Physiotherapists on a par with Doctors- Why can’t Developmental Therapists also be?

Dear friends,

Now there is a heated debate and to great extent agreement too that the Physios should be equated with Doctors and not work under the direction and supervision of doctors for variety of reasons.

I strongly agree that the Physiotherapy should be given status of an independent system of medicine as the PTs have the competence to provide diagnosis and prognosis of medical problems.

On the same node, I strongly feel that the Developmental Therapists too have competence to provide diagnosis and prognosis of various neurological disabilities that we work with and thus we surely make out a good case for grant of such a status to Developmental Therapists.

For now I am leaving the discussion here for your further consideration and comments. Appended below are to two articles on the subject that got prominence on Time of India front page today i.e. 09th June 2008.

The Articles:

Can Physios be put on a par with doctors? House Panel Explores Option 

Manoj Mitta | TNN

New Delhi: Intensifying a turf war between physiotherapists and medical doctors, a parliamentary standing committee is exploring the possibility of upgrading physiotherapy from a paramedical discipline to an independent system of medicine.

If physiotherapists’ claim to have the competence to provide diagnosis and prognosis for medical problems is accepted by Parliament, physiotherapy will attain the status of an independent system of medicine.

Doctors fear that the disruption of the existing hierarchy of healthcare may compromise the interests of patients.

One of the common causes for low backache, for instance, is the spread of cancer to the spine. Says S L Yadav, associate professor at the AIIMS department of physical medicine and rehabilitation: ‘‘Since he is not equipped to detect cancer, the physiotherapist may routinely administer traction or a heat modality, which could aggravate the problem and cause paralysis.’’

Ali Irani, president of the Indian Association of Physiotherapists (IAP), refutes the suggestion that greater autonomy to physiotherapists would undermine the health care system.

‘‘Given our own expertise, we are as capable as general physicians in noticing the pathology of a patient and referring him to an oncologist for cancer treatment,’’ says Irani, who was the Indian cricket team’s physiotherapist for 10 years from 1987.

‘‘It is just that doctors are unable to come to terms with the fact that our science has developed to an extent where we too could refer patients to them and they can’t demand cuts from us any longer.’’

Irani adds that since IAP is not asking for any power to prescribe medicines or to perform surgery, ‘‘nobody can accuse us of encroaching into their domain’’.

What has caused alarm in the health ministry is a note prepared by the director general of health services, R K Srivastava, on February 12 after representing the health ministry at a closed-door hearing of the standing committee dealing with the Paramedical and Physiotherapy Central Council Bill.

The note, a copy of which is with TOI, begins by expressing surprise at the fact that the questions put to Srivastava were ‘‘focused only’’ on the proposed central council for physiotherapy, although it is just one of the three councils envisaged in the bill, which had been introduced in Parliament in December 2007.

A FRESH LOOK

  • A standing committee of Parliament considering raising the status of physiotherapy from a paramedical discipline to an independent system of medicine
  • A 2007 bill defines physiotherapy as a  ‘medically directed therapy’, putting it under doctors’ supervision 
  • Key question for panel: Do physiotherapists have the competence to provide diagnosis and prognosis for medical problems? 
  • Doctors fear disruption of the existing hierarchy of healthcare may compromise the interests of patients

 

Physiotherapists want panel to redefine their discipline

 

New Delhi:

If physiotherapists’ claim to have the competence to provide diagnosis and prognosis for medical problems is accepted by Parliament, physiotherapy will attain the status of an independent system of medicine. The ‘‘salient points’’ of the discussion before the standing committee headed by Samajwadi Party’s Amar Singh included, according to director general of health services, R K Srivastava’s note, a review of the very ‘‘definition’’ of the profession in order to pave the way for ‘‘equivalence to the medical doctor’’ and ‘‘recognition of physiotherapy as a system of medicine’’.
  
In his note, written within a day of the standing committee’s hearing, Srivastava told other ‘‘concerned officers’’ of the health ministry that before the minutes of the meeting were sent by the Parliament secretariat, they should keep their responses ready so that the issues could be ‘‘disposed of quickly’’.
  
Health ministry officials are exercised over the issues raised by the standing committee as they see the hand of the physiotherapist lobby, which has been at work since the early 1990s to counter the proposal of setting up an omnibus council to regulate over a dozen different allied health professionals including radiographers, medical lab technicians and operation theatre technicians. But thanks to the pressure mounted by IAP, the bill that was eventually drafted had accommodated their demand for separating them from other paramedical personnel.

The proposed omnibus regulator was accordingly renamed as the Paramedical and Physiotherapy Central Council Bill with a provision to constitute sub-councils for various disciplines.

In September 2004, the cabinet of the UPA government cleared the bill in that form. But the bill was diluted further when it was introduced in Parliament after a lapse of more than three years. Instead of an omnibus body, the 2007 bill provided for three separate councils, including one for physiotherapists and occupational therapists. Equally significant, the 2007 bill also gave up the idea of allowing medical specialities to have a say in the regulation of their paramedical disciplines.
  
