Friday, August 28, 2009

How Do You Define Physical Therapy?

Many people still are not familiar with the roles that physical therapists play. A co-worker of mine was discussing his line of work with an individual who, though he regularly visited his chiropracter, contended that he never really had a need for physical therapy.

I often explain that my primary job as a physical therapist is related to my expertise in movement science. When something doesn't function as it ought to, it affects neighboring areas of the body (remember my last post on the body of Christ and personal accountability?). Restoring normal movement is necessary for optimal health.

This video from the American Physical Therapy Association (APTA) does a pretty good job of explaining the role physical therapy plays in the health care field:

Move Forward: Physical Therapy Brings Motion to Life

Thursday, August 27, 2009

What Ever Happened To Personal Accountability?

As I continue to accumulate years (sounds better than the word "age"), I am becoming more familiar with the adage about time speeding up. It is unbelievable that we moved from Iowa City to Pella, Iowa over 8 years ago. Since my family and I moved, life has been a whirlwind in many ways.

In the past 2 years in particular, I have changed. Thanks to the wisdom of Dave Ramsey, who I try to follow as much as I can on my XM Radio, our family has changed our spending habits and is nearly debt-free (except for the home mortgage). His constant and unwavering commitment to the "Baby Steps" have been an inspiration to me.

Through Dave's teaching, I have come to realize that I control my own destiny. As a Believer, of course, I know I have my limitations. I know that God ultimately has a specific and unique plan for my life. (On a tangential note, I've never understood the title of the 1940's book, "God Is My Co-Pilot." Shouldn't he be the pilot and I'll play the role of the co-pilot? I guess I should read the book before I comment.) However, Dave has taught (or constantly reminded me) that I am personally accountable for my own actions.

Personal accountability is a Biblical concept. Romans 14 tells us that someday we will present a personal account to God. 1 Corinthians 12 tells us that we are members of a body, the body of Christ, which requires each person in the body to cooperate with the others. And Galatians 6 even tells us that we're accountable to others, our friends, and to encourage them when they waiver.

As a physical therapist, I have a unique view of personal accountability. Unfortunately, all to often it is the lack of personal accountability that stands out. I do not profess to have skills as a physical therapist that will provide the health benefit that each and every person desires. For those that do have a condition that would benefit from my physical therapy skills, though, the most common reason an individual does not achieve his potential is a lack of follow-through. These people do not hold themselves personally accountable to do what they must.

I often consult with industries to provide optimal health solutions. It is sad, even maddeningly frustrating, to observe a corporate culture that is permeated with a "blame them" mentality. When some refers the "them" when describing the source of the problem and that person has the same employer as he who is speaking, there's a problem with personal accountability.

Let's not even get into politics! In the wake of Ted Kennedy's passing, I find myself longing again for the message made popular by his brother, JFK, as he poignantly expressed, "Ask not what your country can do for you..." to be politically correct once again. What can we do about blame, complaining, and procrastination? Look inward.

It is Dave Ramsey who introduced me to John Miller and his book (and philosophy) "QBQ!: The Question Behind the Question." It is a short, easy-to-read book dedicated to blowing the horn of personal accountability. A simple attitude shift ("How can I make a difference?) brings about amazing results: problems get solved, internal barriers come down, service improves, teamwork grows, and people adapt more quickly to change.

Do you have any personal accounts of examples of personal accountability you can share?

Tuesday, August 11, 2009

Is Profit Ruining Health Care?

I am a semi-avid reader of the Evidence in Motion/ MyPhysicalTherapySpace blog. In a recent entry, this blog referenced an article by columnist and surgeon Atul Gawande in The New Yorker from June 1, 2009 ( that discusses in length the debate in health care about rising prices, quality of service, and referral for profit.

It’s a long and interesting article, but the section I’ve included below has some poignant points as it compares a system (like Grand Junction and Mayo) that has focused their efforts on quality care first and foremost and primarily pay their health care providers a salary to a system (like McAllen, Texas) that has created a “shopping center”, profit-driven medical system that often pays based upon revenue generated.

When you look across the spectrum from Grand Junction to McAllen—and the almost threefold difference in the costs of care—you come to realize that we are witnessing a battle for the soul of American medicine. Somewhere in the United States at this moment, a patient with chest pain, or a tumor, or a cough is seeing a doctor. And the damning question we have to ask is whether the doctor is set up to meet the needs of the patient, first and foremost, or to maximize revenue.

There is no insurance system that will make the two aims match perfectly. But having a system that does so much to misalign them has proved disastrous. As economists have often pointed out, we pay doctors for quantity, not quality. As they point out less often, we also pay them as individuals, rather than as members of a team working together for their patients. Both practices have made for serious problems.

Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coordination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check.

This last point is vital. Activists and policymakers spend an inordinate amount of time arguing about whether the solution to high medical costs is to have government or private insurance companies write the checks. Here’s how this whole debate goes. Advocates of a public option say government financing would save the most money by having leaner administrative costs and forcing doctors and hospitals to take lower payments than they get from private insurance. Opponents say doctors would skimp, quit, or game the system, and make us wait in line for our care; they maintain that private insurers are better at policing doctors. No, the skeptics say: all insurance companies do is reject applicants who need health care and stall on paying their bills. Then we have the economists who say that the people who should pay the doctors are the ones who use them. Have consumers pay with their own dollars, make sure that they have some “skin in the game,” and then they’ll get the care they deserve. These arguments miss the main issue. When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes. You get McAllen.

Work Systems has long believed that autonomous, independent physical therapy and occupational therapy practices dedicated to providing quality services with integrity is what is best for the public. Unfortunately, we are struggling to maintain market share while competing against providers that partner with physicians who are currently capable of taking advantage of loopholes that exist in the Stark regulations. Loopholes that create a financial incentive for self-referral.

I agree with the columnist. The need for a general contractor does exist. I personally do not believe the government should play that role, but someone definitely should. What do you think?