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The Sensitive Practitioner

Many health care practitioners view practice guidelines as threats to individual initiative, whereas others, including this Editor, view appropriately drawn guidelines as paths to better practice—more scientific and effective practice. But guidelines are credible when they are based on data, not when they are based only on the power of those who invoke them. Guidelines can be (but are not always) a guarantee that patients will receive the best possible care with due regard to available resources. On occasion, even some of the most passionate opponents of guidelines might admit that they yearn for a more detailed "road map" to guide their behaviors.

When treated as though it could belong to any patient, a disassociated frozen shoulder is a minimal challenge compared with the same diagnosis in a person who is fearful of the physical therapist. Similarly, the athlete who loses the capacity to compete due to a spinal cord injury is not the same as the person with similar neurological damage who finds recreation through the use of computer simulations and catharsis through writing. We humans are, thankfully, not all the same, but reaffirming that obvious truth does not change the unfortunate reality that health care professionals often act as though all people are cut from the same cloth and have weathered life in the same manner.

Patients who seek our services come to us not as the empty vessels of classic imagery, but as complex beings who have lived lives of varying satisfaction and experience. How much of their background do we need to know? When do we move from being health care practitioners with a need to know to being "voyeurs" who collect a great deal of data but use few of those data to guide interventions and other interactions? When it comes to dealing with matters of the patient's mind and heart, many of us would beg for time-proven practice guidelines rather than continue to exist in a murky world of trial and error. In this issue, Schachter, Stalker, and Teram do not offer us guidelines, but in their magnificent demonstration of the power of qualitative research they do offer some guideposts that can help pierce the veil our patients use to hide their fears and pain from us.

Using the words of survivors of childhood sexual abuse, these authors have written a report about what we can do in practice. They give us the means to see better and to hear more clearly. A paper such as this can be used by caring practitioners to sharpen their senses, so that what may seem as indecipherable behavior can be understood for the symbolic action that it is, and so that limitations can be viewed not just as limitations of the musculoskeletal system but as limitations of a scarred psyche.

The message is not just about childhood sexual abuse. All patients need sensitive practitioners.

The title of the report uses presumptive language in claiming that it will move us "toward sensitive practice." Rarely does the Journal allow such broad claims in articles when there is no evidence. But this is a different situation. I urge every physical therapist and physical therapist assistant to both read the report and attend carefully to the Conference discussion that follows. The dialogue suggests that anyone who considers what Schachter and her colleagues have reported will be better for the effort.

This paper is not only about survivors of sexual abuse. It is about all of us—we who chose health care practice and proclaim ourselves to be members of a "helping profession." If readers reflect on their interactions with patients because of this paper, the broad goal of moving us to more sensitive practice will be achieved, not just because of what the article says, but because of what each of us does in response to this vivid reminder.

Schachter et al provide insights into dealing with survivors of childhood sexual abuse. Warning signs are discussed, and suggestions are made. But the paper should also remind us that although abuse survivors have unique needs, they have a primary need that is universal: They need to be considered as individuals. Practitioners need to be sensitive not just because sexual abuse leaves deep and consequential scars, but because all patients and all practitioners carry baggage as we journey through life.

Cynics might dismiss the concept of sensitive practice, but reality tells us that only by listening to our patients can we know about them and their conditions. The knowledgeable listener who can act on what the patient says needs to couple that skill with keen observations of unspoken messages. All the while, the physical therapist must be wary about receiving messages never meant to be sent, messages that come from within the practitioner, born out of bias and personal agendas.

The task before us is not easy, but all of our skills and knowledge will matter little unless we bring to our practice the sensitivity that is the right of all of our patients.

This Article Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Rothstein, J. M Search for Related Content PubMed PubMed Citation Articles by Rothstein, J. M