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The views and opinions expressed within posted comments do not necessarily reflect the views or positions held by the College of Physiotherapists of Ontario.

What’s Your Ism?

Aug 09, 2017

How do your conscious or unconscious biases affect your ability to provide safe and effective care for patients?

If you work in a private practice setting, think about your office for a minute.

Do you have posters for promotion or décor?  Do you have gym equipment?  Is there any chance that these décor elements might intimidate obese, disabled or elderly patients?

Hospital clinics can have some of the same design elements.  Images intended to inspire could have quite the opposite effect.  Is it possible that your décor makes patients hesitant to attend appointments or discouraged about their prospects for recovery?

Décor, while tangible, is the least of the ways that your own feelings or beliefs may have an impact on your ability to help your patients.

I was privileged to attend the World Congress for Physical Therapy last month and one of the sessions which most resonated for me was about critical thinking in physiotherapy.

One speaker, Jenny Setchell, studied stigmatism in physiotherapy. You can find an article she published called “What Has Stigma Got to Do with Physiotherapy?” here.

She shared an anecdote about attending an educational program intended to teach a particular technique for management of lower back pain.  At the session, a colleague noted that it would be difficult to perform the technique on an obese person. Fair enough, and perhaps that opinion would not deter a physiotherapist from performing it anyway, but maybe it would make them less likely to recommend it, or to believe they could perform it well.  Perhaps that patient would have fewer treatment options, not because of real physical barriers but because of an undetected stigmatism on the part of the physiotherapist.

Ms. Setchell talked about stigmatism for disability, mental illness and persistent pain, as well as obesity.

What do you think?  Do you stigmatize patients?  Or potential patients?

We’re worried that the images on our College website perpetuate some isms – and we’ve set a goal of attaining a more realistic picture of physiotherapy practice.  Real PTs, real patients!

Contact us if you’d like to see yourself or your practice on our website at communications@collegept.org.  We’re hoping to collect some new photos of real people over the next year to support all of you in identifying and managing your own isms.

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  1. JW | Nov 08, 2017

    PS 

    Re: "we’ve set a goal of attaining a more realistic picture of physiotherapy practice."

    I hope so! Please feel free to visit us anytime. We would be happy to offer a perspective of life in the field.

  2. John Wright | Nov 08, 2017

    Hi Shenda.

    I am in full agreement that patient's bring a unique and often difficult to understand mix of experiences, challenges and attitudes to a physiotherapy practice. We deal with people in pain, often in one of their most difficult times. We all struggle with our demons - some more obviously and in less accepted ways. Improving our profession's awareness of this would be a positive; most allied health programs teach these professional ethics in the classroom. Granted I have been doing this a while, but it was never even discussed in my day.

    I would like to comment about a couple of things you remark upon in your post.

    I find it remarkable (as did our entire staff!) that you might consider exercise equipment to be part of the decor or a 'design element'. I think you are saying that in order to widen the appeal of physical therapy treatment we could consider stopping supervised exercise in our clinic.

    That would I am sure broaden the appeal!

    That said, therapeutic exercise is what we do. I am reminded of your insightful discussion in the Communique of a therapist who had moved past exercise into more spiritual healing and her supported decision to leave the profession. I think I will keep my equipment!

    I ask you Shenda to consider that this might be reflective of overthinking things. Some people are not going to come to physiotherapy because they are intimidated by exercise. Yes, and .... Often the expectation of a perfect world (even when packaged as accessibility) surpasses the possible. 

    Second I would point out that your original statement was suggestive that our beliefs and attitudes could impact safe and effective care. This is your area of expertise and authority and in that context I am in full agreement. However this is not what you go on to argue. 

    You suggest several typical patient groups and ask if we stigmatize them thus reducing their treatment options or accessibility. Does our professional culture (motivational posters and the like) limit accessibility; not relevant. Treatment options and accessibility are not your professional expertise or authority. The fact that you are correct is not at issue. Just as our patients are free to choose a practitioner or treatment plan we are free to explore our interests, talents and training and treat [given safe and demonstrably effective] as we see fit. It is an impossible goal to accommodate everyone. Impossible.

    I would like to have read the entire article. I feel stigmatized by the paywall and my decision not to be a member of the CPA. My accessibility to the exchange of professional information is limited by my disability of having a kid in college! (He said: Tongue in Cheek).With kind regards, and hopes Jason and A. that this discussion can remain civil and 'academic' so that together we can explore both how we are regulated and the scope of that regulation.

  3. John Wright | Nov 08, 2017

    Jason and Mr. A. As a fellow member of our college I must address your comments.

    I find your comments, allegations and frankly offensive tone are unprofessional and unhelpful in addressing what may be valid concerns. I do plan to address Shenda's musings in a separate comment.

    I hope that opening a discussion can occur. I invite both of you to comment on my response (not this one: suck it up) in order to encourage participation in professional and reasoned leadership. We are after all SELF regulating.

    If we choose engage in unhealthy dialogue we can only accept what our regulatory agents determine to be appropriate business, professional and socially acceptable behaviours. The more appropriate way to address concerns; yes I have a concern with Shenda's viewpoint, is to express our picture in a clear reasoned and informed way. 

    Again as a fellow professional I sincerely request that you either accept what Shenda has to say as reflective of how you want our profession to evolve or be more constructive in your comments.

    Kind regards

  4. Anonymous | Aug 10, 2017

    I couldn’t agree with you more. Maybe it’s time for the CPO to have a new Registrar. She seems to be somewhat incompetent and is wasting the college’s funds on topics that are irrelevant to the general public. I’ve heard that she will actually move forward with prosecuting physios if a complaint is made against them that is unfounded. All to prove that she is needed and the college is needed to “protect” the public. It is a self for filling prophecy (and a massive conflict of interest – not to mention a huge power imbalance against the member from the college) that the Registrar can partake in investigations against the membership in order to show that she is “needed” to govern the physiotherapists. Self governing bodies like the CPO should have a maximum amount of time that the executive, including the Registrar, can hold their positions in order to not loose sight on what their roles actually should be.

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  5. Jason | Aug 09, 2017

    The Registrar is an idiot. So now she is saying if a physio is uncomfortable performing a manual technique on a client because of the physical restrictions of the situation ie: the small size of the therapist or the large size(or obese) of the client they are doing the client a disservice.
    It sounds like if the Registrar is informed of this type of situation she may move forward is prosecuting the physio for professional misconduct.
    The CPO needs to stop enabling the general public and attempting to put ideas in their heads when there isn’t any actual problem. Perhaps the members of the public who may have an issue with the decor or wall posters should see a professional psychologist instead of the CPO implementing yet another administrative heavy policy that they force upon the membership.
    Here is a novel thought, why doesn’t the CPO actually put their time, energy, and funding into properly assessing the membership in the field. This profession is an objective, hands on job and the CPO still believes that doing a ” paper assessment / chart review / interview ” is the way they should ensure the members are qualified in the field.
    No other professional organization has an oral, subjective assessment tool for a client centric , objective occupation. Put some energy into ensuring from the point of the therapist and client contact onwards that the members are treating their patients with the upmost respect, dignity, and education that is expected of a Physiotherapist. Just asking questions and looking over paperwork is not for filling the CPO’s role as a professional governing body.
    Stop wasting everyone’s time with worrying what’s on the God damn walls.

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