Physiotherapy within Overall Health Services Structure
The central place of physiotherapy in the domestic health services structure is evident from the specialisations available, the interdisciplinary teams coordinated with, the varied departments they join in tertiary health care institutions, the avenues open for individual practice, and the range of therapies that may be administered. As well, physiotherapy practitioners must be registrants, as is true in every other medical field.
Like other specialties, physiotherapists may opt to open up an individual practice, an option that owes much to the need to restore neuromuscular capability of patients over the medium- and long term but in community and home settings. Within a hospital, physiotherapists may be alternately engaged to help manage musculoskeletal, respiratory, neurological, even obstetric, and psychiatric patients. Others find themselves in long-term ‘rotations’ in geriatrics, cardiac recovery, intensive care, and paediatrics (Department of Education and Training, Queensland, 2009).
Between the extremes of individual and major-institution practice lie a variety of engagements providing therapy to outpatients or residents of nursing homes, special schools, psychiatric clinics, government agencies, community health centres, sports clinics, health and industrial clinics.
Like peers in other health professions, physiotherapists pride themselves in taking a holistic approach to the ‘prevention, diagnosis and therapeutic management of disorders of human movement caused by injury or disease and the improvement of a body function to enhance health and wellbeing (Department of Education and Training, Queensland, 2009, p. 1).
In the popular imagination, the special participation of physiotherapists is limited to treatments aiming to restore mobility to the patient. Hence, one readily visualizes a physiotherapist administering massage and hydrotherapy, manipulating and mobilizing the spine and peripheral joints so as to stretch and, over time, strengthen affected muscles and joints. And when the patient is able to stand and is willing to make the effort to become mobile again, the public readily comprehends the scenes of therapists coaxing along a patient to get around again with support devices – like walking frames, crutches wheelchairs, and splints – and prosthetics in the case of the severely mutilated. When the injury or weakness is to the upper limbs, the physiotherapist may employ less intrusive exercise equipment such as squeeze balls.
Away from the public eye, physiotherapists very often need to initiate a course of treatment by applying heat or ice packs, ultrasound, relaxants and analgesics, and electrotherapy to treat pain, ameliorate swelling and get the patient started on the road to recovery and enhanced range of movement.
Like other medical practitioners, physiotherapists are involved in the entire process of managing patients. A therapist can be called on at the assessment and diagnostic stage, if only to better understand the physical condition, diagnose primary and related problems and plan effective treatment. Physiotherapists may also educate outpatients and those released from confinement on breathing and relaxation techniques while continuing to prescribe an increasingly demanding regimen of exercise. The physiotherapist also has a hand in educating the families of patients and engages in community outreach aimed at inculcating healthier lifestyles, while forestalling injury and disability. In the company of cardiologists, internal medicine specialists and dieticians, the profession can engage with the community to agree on and implement fitness programs.
Training, Registration and Licensing
Indicative of the stringent screening and high standard of academic training needed to qualify for the profession, the University of Sydney (2009) degree in Bachelor of Applied Science (Physiotherapy) includes clinical education that is applied training in clinical schools and placements. A variety of health care settings is ensured since each of five clinical schools comprises hospitals, community health centers, private practices, rural primary care and other facilities in a contiguous geographical area. Even as student-registrants, future physiotherapists already assess and treat patients whilst supervised by clinical educators.
Under the Physiotherapists Registration Act of 2001 (the Act), one must be registered in the state where the practice is contemplated. However, the regulations meant to assure safe and competent health service delivery in any given state grant automatic registration, under the Mutual Recognition Act 1992, for physiotherapists who gained their credentials in another state. The sole requirement is to invoke the mutual recognition process when filing to be a registrant in the state one is moving to. The country, Western Australia excepted, also grants the same privilege to possessors of a current practicing certificate from the Physiotherapy Board of New Zealand under the Trans Tasman Mutual Recognition (Qld) Act 1999.