Despite the concessions extracted in 2004 and 2007, IAP discloses in its latest website update that it is trying to get more changes in the bill by being ‘‘in contact with all top politicians and parliamentarians’’. Drawing support from a couple of state legislations, IAP’s most ambitious demand is that the standing committee should recommend a radical change in the definition of physiotherapy. This is because the bill defines it as a ‘‘medically directed therapy’’, thereby implying that physiotherapists will continue to work under the supervision of doctors such as orthopaedicians, physiatrists and neurologists. In a bid to gain more autonomy, IAP proposed that their subject should instead be defined as a ‘‘physiotherapeutic system of medicine’’ involving ‘‘treatment modalities which have a diagnostic, prognostic, preventive and rehabilitative dimension’’.

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6 Responses

  1. Thanks for the information on physiotherapists. That’s an interesting argument.

    We recently wrote an article on physiatrists at Brain Blogger. As you may know, physiatrists work in the field of physical medicine and rehabilitation (PM&R), and play an important role in their practice. But what exactly defines a physiatrist and what do they mean to you?

    We would like to read your comments on our article. Thank you.

    Sincerely,
    Kelly

  2. It is a serious medical malpractice in India especially in North India regarding use of prefix of Dr. by physiotherapists. How can a Para-medical person like physiotherapists can entitle themselves as a Doctor. Physiotherapy is only a For and half year course and not studying detail about the medical conditions and management. [Refer Physiotherapy syllabus from a reputed university.] Physiotherapy is not a medical specialization. It only deals with rehabilitation, massaging and exercise; it is given with the medical treatment as a supportive care. Can a physiotherapist can treat a cancer patient or any other diseases without any medical treatment, NO? . then how can a physiotherapist can use prefix as a Dr. if they claim for this matter why can’t a BSc Nurse or a B.Pharm can claim they are studying much better than a physiotherapist. If all Para-medics is using salutation as a Dr. what is the difference between a Doctor and others. There should be serious action or a law should be made for prohibiting use of prefix Dr by physiotherapists. If physiotherapists using prefix as a Dr it makes misunderstanding for the general public. If necessary there should be separate prefix like Py. [Indicating Physiotherapist] before their name [for e.g.: Er. is a prefix for engineers].
    Thank you
    JINO ANCHAL BScN, LLB
    08447505107
    jinomp@yahoo.com

  3. ARE PHYSIOTHERAPISTS ARE DOCTORS
    It is a serious medical malpractice in India especially in North India regarding use of prefix of Dr. by physiotherapists. How can a Para-medical person like physiotherapists can entitle themselves as a Doctor. Physiotherapy is only a For and half year course and not studying detail about the medical conditions and management. [Refer Physiotherapy syllabus from a reputed university.] Physiotherapy is not a medical specialization. It only deals with rehabilitation, massaging and exercise; it is given with the medical treatment as a supportive care. Can a physiotherapist can treat a cancer patient or any other diseases without any medical treatment, NO? . then how can a physiotherapist can use prefix as a Dr. if they claim for this matter why can’t a BSc Nurse or a B.Pharm can claim they are studying much better than a physiotherapist.
    In the last winter session of parliament (2007-Dec) there was a serious question raised by Samajwadi Rajya sabha MP Shri Kamal Akhtar to treat physiotherapy graduates at par with MBBS graduates. Should we allow this to happen further in our country?

