Is professional autonomy the answer?

**nari** · 24-11-2005, 10:32 PM

I have noticed over the years of forum-watching and participation, that a solution to some of the diverse situations that PTs are faced with in clinical practice could be resolved to a high degree with the benefit of autonomy.

If one is bound to follow what a referring doctor is "ordering" (rather than suggesting) - how could we ever learn to think broadly for ourselves and progress?

I know some PTs discuss their preferences with doctors and obtain an agreement, but as a whole, this does not seem to happen. I'm not talking about protocols for post-surgical patients after complex surgery - it's all the others where the referring doctors seem to think they know about physical therapy.

Isn't autonomy worth a struggle to achieve?

Why are PTs reluctant to work towards this goal? Maybe it is the fact that PTs are not congruous, or less homogenous than I think they are; and some are happy to follow whatever medical model they are faced with.

Autonomy seems to be an issue that is either not relevant, or too difficult to resolve. Coming from an environment where we have had autonomy for nearly 30 years, I find this hard to comprehend.

Anyone with some ideas on 'Why'?

Nari

**cedric** · 26-11-2005, 11:04 AM

autonomy means that we would be able to decide without (theorically) any possible mistake.
So, i believe, we should learn more (longer studies). In france, the cursus is 3 years long.. to be a doctor (with autonomy) request 8 years (approx.)

on one other hand, autonomy means that the professionals would like not to follow someone else choices. Which means that we have to be professionaly responsible

**nari** · 26-11-2005, 11:39 AM

Cedric.

I agree we have to be professionally responsible; that goes without saying.
In thirty years the cases of litigation against us have been rare.
It does not need a doctorate for this requirement; our course is a four year degree. So maybe an extra year would be all that is theoretically needed for your colleagues to become autonomous. Indemnity is not expensive here - about $350 a year, with cover for $5 million. (Not sure of the equivalent in Euros).

But it has to be a concerted effort by all physiotherapists to swing the pendulum away from the status quo.

Nari

**bernard** · 28-11-2005, 07:24 AM

Hi All,

Autonomy is a mandatory and logical way of PT evolution.
Cedric said that we get our diploma in 3 years and GP in 7 years but they do not overlap anyway! We are a sub-part of Medicine and GPs do not learn this sub-part. They watch/see our practice within few hours and we recognize that 3/4 years is only a start.

The problem comes here (in France) with the economical side of Health system, oriented to an unique director of all treatments : Goverment gives an absolute power to GP (they govern already the specialist's examination), and GP think they'll gain autonomy. That's just wrong! All the medical professions will lose by this stubborn/blind behaviour.

**cedric** · 28-11-2005, 12:47 PM

there is a project in france wich includes the right for the PT to "prescrire" (bernard i need your help to translate) some small materials or thing that we would need (sticks, strapping materials...)
it is only a first steep but it is...

also we theorically have the tight to choose the methods and things WE judge to be appropriate, and we could also decide if the GP is ok the number of "lessons" (i can't translate séance bernard...

)

**bernard** · 28-11-2005, 01:06 PM

Cedric,

I'm using Babylon as English dictionnary.
prescrire = prescribe, order.
Lesson = session

24-11-2005, 10:32 PM	#1
nari NeuroNut Evangelist Join Date: Mar 2004 Location: ACT Aust Posts: 7,679 Thanks: 706 Thanked 233 Times in 167 Posts	Is professional autonomy the answer? I have noticed over the years of forum-watching and participation, that a solution to some of the diverse situations that PTs are faced with in clinical practice could be resolved to a high degree with the benefit of autonomy. If one is bound to follow what a referring doctor is "ordering" (rather than suggesting) - how could we ever learn to think broadly for ourselves and progress? I know some PTs discuss their preferences with doctors and obtain an agreement, but as a whole, this does not seem to happen. I'm not talking about protocols for post-surgical patients after complex surgery - it's all the others where the referring doctors seem to think they know about physical therapy. Isn't autonomy worth a struggle to achieve? Why are PTs reluctant to work towards this goal? Maybe it is the fact that PTs are not congruous, or less homogenous than I think they are; and some are happy to follow whatever medical model they are faced with. Autonomy seems to be an issue that is either not relevant, or too difficult to resolve. Coming from an environment where we have had autonomy for nearly 30 years, I find this hard to comprehend. Anyone with some ideas on 'Why'? Nari

