There are many powerful critical arguments about health professional practice. Anyone who has studied how health professionals came into being, whose interests they served, or how they’ve adapted to the broader changes happening in society, can’t fail to be shaken by the belief that the fight to become the agents of our own destiny is one with many casualties, many of whom are the people we earnestly claim to serve.
Perhaps one of the most powerful arguments pertaining to physiotherapy – especially those areas of the practice that relate to long-term illness and disability – comes from disabled people themselves, who, for more than half a century, have been vocal in their criticism of healthcare professionals.
Finkelstein called it ‘able-bodied chauvanism’ (Finkelstein 1999, p. 23), when doctors, physiotherapists and others pontificated on questions of quality of life, ‘determining where [disabled people] can park their cars…and whether they are capable of working’ (Hammell 2006, p. 19).
Such criticisms remind us that ‘the rehabilitation professions are not apolitical and that the rehabilitation process is often irrelevant, meaningless and useless’ for disabled people (Hammell 2006, p. 5).
A recent piece by Ray Moynihan in The Conversation returns to this message, examining how the diagnostic label of osteoporosis has morphed over time (link). We are now seeing the emergence of ‘pre-‘ diagnostic definitions, capturing markers of disease before they even happen – opening up entirely new markets for healthcare workers to colonise and parasitise.
A study cited in the article found three features of this work of diagnostic labelling:
- “First, the expert panels of doctors who made these changes often decided to widen definitions classifying more people as patients. Generally, the motivation was that treating milder problems, or finding diseases earlier, would benefit the newly diagnosed.
- “Second, these panels did not rigorously investigate the downsides of that expansion; none examined how many people would be overdiagnosed.
- “And, third, most panel members had financial relationships with drug companies that stood to benefit from panel decisions” (link).
Physiotherapists, like all orthodox health professions, are complicit in these arrangements whenever we look to broaden the classifications of problems that we work with, when it can be clearly seen that the impetus to do so is driven by professional interests rather than the interests of the clients or their communities.
More critical thinking around these issues is needed to help us see more clearly when we get the balance of these responsibilities wrong.
Finkelstein, V. 1999, A Profession Allied to the Community: The disabled peoples trade union, in E Stone (ed), Disability and Development: Learning from action and research on disability in the majority world, The Disability Press, Leeds, pp. 21-4.
Hammell, K.W., 2006, Perspectives on disability & rehabilitation: Contesting assumptions, challenging practice, Churchill Livingstone/Elsevier, Edinburgh.
Swain, J., French, S., & Cameron, C. (2003). Practice: Are professionals parasites? In Controversial issues in a disabling society (pp. 131-140). Buckingham: Open University Press.