Ethical Discussion: Public Displays of Medical Conditions and Your Responsibility in Addressing Them

I was at a Hibachi Grill with my fiancé's family when I noticed something different. It wasn't enough for anyone else to notice, it seemed, just enough to peak my interest. As many of you know who have been to these establishments, the chefs cook on a hot grill in front of your dinner party and commonly interact with the dinner-goers. They squirt water or sake in your mouth, have you catch hot food off of the spatula, etc, etc. But in this instance, a man across the room at a different table wasn't interacting quite like everyone else. While everyone at his table was laughing and interacting with the chef, this man was stoic without reaction. He blinked quite sparsely. He didn't react with any sort of emotion, nor reacted with the members of his party. His chewing was mechanical in nature with food spilling out occasionally. He neither looked engaged nor particularly disengaged, he just simply was existing at the dinner table, quite possibly without any knowledge of his surroundings.

Then it happened. The chef began challenging people at the table to catch remnants of the food he had cooked out of the air with a toss from his tools. Everyone was laughing an enjoying himself and then it came time for the man to participate in this feat. First toss. He didn't react. Everyone laughed and jeered. Second toss. He didn't even blink this time. His party continued to tease him. Third toss hit him square between the eyes. No reaction. The man continued to chew and spill his food. And the chef moved on. At the end of the meal as they filed out, the man demonstrate difficulty initiating movement from sitting to standing, was unable to don his coat without help, and shuffled out of the restaurant with his family, festinating at the beginning of his attempt to leave.

This was quite possibly one of the most cringe worthy-experiences I have experienced in a social context. This man obviously had something wrong with him. Without objective measures, my highest suspicion was possible Parkinson's Disease. This event made me ponder. What is our responsibility in this matter? Do we educate? Do we intervene? Do we engage at all?

Now, I would hope that if this man's family was aware of his condition, they wouldn't have laughed and jeered in the manner that they did at his inability to catch the food from the air. I'd like to think that they would have either educated the chef, asked him to stop, or maybe even avoided the situation all together. But maybe not. Maybe they were aware of his diagnosis and were determined to live a normal life, despite the symptoms and the stigma. Maybe this was a discussion that hasn't occurred yet, and without a consent to treat provided by the patient (and I consider education a treatment), I am outside of my legal boundaries to act otherwise.

With the opportunity that the intervening physical therapist could be hailed as a hero, that same person has as equal an opportunity to be hailed a villain.

There was a recent article floating around on the DPT student Facebook page about a PT who was on a flight and was able to identify and treat a case of BPPV in a flight attendant on the flight. She was hailed as a hero, but she had a very unique set of circumstance in this situation. First, a medical doctor was present on her flight and was able to assist the PT in clearing the patient of any cardiovascular or neurological conditions. This gives her extra credibility in the eyes of the public who aren't familiar with the services that direct access PT can provide. Second, this PT has extensive training in management of balance and vestibular disorders and was comfortable intervening. Without this training, injury could result to the patient, thus making a bad relationship worse. Third, the individual who was experiencing the condition was able to be educated on her care, and provided a verbal consent to the treatment provided.

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This was a near perfect situation and leads to little discussion on the pros and cons. However, if even one of these components is less than perfect, it's a recipe for a hefty lawsuit where even the best intentions can get you into trouble. If you are intervening to inform a patient that they might have Parkinson's, you are breaking several rules. First of all, that person never consented to your treatment, and education is an intervention. Second of all, as a PT, while we can screen for conditions such as Parkinson's Disease, CVA, and other impairments, we technically don't diagnose them. This makes your actions an automatic violation of scope of practice, demonizing our field as overzealous and giving the AMA more fuel to use against us in our campaign for full and unrequited direct access. Lastly, while Good Samaritan laws exist in many states, these truly are reserved for emergent situations. And even then, you need to ask the individual if they desire your assistance, and if the answer is no, your hands are tied at that moment. Good Samaritan laws vary from state to state, and people are still able to sue around them.

This is an important issue to discuss, revisit, and continue to digest in our field. As our field shifts, our role in the eye of the public will as well. When people ask for an individual with medical training to assist in an emergency, not even their 6th choice is that of a physical therapist, despite our extensive training in school. My fiancé is also a DPT and didn't even realize the situation until I pointed it out to him. I attribute this to our differences in training. I work in inpatient rehabilitation and am used to identifying medical emergencies and symptoms of diseases that might be developing in people who are already medically delicate. He works in the outpatient manual therapy setting and isn't as attune to treating every change and behavior as a potential crisis. This is similar to an endocrinologist treating patient for a heart attack. They don't have the skills necessarily and neither will we at times.

Our experiences lead to our actions and will continue to build the public's opinion about us, so let us work towards building a positive interaction by being mindful of our actions and the perceptions that others have of us.