    Most of the medical and allied health boards in USA, Canada and other countries have barred physiotherapists (even the PhD’s) to affix “Dr’ the word “Doctor” to project themselves as physician or a surgeon in front of patients, hospital premises, in the business cards and letter heads (Physical therapy board of California and Regulatory board of physical therapy in Canada). Whereas in India most of the physiotherapists are gustily and illegally affixing “Dr” with their name in private practice, in corporate hospitals name board (Eg: Delhi’s Sir Gangaram Hospital ; 2 years diploma holder in physiotherapy after 12th pass is affixing as “Dr” in this hospital). Even in countries prestigious medical institute All India Institute of Medical sciences (AIIMS), most of the physiotherapists are illegally affixing “Dr” with their name.
    Medical council of India (MCI)’s stand and the court judgments in this regard?
    MCI in its Letter No. 211 (2) (158)/2002/Ethical dated 26/7/04 clearly says all the paramedicals including physiotherapists should not affix “Dr” with their name and if they violate this they can be punished accordingly. In a defamation suite against a medical doctor by a physiotherapist in the District court of Delhi (Civil appeal No. RCA 27/05), it is clearly mentioned that physiotherapists are technicians who follow prescription of doctors and no medication can be prescribed by the physiotherapist, the physiotherapist who put this case against a doctor also admitted that physiotherapy is not a medical qualification. There was also a case in Patna high court in which physiotherapists claimed themselves as doctors (CWJC/8444/96), the court dismissed the case.
    Who are the physiotherapists?
    It is well known fact that most of the medical specialties have paramedical technical staff to assist in the health care delivery like nurses, radiographers, medical lab technicians and so on, physiotherapists are also one of the paramedical personnel who work with medical specialties like orthopedics, physical medicine & rehabilitation, neurology, pediatrics so on. World Health organization in its 2000 report on Allied health (paramedical) services and Education report and in 2003 on Health care systems in transition also listed physiotherapists with other paramedical personnel. In our country also there are diploma and degree courses awarded by various institutions in physiotherapy after 12th pass just like any other paramedical courses like nursing, dieticians, radiography, speech therapy, medical lab technology. Earlier physiotherapists used to register in rehabilitation council of India (RCI) along with other paramedics like clinical psychologists, speech therapists, audiologists, orthotics and prosthetics. After physiotherapists declined to register at RCI, the RCI has started a 4 years course in bachelor in rehabilitation therapy, which is similar to physiotherapy in its content, course duration and even in patient care.
    What role politicians and bureaucrats are playing in this game?
    In spite of there is already a first state level paramedical council exists in Madhya Pradesh (Madhya Pradesh Paramedical council-2003), which includes physiotherapists as paramedics along with Radiographers, Lab technicians, speech therapists. All the politicians are trying their best to make physiotherapy equaling to MBBS (refer parliament website (http://www.parliamentofindia.nic.in/), the questions asked by these party members in parliament). They are now trying to stall the newly introduced bill in parliament “Paramedical and Physiotherapy central council bill –2007”. Physiotherapists are claiming there is a separate system of medicine called “Physiotherapeutic system of Medicine”. They want a council equal to Medical Council of India with an independent practice. Have you ever heard nurse’s claiming as nursing system of medicine and an independent practice in India? Even bureaucrats in the health ministry are supporting this illegal move to counter the medical doctors.
    Historic 1998 Supreme Court’s judgment on medical practice in India?
    When there was a case against Indian system of medicine doctors who used to practice like MBBS doctors, the case was filed in Supreme Court. It took 11 years to get this judgment. The Supreme Court in this Judgment (Civil appeal no. 69/1987) on 13/10/1998 questions question relating not only to the right to practice medical profession but also to the right to life, which includes health and well being of a person. It says the systems of medicines generally prevalent in India are Ayurveda, Sidha, Unani, modern system of medicine (Allopathic) and homeopathic. It also says only a registered practioners in state medical register (MCI) can practice modern system of medicine including prescription of drugs, diagnosis, blood and x-ray investigations. Like any other paramedical courses (nursing, radiography, lab technicians, speech therapy) in the modern system of medicine, it is well known fact that most of the content in physiotherapy is borrowed from MBBS or MD curriculum and teachers for these courses are medical professionals. After studying for 2 (diploma) to 4 (degree) years, if non-medical qualified personnel like physiotherapists claims he is a medical personnel by affixing “Dr”, what will happen for a qualified doctor who has to undergo vigorous training for a minimum of 9-12 years to become a specialists?
    If this trend continues what may happen in future?
    If today physiotherapists claim they are doctors by affixing illegally “Dr” then tomorrow all the hospital staff including nurses, pharmacist, radiographers will also claim as doctors, then who will do the work of physiotherapists, nurses, pharmacist and radiographers. If every non-medical personnel become a doctor, Will it not confuse the patient? Will it not allow more number such kidney rackets?If physiotherapists (diploma and degree holders) are considered at par with MBBS graduates what about the speech therapists, nurses, psychologists, dieticians, radiographers, rehabilitation therapists and various other paramedical personnel who have also done PhD’s after undergoing 4-4 ½ years of training. Will this not create unhealthy environment among doctors and other non-medical professionals? Will it not affect the health care delivery system and general public.
    Regarding dentists- dentistry is actually like a sister branch of Medicine. They’ll study all the subjects of MBBS, but then their stress will be oral medicine. They know very well about the pathology, clinical Medicine and pharmacology. If a dental patient. comes with other medical problems like HTN, DM,etc, they can manage without the need of medical doctor.
    Ayurvedic, Homeopathy.etc they are called doctors? Because they’ll study all the subjects of MBBS curriculum including pharmacology. But their pharmacology is not allopathic.-it’s ayurvedic, homeopathic n so on. Even nurses are studying – anatomy, physiology, microbiology, community health, medicine, surgery, psychiatry, pediatrics, ortho and pharmacology better than a physiotherapist. So are they doctors? Not at all, because their curriculum is designed in a way to help the doctors. Even physiotherapy got its restart by some very well trained nurses had knowledge in physical education. [Physiotherapy is also part of some nursing curriculum] who

    Finally if all Para-medics is using salutation as a Dr. what is the difference between a Doctor and others. There should be serious action or a law should be made for prohibiting use of prefix Dr by physiotherapists. If physiotherapists using prefix as a Dr it makes misunderstanding for the general public. If necessary there should be separate prefix like Py. [Indicating Physiotherapist] before their name [for e.g.: Er. is a prefix for engineers].

    Thank you
    JINO ANCHAL BScN, DNA, LLB
    08447505107
    jinomp@yahoo.com

  4. a physiotherapist is able to understand the disease its diagnosis and treatment a physiotherapist is not asking to govt.to give the power to prescribe the medicin and perform the surgery just we r fighting for our right when a yoga therapist have to suffix dr. so we r specialised in physical medicin why should be not have the authority to write doctor in front of our name………………

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