Critical Thinking

Let’s quit comparing our knowledge to Physicians

A year ago, I was introduced to a post titled, “I am a Doctor of Physical Therapy“.  This post attempted to define who we are, what we are and where we intend to go.  While I appreciate the intentions of this post, I am left with the following question:

Why do we feel compelled to compare ourselves as Physicians?  I am ok with us introducing ourselves as Dr. ____, as long as you have a doctoral degree.  But recently, I have heard the argument (not just from the post above), that our knowledge of the musculoskeletal system is second only to Orthopedic physicians.   This statement is often based off of this 2oo5 article by Childs et al.  Lets take a closer look at this study (to see if it truly leads to the above statement).

This study was a cross-section design which looked at the results of a standardized test completed by 174 PT students and 182 “experienced” PTs.   The test, as described by the authors, consisted of:  25 open-ended questions that were selected based on         commonly encountered musculoskeletal diagnoses encountered in the primary care setting (ie, fractures and dislocations, low back pain, sciatica, and arthritis) and consideration of orthopaedic emergencies that warrant immediate referral to an orthopaedic surgeon  or the emergency department (ie, compartment syndrome, hip dislocation, etc.)

The results of the open-ended questions were then graded by “physical therapist faculty with considerable experience in providing direct access care for patients with musculoskeletal conditions.”    The scores and pass rates were given based upon criteria designed by Freedman and Bernstein, who conducted a similar study.

Childs et al then took the results of their study, and compared it with the results found by Freedman and Bernstein.

This where I suspect the conclusion made by many, is a bit misconstrued. 

First, the graders of the test in each study had different levels of education.  ie. Physical Therapists graded the results of the study on Physical Therapists knowledge, and Physicians graded the results of the study on Physician knowledge.

Furthermore, the study by Childs et al was published 7 years post-the Physician study.   I am curious if the results would have been different if the Childs et al study was conducted in 1998 or if the Freedman study was performed in 2005.

In addition, both of these studies examined knowledge base off of a 25-question examination.  This may limit their actual implications to clinical practice.

To truly compare results, as obtained by the two studies above, one needs to conduct one study, in which an examination is given to all of these fields of practice, the same way, at the same point of time, and graded by the same pool of examiners (who are blinded to the participants).   Even in doing so, I am not quite sure if it would define who is better or safer clinical practice.  It would tell us who got better results on a test (or who was able to answer a way which pleased the grader).

As Eric Kruger so eloquently wrote in his last post on this site: “What is not widely discussed is the drawbacks of science.  Science after all can only tell us what has occurred and what is likely to occur given a specific set of determinants.  What it cannot say is what should be or what could be.  These are much more difficult questions to answer.  In fact these are not scientific questions but belong to the province of humanism: the ethics, values, and knowledge surrounding acts of human creation.  A particularly apocalyptic example is that of nuclear physics: a branch of science that has given us the atomic bomb.  While science for its part has created the technology and power, it is us, as humans, that must determine its use.”

So in the above studies, who knows who is truly better within clinical practice.  Who knows who is more right when science cannot say what should be or what could be. To move forward, I hope we will quit comparing our knowledge-base to Physicians and accept that we both have very unique and valuable roles in the healthcare fields.   We need to stop saying we are “second only to…” and instead say, “I am a Physical Therapist.  I may be able to help you.  I offer conservative care.”

What do you think?

 

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5 replies »

  1. I’d agree with all of your statements. Comparing separate studies completely nearly a decade apart by different clinicians is a rubbish way to draw conclusions. Also, whether or not or knowledge is more or less than a orthopaedic physicians really doesn’t matter does it? We are both highly educated individuals putting what knowledge we have to good use by helping people. As long as we both get results that improve a patients condition I couldn’t care less who “knows” more.

  2. They don’t care how much you know until they know how much you care. All of the alphabet soup behind your name, the years of clinical experience, or the blogs and discussions you follow/contribute to will do little to impress or improve your patients and their outcomes unless you can adequately convey to the patient you are invested in them, in their unique and individualized story, and in their return to function. Can physical therapists do this (DPT, MPT, PT, PTA)? Sure. Can physicians do this (MD, DO)? Absolutely. Do you do this? ___________.

  3. I like to think of the circumstances around published work and the potential reason as to why anyone would care about the results. Our profession continues to mature. We have real life obstacle that we face. As we fight for real direct access and the huge “safety” and “training” obstacle, it’s nice to have evidence of our value, evidence of our knowledge. Even though you disagree with what occurred, I can see value. An established, peer-reviewed study that should have credibility in the physician world was somewhat replicated. The Childs’ study created an implication… and a potential reason to follow up to learn more. I welcome studies that help improve the image of our skill set. I suppose I view things more in term of big picture. Primary care physicians will become extinct (okay… exaggeration there), and as that happens access to care will be affected. Physical therapists are the perfect choice to step up their game and be a solution to the upcoming train wreck. If articles like the one you are describing help our profession become a game player in society to create a win/win, I fully want them published.

    Thanks for the opportunity to share my view.

    • Thanks for the replys guys.

      I am with you Selena. I commend Childs et al for performing this study and I do see some value. I do think it gives us “some” information and I do see the big picture. That stated, I am unwilling to say we are “2nd only to Orthopedic Physicians” in knowledge of the musculoskeletal system, when I am not sure we can extrapolate that from this study. I am not even sure we can accurately assess something like this.
      Moving forward, I suspect we need to distinguish ourselves as a profession. We need to study our ability to medically screen (ie. our safety as direct access providers) as well as the cost-effectiveness of our services (and knowing “what we cost”—similiar to what Dr.Childs wrote on his own blog this week). If we continue to say, “We are 2nd to _____”, based on little data, then we will continue on as ancillary providers. At some point, we need to just say, “This is what we do. This is what we know. That is why you should see me”.

      • I agree “we need to distinguish ourselves as a profession.” This can be done through research to further evidence based practice or even through one on one interactions PT to MD. Physicians we talk to often view Physical Therapy as a ‘black box’ where they send their patients in, something happens, and the patient comes out better (hopefully). If a PT can develop a professional relationship with a physician that’s a good opportunity to impress them with our knowledge. As they become familiar with our knowledge base they might start to ask questions and ask for our opinions. This has been my experience at least. I see myself as a PT ambassador to physicians with the goal of demonstrating the benefits of a close working relationship. I do not view ‘ancillary care’ status as such a bad thing right now. If we grow our profession responsibly then there is a chance for greater independence later.

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