Professionalism: More Than a Word, Bigger Than the Profession
Read this Member Submission by: Chris Wilson, PT, DPT [...]
Before I get into the meat of the article, I want to present a concept for consideration: “Culture eats strategy for breakfast.” This was a concept I was exposed to at the APTA State Policy and Payment Forum and I think it is very powerful. What this means is that even when the strategy or decision making process is sound, if the culture isn’t ready for or accepting of change, then the strategy is doomed.
Strategy and culture change are very important to the APTA. Recently they completely revamped the vision statement which now reads: “Transforming society by optimizing movement to improve the human experience.” Take a moment to let that sink in if you haven’t done so already. In addition, APTA has woven professionalism into the core of physical therapy. It is the tie that binds. It separates our profession from those of technical trades, is a key component of our ethical practice and it is outlined in detail in the professionalism core values of Accountability, Altruism, Compassion/Caring, Excellence, Integrity, Professional Duty and Social Responsibility.
Historically, the profession of physical therapy was one of subservience to physicians. We weren’t always viewed as the musculoskeletal and movement experts we are today; in fact, many outside of PT still don’t understand our full value in those arenas. As a profession we have moved forward in increasing our role and practice with the advent of the DPT entry-level degree, numerous board certified specialty areas, residency and fellowship programs and the adoption of the principles of evidence based practice. In addition, all 50 states now have some element of direct access to PT. Yet we are slow to embrace and champion these advances outside of the profession. If you are a more senior therapist, ask yourself how has this progress changed my practice, my view of myself and my relationship with referring providers? If you are a relatively new therapist, ask yourself how am I embracing and leveraging these advancements in my practice and professional growth?
It is important to note that the message of professionalism is not limited to therapists and often starts with other members of the PT team. The front office team sets the tone in their initial interaction with the patient. Small examples include: Asking for a referral to see a physical therapist rather than asking for a prescription for PT. Asking if they have received services from a physical therapist previously rather than asking if they have tried PT. And, for those who have a DPT, referring to them as “Doctor” to convey the level of training to the patient while at the same time prepared to answer patient questions to ensure those without a DPT are not devalued in the eyes of the patient. Many of us may be leery of embracing our role as a doctoring profession; however if you have the DPT, you paid for it in time and money I encourage you to embrace it. You can always build a more informal relationship with your patient but setting that professional tone initially can go a long way.
Once the patient reaches the physical therapist, it is important that the therapist leverages the professional tone set by the front office team. Be consistent with your messages regarding the services of a physical therapist rather than the commodity of physical therapy. In addition, be mindful of your appearance. First impressions are important in PT like everything else. The benefit to physical therapists is that the patient sees you regularly and at least one study has shown that the importance of dress decreases with visits. But don’t rely on time, set the tone early. Studies have demonstrated that patients do recognize the physicality of PT and thus more formal physician-type of dress is not preferred. In looking at two studies, both patients and clinic directors preferred polos and khakis as the uniform of choice, representing a balance of comfort, function and professionalism. Just realize that a professional image is more than your clothes, it is a multi-variable concept.
As physical therapists it is important that we act as professionals with our patients as well as in our relationships with other members of the healthcare team including referring providers. Historically, our relationship with referring providers, largely physicians, was that of a parochial relationship likely developed from disparities in education levels, gender differences, practice acts and legislation, practice models, etc. As many of these disparities are changing and being reduced or eliminated, we have to be careful not to call into question the value of the referring provider either directly or indirectly. At the same time, we should expect the same of those referring providers. This becomes particularly evident if you are in an environment in which the doctors have a visible presence in the PT treatment areas. Our evolving role has us shifting from subordinate to peer. This is a significant change and as such it is important to embrace the change and perhaps err on the side of overt assertion of our professionalism initially until a happy medium is found.
Part of finding that happy medium is patient education. While we are great about educating the patient about home exercise programs, post-op precautions and the nature of their movement dysfunction, are we great at educating them about what we do and the value we bring? We need to have an elevator speech ready to go that is short, concrete and understandable by our patients. An example that comes to mind of the need for this elevator speech is an interaction I overheard between a respected colleague and one of his patients. While I didn’t get to hear how the situation was handled, I did hear the patient make an alarming statement. In short he viewed the field of real estate as much more complex than what we do as therapists. He couldn’t fathom how we needed 7 years of school to become a physical therapist when a realtor class was just 7 days. That says something about public perception, doesn’t it? In addition, as a DPT student at the University of Cincinnati, we had an orthopedic surgeon come and speak. He referenced a study of practicing physicians whose perception of training of physical therapists was comparable to an associate’s degree. I hope he was wrong or that it was an old study but it concerns me that it might be true.
Either way, it impresses the importance of asserting our professional skills and training in the public and within the healthcare team. It is important to remember we are peers, not subordinates and that our growing direct access status speaks to that point. Subtle changes can have a big impact here. For instance, when completing your note, do you sign “thank you for letting me treat “your patient””, referring to the physicians patient, or do you say “thank you for including me as a team member in the care of John Smith” or more simply “thank you for the referral”? When you conduct an initial evaluation do you present physical therapy as a commodity in asking if the patient has tried physical therapy before or do you present us as professionals in asking have they been treated by a physical therapist before? Subtle, but important differences. Communication is an art form but it is critical component of what we do as professionals. Of course our communication also carries over to the patient specific interactions we have with the referring providers. Keep in mind, that they, like you, are busy. Whenever you get ready to have a conversation, phone call, email exchange have a clear and objective message ready to go to be respectful of everyone’s time restrictions.
PT continues to move forward. Currently, we are moving forward in the form of seeking legislative change (in Ohio we are seeking to gain the privilege of ordering diagnostic studies and providing a diagnosis within our scope of practice). Part of professionalism extends into being able to advocate for the profession to legislators certainly, but also other professionals and even the public or at least being knowledgeable enough to answer questions that may relate to an understanding of what these changes confer. As far as we have come, we still have far to go. In Ohio, as we push for legislative change we have met disparaging resistance. A direct example comes from a traditional referral source when we offered the suggestion that physical therapists can be a referral source back to this provider. The response: “You don’t refer to us, we refer to you. You are under us.” These are the preconceived notions we have to fight to overcome.
Lastly, it is important to incorporate these changes into your practice. If the legislation changes but internal policy doesn’t change, then what value was the legislative change? If we earn direct access privileges in our practice act but work in an environment that denies us the right to practice within our full scope, what is the value of the breadth of that scope of practice? Change doesn’t end with legislative success, it just affords a new beginning.
For more information, contact Chris at: firstname.lastname@example.org
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- APTA Vision: http://www.apta.org/Vision/
- APTA Professionalism: https://www.apta.org/Professionalism/
- Ingram, Debbie, Nancy Fell, Matt Grubb, Jessie Higgins, and Ann Royal. "Physical Therapy Clinic Directors' Perspective on Physical Therapist Attire." HPA Resource 12.3 (2012): 13.
- Ingram, Debbie, L. Hollis, N. Fell, S. Cotton, and S. Elder. "Patient Preference, Perceived Practicality, and Confidence Associated with Physical Therapist Attire: A Preliminary Study." Physical Therapy Journal of Policy, Administration and Leadership 11.2 (2011): J2-J8.
- Mercer, Erin, Marilyn MacKay-Lyons, Nicki Conway, Jennifer Flynn, and Chris Mercer. "Perceptions of Outpatients Regarding the Attire of Physiotherapists." Physiotherapy Canada 60.4 (2008): 349-57.