26-11-2005, 11:04 AM	#2
cedric the real friskey Join Date: Oct 2005 Location: 93 - gournay sur marne (close to disneyland paris) Age: 36 Posts: 344 Thanks: 0 Thanked 0 Times in 0 Posts	autonomy means that we would be able to decide without (theorically) any possible mistake. So, i believe, we should learn more (longer studies). In france, the cursus is 3 years long.. to be a doctor (with autonomy) request 8 years (approx.) on one other hand, autonomy means that the professionals would like not to follow someone else choices. Which means that we have to be professionaly responsible __________________ ------------------------------------------------------ french physio like paediatrics and sports trauma

28-11-2005, 07:24 AM	#4
bernard Admin, Moderator... Join Date: Mar 2004 Location: France Age: 56 Posts: 12,013 Thanks: 241 Thanked 137 Times in 91 Posts	Hi All, Autonomy is a mandatory and logical way of PT evolution. Cedric said that we get our diploma in 3 years and GP in 7 years but they do not overlap anyway! We are a sub-part of Medicine and GPs do not learn this sub-part. They watch/see our practice within few hours and we recognize that 3/4 years is only a start. The problem comes here (in France) with the economical side of Health system, oriented to an unique director of all treatments : Goverment gives an absolute power to GP (they govern already the specialist's examination), and GP think they'll gain autonomy. That's just wrong! All the medical professions will lose by this stubborn/blind behaviour. __________________ Simplicity is the ultimate sophistication. L VINCI We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON Everything should be made as simple as possible, but not a bit simpler. If you can't explain it simply, you don't understand it well enough. Albert Einstein bernard

28-11-2005, 12:47 PM	#5
cedric the real friskey Join Date: Oct 2005 Location: 93 - gournay sur marne (close to disneyland paris) Age: 36 Posts: 344 Thanks: 0 Thanked 0 Times in 0 Posts	there is a project in france wich includes the right for the PT to "prescrire" (bernard i need your help to translate) some small materials or thing that we would need (sticks, strapping materials...) it is only a first steep but it is... also we theorically have the tight to choose the methods and things WE judge to be appropriate, and we could also decide if the GP is ok the number of "lessons" (i can't translate séance bernard... ) __________________ ------------------------------------------------------ french physio like paediatrics and sports trauma

28-11-2005, 01:06 PM	#6
bernard Admin, Moderator... Join Date: Mar 2004 Location: France Age: 56 Posts: 12,013 Thanks: 241 Thanked 137 Times in 91 Posts	Cedric, I'm using Babylon as English dictionnary. prescrire = prescribe, order. Lesson = session __________________ Simplicity is the ultimate sophistication. L VINCI We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON Everything should be made as simple as possible, but not a bit simpler. If you can't explain it simply, you don't understand it well enough. Albert Einstein bernard

26-11-2005, 11:39 AM	#3
nari NeuroNut Evangelist Join Date: Mar 2004 Location: ACT Aust Posts: 7,679 Thanks: 706 Thanked 233 Times in 167 Posts	Cedric. I agree we have to be professionally responsible; that goes without saying. In thirty years the cases of litigation against us have been rare. It does not need a doctorate for this requirement; our course is a four year degree. So maybe an extra year would be all that is theoretically needed for your colleagues to become autonomous. Indemnity is not expensive here - about $350 a year, with cover for $5 million. (Not sure of the equivalent in Euros). But it has to be a concerted effort by all physiotherapists to swing the pendulum away from the status quo. Nari

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