Qualified physiotherapists from other nations, on the other hand, first need to qualify under the Australian Physiotherapy Council (APC) assessment process. When successful, they may proceed to apply for registration to the Physiotherapists Board. If not, foreign physiotherapists must take their training gaps under advisement and undergo courses and bridging programs that will enable them to come up to Australian standards (Department of Education and Training, Queensland, 2009).
Ethical Behaviour and the Code of Ethics
In general, the Code applicable to physiotherapists in respect of patient management, records handling, professional relations and advertising is as stringent as applies to physicians and others in the health profession.
Concerning case management, the code admonishes physiotherapists to, first of all, be knowledgeable and judicious about administering only those therapies and treatments that fall within their ambit (The Physiotherapy Board of South Australia, 1996). Relations with colleagues and others assisting should be marked by utmost professional courtesy and cooperation whilst exercising discretion about training non-professionals to administer therapeutic procedures. Evidently, there have been instances of the latter and the Board has therefore also specifically proscribed having patients fraudulently billed for physiotherapeutic services using the name of an accredited member but performed by unqualified third parties.
Still, in the area of professional relations, the Code also addresses improper behavior post locum tenens arrangements, when one fills in for a colleague who has to be away for some time. Physiotherapists are reminded that only express permission by the principal entitles the one filling the practice temporarily to continue treating patients. Neither should the temporary assistant expect to take over the practice of a principal except by mutual consent and negotiated purchase. Even in extreme cases where the principal never returns, the temporary assistant must make arrangements with the former’s representatives, presumably heirs and assigns.
In the increasingly diverse society that is Australia, secondly, the Board considers it vital to remind members of the profession to adhere to non-discriminatory practices. Physiotherapists must be open and give their best to all who need their help regardless of income, creed, race, politics or culture.
Thirdly, physiotherapists must hold patient records in strictest confidence. Disclosure to third parties is permissible solely when consulting about a patient or to facilitate coordinated management.
The fourth general area of professional practice concerns advertising, promotions and publicity. Members may not endorse any commercial product unless the publicity material is silent about their “vocational or professional affiliation”. Physiotherapists may advertise their practice so long as they adhere to regulations covering all professional specializations. Claims should be completely truthful, not designed to mislead or deceive. Advertising executions must tread the fine line between seeking to establish one’s credentials in a high-toned manner and crossing over into vulgar hyperbole about one’s own qualifications. Comparative advertising is banned. Even denigrating colleagues so as to imply superiority or actually suggesting an advantage over other practitioners is deemed unethical. Physiotherapists attempting to skirt this prohibition by soliciting testimonials or endorsements (presumably from patients) and including these in advertising layouts are told in no uncertain terms that this is unethical.
Lastly, the Code addresses itself human or animal experimentation and other types of research with human subjects. With reference particularly to human subjects, physiotherapists are reminded to apply for approval with the Institutional Ethics Committee concerned and to comply with the ‘Statement on human experimentation of the National Health and Medical Research Council. (NHMRC, 2007). Tabled in Parliament in March 2007, the ‘National Statement’ directs physiotherapist attention to such relevant matters as required consent, treatment of the frail and elderly (at risk of, or suffering from the aftermath of, a stroke), treatment of unconscious persons, trials with innovative therapies or interventions, and common experimental situation, such as administering a placebo being tantamount to deception and those recovering from falls or leg injuries being under covert observation for the distance they can walk unsupported before collapsing (National Health and Medical Research Council, 1999, pp. 12, 26, 28, 39, 51).
The Draft Code of Conduct remains pending approval with the Minister of Health. Nonetheless, physiotherapists are well-advised to adhere to a Code that is no more stringent presumably than applies to other health professionals in the country.
Bibliography
Department of Education and Training, Queensland (2009) Physiotherapy.
National Health and Medical Research Council (1999). National statement on ethical conduct in research involving humans. Ausinfo. Web.
National Health and Medical Research Council (2007). National statement on ethical conduct in research involving humans (1999). Web.
The Physiotherapy Board of South Australia (1996). Code of Ethics. Web.
University of Sydney (2009). Bachelor of Applied Science (Physiotherapy) – B.App.Sc.(Phty). Web.