original theme of over-simplification.


Furthermore, not only was this posted on the internet, but it was also blasted all over Times Square as a publicity stunt for the world to see. I would like to point out, however, that the APTA is not the only organization to be doing this. The Partnership for a Drug-Free New Jersey also posted this equally disturbing, but somewhat more extreme sign as well.

Drug addiction is a serious and complex societal issue, and while I understand that marketing typically needs to be quick and snappy, I feel that the APTA missed the mark(-eting) on this great opportunity for advocacy and change. While I will continue to support the role of physical therapy in pain management, I will not defend the way it is being marketed.

The opinions reflected in this blog post are not representative of the views of the APTA, the CDC, or any other organization mentioned in this post.

Why Blog About It?

I am a technophobe. While I don’t dislike all technology, I dislike most of it. I write letters and send birthday cards. I find it disgustingly impersonal to “tweet at” a friend on her birthday or write a ridiculously long Facebook status post about how “MY friend is amazing to ME and has helped ME in so many ways and what will I do without her?” Get the picture? Despite that, I do have a Facebook account, I have used Twitter for class projects, and I hold multiple email accounts. But, obviously, this is a topic that is debatable, but we will save that for another post.

Again, I dislike technology, but I feel that this is an appropriate venue for reaching the masses. Its more permanent than a Facebook page but allows for greater depth outside of 140 characters (I’m looking at you Twitter!).

I am starting this blog as I feel that often, and this extends beyond just physical therapy, people are too reactionary. They don’t think, they do. They don’t stop, they run. They don’t disagree, they accept. We don’t take enough time to really delve into the darker side of the issue for fer that is might change our opinion. We need to stop and think about who our intended audience is and what they will do with the message in addition to what seemingly non-involved parties will do with the message.

I guess what I am trying to say is that this isn’t one of those feel-good, bubble-gum, “look at me while I do all these amazing things” blogs. This is a blog about the issues and how they relate to PTs, SPTS, PTAs, sPTAS, other support professionals, and the greater community. This is a solution-oriented blog that will not only ask the hard questions, but also search for the answers to these disputes. In a way, we destroy the building, but then we are present to but it back together, stronger and better than before.

About This Blog

As the field of physical therapy is often under threat by other professional organizations, insurance company policies, brand intrusion, or other incidences, hasty responses are made in the essence of time to defend our noble profession. Are these the right responses? If right, are they executed in a proper manner? These are the questions we should be asking ourselves everyday.

The purpose of this blog is not to undermine or discourage the actions of the American Physical therapy Association (APTA), but to challenge its actions and views to assess their appropriateness, effectiveness, and impact on the world. Through exploring topics from all sides, we are  able to come to stronger conclusions, or perhaps choose a pathway that is more appropriate for the given situation. Thus, progress is born from the ashes of debate and discussion.

Mission: To provide a space for discussion of alternative hypotheses, dissenting opinions, and critical analyses in response to the hot button issues facing the field of physical therapy.

Vision: To challenge the views of physical therapy related topics in hopes of facilitating dynamic discussion and progress of the field.

In no way are the opinions expressed in this blog by any party a reflection of the views of the American Physical Therapy Association, Angelo State University, or any other entity or company discussed.