Physical therapy is a profession that struggles with identity. Not only do patients have a limited understanding of what exactly a physical therapist does, but physical therapists themselves have difficulty defining what makes a physical therapist. This identity crisis is a multifaceted issue, but one of primary contributors is the idea of defining the physical therapy profession with particular interventions. The argument that physical therapy does not have an identity outside of interventions such as exercise is not an argument worth making — this is because the profession should not be trying to identify itself with particular interventions at all, exercise or otherwise. The identity of physical therapy should instead be defined by the education, clinical processes, impact on healthcare and dedication to science that embodies the profession — a particular treatment or set of interventions can not possibly capture this. What is often seen is this identity crisis brought about when individuals critique the benefits, use or relevance of certain interventions and fringe treatments — “well if we don’t have therapeutic cabbage rubbing and all we do is exercise people, what makes us different than personal trainers!?” — As if treatments such as therapeutic cabbage rubbing or the new modality du jour are somehow essential to what a physical therapist is, what a physical therapist accomplishes or defining a physical therapist’s value. What is ironic is that most of the treatments or products indirectly argued to be an essential part of a physical therapist’s identity are hardly unique to physical therapy.
Not too long ago, Kyle Ridgeway shared this excerpt from a Farnam Street post with me, which I think is wholly relevant to the idea of physical therapists associating interventions with identity:
Ever notice how some businesses will add one feature on top of another to their products but fail at basic customer service, so you leave, never to return? That’s a business that thinks it’s in an additive system when they really need to be resolving the big fat zero in the middle of the equation instead of adding more stuff.
When the profession over emphasizes ancillary treatments, novel (but often ultimately useless) modalities and other additive products as somehow being essential to physical therapy's professional identity while failing to improve the critical thinking, scientific literacy and understanding of the complexities of who and what a physical therapist works with — the profession misses the point. Physical therapy should focus less on adopting the latest trendy treatment or cure-all proprietary system and instead dedicate itself to refining the basics which serve as the foundation of the profession and allow the profession to succeed in a wide variety of settings — a commitment to evidence based practice, well reasoned utilization of low risk/conservative treatments grounded in science, patient centered communication, therapeutic alliance and being part of an interdisciplinary team.
Physical therapists are uniquely positioned to drive significant change in healthcare across a wide span of populations — whether it be improving physical outcomes in post-critical illness, reducing the risk for hospital readmissions or falls, providing more cost effective musculoskeletal care, decreasing complications after severe burn injury, promoting fulfilling lives after spinal cord injury, enhancing physical function in patients undergoing chemotherapy, or helping limiting the need for riskier and more invasive procedures in chronic pain. The impact of physical therapy can and should be far reaching, not because of any specific intervention physical therapists do or do not use — but because of the sound clinical process employed by physical therapists. Surely other professions might use interventions that physical therapists leverage — exercise is certainly not unique, nor is education, modalities, biomechanics or manual therapy. But, chiropractors do not work in pediatric oncology units. Personal trainers are not coaching people after knee replacement on post-op day zero. This is not because these professions do not have value, are not adequate at prescribing exercise, or performing any other intervention within their scope of practice, but it is the foundational knowledge, extensive training in different healthcare venues and expertise that separates physical therapy from other professions and allows physical therapists to thrive throughout the spectrum of healthcare.
As a home health physical therapist, my role and identity is simple — my job exists in order to help individuals with various pathologies and associated deficits safely thrive in their home environment and ultimately reintegrate into their community. In more detail, I play a significant role in working to reduce the risk for things like complications after major surgery, falls, medication complications stemming from polypharmacy or missed drug interactions, and further loss of function or independence while working to transition patients to the next level of care as quickly and safely as possible. I primarily accomplish these things by facilitating movement and providing education based off of an in-depth understanding of how my patient’s individual circumstances, physiology and pathology affect their ability to live safely in their home. Note that I did not mention specific exercise approaches, manual therapy, assistive device training, pain science education, taping, needling, therapeutic cabbage rubbing, cupping, or whatever other modality you can think of. What allows me to accomplish my role and my goals as a home health physical therapist are not particular products, but a process that is built upon a foundation of science, critical thinking, clinical training and the commitment to being part of an interdisciplinary team.
If there is an identity crisis in physical therapy, it is one physical therapists have manufactured themselves in part by attempting to define their identity with particular interventions rather than working to refine the foundational aspects of the profession that allows physical therapists to succeed throughout diverse settings and populations. Physical therapists have a remarkable skill set — to attempt to define the profession with a particular batch of tools does physical therapy and the people seeking their care a remarkable disservice.
Header imager is a promotional logo for the Matthew Weiner show Mad Men — Go watch it, it's a show about identity.