Appropriate Treatment Good; Inappropriate Treatment Bad

Photo Credit: Carl Carpenter

Photo Credit: Carl Carpenter

Ok. So you know that I don’t like the idea of defining the world as “Good Things” and “Bad Things”. I also generally don’t like politics and advertising. Both have the one goal of defending a position no matter what. I’m just not a fan of blind promotion. It really leaves you open to the false dilemma fallacy.

Even though I am a physical therapist, I am not a fan of blind promotion of physical therapy. I think it hurts the profession more than it helps. More importantly, it hurts patients.

One example in particular is when we compare ourselves to other providers and treatments wholesale. This is almost always as a comparison to the horrible and evil demon-practice commonly known as “surgery”. We will cite a study then add our own synopsis headline, “Physical therapy shown to have better outcomes than surgery for [enter common malady]!” It is usually some ambiguous and non-specific disease like “pain” (neck pain, back pain, knee pain, shoulder pain, etc), whatever that means.

Now I won’t even get into what they define as “physical therapy”. Since a lot of these physical therapy treatments are known to have minimal effects, what many of these studies define as “physical therapy” may be better described as “supervised neglect”. Probably not something that we should be screaming from the rooftops.

The headline that should be promoted is, “Appropriate treatment shown to have better outcomes than inappropriate treatment.” But that isn’t very sexy now is it?

Why must we always portray ourselves as the alternative to other treatments such as surgery? In some situations, we are the most appropriate provider for the job. In other situations, we are not. I hate to tell people this, but sometimes surgery is warranted (GASP!). Through a proper screening process specific to each presentation, certain patients can be identified as appropriate for surgery (or physical therapy, or pharmacological interventions, etc). It would not be in the best interest of the patient to stubbornly keep them from the most appropriate care whatever that may be just in the name of “self-promotion”.

Are surgeons really “evil”? Actually, they have the same issues that we have. Part of the requirement that we have for each physical therapy student that comes through our facility is to spend some time shadowing a surgeon in their clinic. Watch patients beg and plead for surgery. Watch the patients wish for the surgeon to explain their symptoms in a way that can be fixed by surgery. Watch the patients want to worship their surgeon as their savior.

Now, of course my students shadow evidence-based, ethical surgeons who would never bow to such pleas. But it becomes obvious how easily a surgeon might start to think, “Maybe we WOULD find something during surgery that is the true cause of their problem. I don’t want to neglect and dismiss this patient when I MIGHT be able to help them. I should at least TRY to help them.” Next thing you know, the patient has an inappropriate surgery.

Sound familiar? This is the defense used by physical therapists who continue to use treatments that have been shown to have little value. “We can’t just educate them and turn them away! We must at least try SOMETHING!” We ask what COULD we do, instead of what SHOULD we do. There really is no ethical difference between that and inappropriate surgery. Inappropriate care is inappropriate care – no matter how harmless and cheap you may think it is.

The most compassionate thing you can do is educate and try to determine the most appropriate plan of care, even if it is a plan of care that you yourself cannot provide.

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