Physiotherapy and populations; the missing link?
Article Type: Editorial
Subject: Physical therapy (Practice)
Therapeutics, Physiological (Practice)
Physical therapists (Practice)
Medical care (New Zealand)
Medical care (Supply and demand)
Author: Chadwick, Martin
Pub Date: 03/01/2011
Publication: Name: New Zealand Journal of Physiotherapy Publisher: New Zealand Society of Physiotherapists Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 New Zealand Society of Physiotherapists ISSN: 0303-7193
Issue: Date: March, 2011 Source Volume: 39 Source Issue: 1
Topic: Event Code: 200 Management dynamics; 600 Market information - general Canadian Subject Form: Medical care (Private); Medical care (Private)
Product: Product Code: 8043600 Physical Therapists; 8000001 Medical & Health Services; 9105210 Health Care Services NAICS Code: 62134 Offices of Physical, Occupational and Speech Therapists, and Audiologists; 62 Health Care and Social Assistance; 92312 Administration of Public Health Programs SIC Code: 8049 Offices of health practitioners, not elsewhere classified
Geographic: Geographic Scope: New Zealand Geographic Code: 8NEWZ New Zealand
Accession Number: 263880332
Full Text: Confession number one: In the first half of my career I never read an editorial In a physiotherapy journal. Confession number two: in the second half of my career I often do not make it past the editorial. In reflecting on these confessions I believe that the first was due to being very focused clinically and not being interested in the greater happenings of the profession. This clinical focus has now shifted over time to a deep caring about what is going on in the broader aspects of the profession. It was this care and concern that led me to e-mail Fiona Murdoch to discuss further the article that was published in the last edition of the NZJP, wherein lies a chief lesson of this editorial, do not engage the author or editor in ongoing dialogue lest you end up writing the editorial!

My dialogue with Ms Murdoch was along the lines of "good article, but what does it mean for physiotherapy?" This is why I now enjoy reading editorials as they are a flavour of what is going on at the time, what is topical for the profession, and what articles such as Ms Murdoch's mean for it.

A review of publications in the NZJP over the last 6-7 years reveals an ongoing questioning as to who we as physiotherapists are, and how we now "fit" into the crowded healthcare landscape. The article published by Nichols and Larmer (2005) asked the question whether we as physiotherapists still saw the body as a machine and ourselves as the mechanics, or whether there was a shift towards seeing more the body of a person in their environment and how we were choosing to respond to it. A second article published by Nichols, Reid and Larmer (2010) asked the question as to how physiotherapists were placed to contribute to a rapidly changing healthcare scene, and what are the opportunities we as a profession are willing to embrace. The most recent article by Murdoch (2010) begins, I believe, to provide a direction for us collectively.

That the profession is changing is I now believe an irrefutable fact, driven in a large part by the changes in the ACC funding of services. It has however forced us as a profession to ask some very deep and difficult questions; who are we in the healthcare system, and how do we choose to place ourselves now and into the future. There is a key word in the last sentence, 'choose'. What do we consciously choose to do? Do we choose to continue to view the body as a machine, or do we choose to see the body of a person in their environment and respond to it? Do we or should we care? This is of course a leading question, as I believe that as a profession we have always cared about the environment of the individuals we see to a greater or lesser extent, but I would also argue that we have not done as good of a job in caring about the wider community in which the individual lives.

Herein lies a future path for us professionally, to better understand and to be better engaged with the wider health needs of our community. Murdoch in her article states that there is a growing demand for services to be provided to the older person, and this demand is only set to increase in the coming years. Des Gorman as the current chair of Health Workforce New Zealand describes healthcare as a taonga, a treasured possession that the public of New Zealand expects and will not give up easily. In this context, there will be a growing demand for healthcare services that will not easily be given up and it would take a very brave political party to suggest they be given up in any shape or form. So if this is the demand for healthcare services into the future, how well placed are we to meet it? Do we as a profession have the skills and ability? Absolutely.

Another growth area in healthcare is the management of long-term/chronic conditions. The incidence of diabetes in Counties-Manukau where I am based is threatening to overwhelm the healthcare system, let alone respiratory conditions such as Chronic Obstructive Pulmonary Disease. The evidence of the benefit of interventions that can be provided by physiotherapists is extensive, and yet how much of our workforce is devoted to providing care in these areas?

Change is often not an easy process, and there is some thought that it can take ten years to change the culture in an organisation. While a profession such as physiotherapy is not an organisation, there can be some comfort in recognising that change can occur gradually. Kotter (1996) is recognised as one of the key authorities on change and he describes creating a desire to change; that desire could be because the current state is too uncomfortable to stay in; or because the future state is so much more desirable than the current state. I believe that the current state of the profession has become too uncomfortable for many to continue on in, but the future state is still too unclear to want to change. However, I do also believe that there is a very viable future for the profession, but it will require us collectively to look at the present healthcare state, to look at the needs of the communities where we live, and begin to identify in new and different ways how the wonderful skills and talents we have as professionals can be used.

Lastly, an editorial tends to be grounded in what is topical at the time and I would be remiss to not acknowledge the tragedy that has unfolded with the Christchurch earthquake. Our hearts and deepest sympathies go out to those who have been affected, and I have no doubt that our profession will have a needed role to play in the healing of the region.

REFERENCES

Kotter JP (1996): Leading Change. Harvard Business School, Cambridge MA.

Murdoch F (2010): An overview of DHB-funded health services for older people in New Zealand. Current situation and future need. New Zealand Journal of Physiotherapy 38(3) 113-119.

Nicholls D, Larmer P (2005). Possible futures for physiotherapy: an exploration of the New Zealand context. New Zealand Journal of Physiotherapy 33(2) 55-60.

Nicholls D, Reid DA, Larmer P (2009): Crisis, what crisis? Revisiting 'possible futures for physiotherapy'. New Zealand Journal of Physiotherapy 33(2) 55-60.

Martin Chadwick MHS, PG Dip HS, MPNZ

Director Allied Health

Counties Manukau District Health Board

Email: martin.chadwick@middlemore.co.nz
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