A voice. A commentary. A thought.
The context of this Physiospot Voices post surrounds a guest blog post at Exercise Works! titled “Health Equals Fitness, Fitness Equals Health.” You can find these two posts here at: Part 1 – and – Part 2.
The premise of this guest article was based on the fact that much of recent physical rehabilitation literature has pointed to the musculoskeletal (MSK) system as the most reliable indicator of health; this expands to morbidity, mortality/survivability, quality of life, general wellness, etc. The momentum in this line of thought has only been accentuated by a JAMA article published in 2011 titled “Gait speed and survival in older adults” (Studenski S et al) which concluded gait velocity was a better predictor than the usual measures of age, gender, past medical history, blood pressure, or diabetes in relation to survivability in older adults.
With this in mind, and, when considering the many online discourses on the need for a primary care musculoskeletal healthcare provider – I was hoping to generate some interest, discussion, and advocacy by broaching a case for the “Primary Care Physiotherapist (Physical Therapist).”
In my guest posts from Exercise Works!, I identified three notable predictors of health outcomes – all which were firmly seeded in the musculoskeletal system: (1) gait velocity, (2) the ability to sit/stand (as noted from the “Short Physical Performance Battery”), and, (3) fall/floor recovery – the ability to get off of the ground. These three performance tests of the musculoskeletal system have been impressively established as prognosticators of human health; cited in these posts were peer reviewed publications which noted superior accuracy in predicting health when compared to traditional biomedical measures.
And thus, the question begged: As science and medical literature has demonstrated that long term health concerns ultimately circulate around the musculoskeletal system, why isn’t there a primary care provider in this venue? Moreover, as the traditional medical concerns (while important, as they are) of past medical history, gender, blood pressure, internal organ function, labs, etc. have unfortunately been shown to be less predictive than musculoskeletal contributions to health status. My thoughts ran further to what a typical visit to a primary care provider tends to look like in the scope of an industry norm. I think most of us have experienced something in the following:
You go to your general practitioner… your primary care physician… your family “doctor” or perhaps a nurse practitioner. Their knowledge and training is largely in medical concerns, centralizing in the internal organ functions, prioritized by heart/lungs, liver/kidneys, then GI.
The usual visit begins with a medical assistant or nurse to check your blood pressure, heart rate, and temperature. If you’re lucky, they will check your respiratory rate. When you get examined by your provider, they will check your eyes, your ears, your heart sounds, your lung sounds… and, if your doctor is “old school”, they’ll palpate your abdomen for tenderness.
In the end, you’ll get a biomedical explanation of what is going wrong, and, a prescription drug (and sometimes an over-the-counter alternative) to placate your ailments. Sound familiar?
So, I must ask: Do they check your muscles? Do they thoroughly check your joints? Do they objectively score & examine how you get on and off the chair and/or examination table? Will they analyze your gait? Are you lucky enough for them to assess your fall recovery strategy? Are they experts in balance disorders, trained to analyze your vestibular system and general equilibrium?
In the frame of established science by which human health can be best predicted by physical performance measures, I must painfully, reluctantly, and respectfully ask the question: “Who is the real doctor?”
Answer: The Physiotherapist (Physical Therapist).
Consider this classic study by Childs et al 2005, “A description of physical therapists’ knowledge in managing musculoskeletal conditions” which concluded that “Experienced physical therapists had higher levels of knowledge in managing musculoskeletal conditions than medical students, physician interns and residents, and all physician specialists except for orthopaedists.” Being that this publication was nearly 10 years old, and that physical therapy training has largely progressed into the doctorate level of education & training, it gives sound reason to consider that physiotherapists are quite possibly able to outperform even the orthopedists at this present time in management of MSK conditions given a replication of this study.
In a time when healthcare has become a social construct, an economic desperation, an ethical turmoil, and a cultural uncertainty which looms upon the public, I look to innovative minds who have demonstrated historical significance in forging solutions.
The words of Thomas Edison resonate: “The doctor of the future will give no medicine but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease.”
Does this not describe your Physical Therapist? Who else, in healthcare, holds conservative measures upon dispensing drugs, specializes in the human frame, are quickly penetrating the nutritional scope en masse – AND – innately provide care through a causation-intervention/prevention model?
Now, I’m not by any means downplaying significance of primary care internists or family practitioners. Certainly, I am not disregarding surgeons nor other allied healthcare professionals. All these areas of practice are necessary for their respective scopes of practice; we need them all for their content expertise.
I am, however, pointing out that the scientific literature has identified a gaping hole in healthcare; an area for which all individuals, consumers, subscribers, clients, patients, customers, beneficiaries, and otherwise of healthcare should and MUST have access to achieve best health. And, as such, I must point out that the market leaves the same gaping hole: we have a primary care physician (typically filled by an internist, general practitioner, or family doctor); we have a dentist, an optometrist, and even a family counselor for mental/emotional health.
The gap proves more than self evident; the need for which the public requires to be filled, is a musculoskeletal primary care provider. And, as musculoskeletal health & movement defines human life in better terms than all the other traditional medical measures, I must present this case for the emergence of the Primary Care Physiotherapist/Physical Therapist (PT). The presence of a Primary Care PT should be an open option for public access. The profession is compassionate, realistic, problem solving, accurate, evidenced based, data driven, and highly economical.
The Physiotherapist (Physical Therapist) is the only professional suited to fill this public health need – a cry for a musculoskeletal primary care provider.
This is my voice. My commentary. My thought… what are yours?