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Editor's Notes |
jules-rothstein@attbi.com
Never before have I been among a group of people who are so interdependent, people whose lives, fates, and souls are so intertwined. People who are intimately connected not only to each other but also to thousands more across the world—perhaps even to some of you who are reading this Note. Most astounding is the fact that these people will always be interdependent, seeking strength, solace, and even life from one another.
Some of these people were born twice: once from their mother's womb, and a second time through the donation of an organ.
I am watching thousands of these people march into a stadium in Lake Buena Vista, Fla, for the 2002 US Transplant Games. Never before in one place, in one field of view, have I seen so many people who have benefited from the efforts of physical therapists.
As we contemplate the miracle that occurs with organ transplantation, we might consider the role of the physical therapist to be relatively minor—but only if we take a parochial approach to life. That parochial approach cannot help but fail when you see a mother wearing a pin with the image of her deceased 7-year-old daughter, so aptly named Angel, whose organs now live on in the bodies of others. Or when you hear an Olympic athlete talk about the liver that not only saved his life but also allowed him to snowboard down a hill toward the realization of a dream. Or when you meet a teenager who runs marathons in San Diego, living proof that the heart of a boy who was named Tommy remains vibrant and vital.
At the Transplant Games, those who mourn their loved ones are honored, and those who gave organs from their living bodies are heroes. From these people, organ recipients draw not only life but inspiration. In return, the gift of giving provides meaning in a world too often devoid of kindness and reason. How can you fail to be brought to tears when a grandmother who proudly wears her deceased grandson's pictures on her chest takes the time to wish you well as you await a transplant? She better than anyone else knows that an organ donation will be accompanied by mourning even as it gives life.
The Transplant Games show us how far the athletes have come from their darkest days, and that is true whether they are organ recipients, living donors, or members of donor families. The thing that strikes me is this: People here do not seek to assert their autonomy as they demonstrate their independence and achievements. By their deeds alone, they proclaim the extent to which they are unfettered by disease and sorrow.
Their example makes me uncomfortable about our profession's call for "autonomous practice."
Although our intent may be reasonable, I believe that our use of the word "autonomous" sends the wrong message. We currently offer the world our own unique definition of the term:
Autonomous physical therapist practice is characterized by independent, self-determined professional judgment and action. Physical therapists have the capability, ability, and responsibility to exercise professional judgment within their scope of practice, and to professionally act on that judgment.1
Unless you are a member of our profession, you could easily assume, based on the dictionary meaning of "autonomous," that physical therapists are arrogant and, potentially, irresponsible! According to the dictionary, "autonomy" means having the right or power of self-government; undertaken or carried on without outside control: self-contained; existing or capable of existing independently; responding, reacting, or developing independently of the whole.2 Is this really who and what we are as a profession? No! We are linked to our health care system (whether we like it or not), and we are responsible to our patients and clients. And, indeed, when you read APTA's explanation of the attributes of autonomous practice in 2020, you see that "autonomous" is not really what APTA means:
Each of these elements imbeds two over-arching concepts: recognition of and respect for physical therapists as the practitioners of choice, and recognition of and respect for the education, experience, and expertise of physical therapists in their professional scope of practice.
- Direct and unrestricted access:
The physical therapist has the professional capability and ability to provide to all individuals the physical therapy services they choose without legal, regulatory, or payer restrictions.
- Professional ability to refer to other health care providers:
The physical therapist has the professional capability and ability to refer to others in the health care system for identified or possible medical needs beyond the scope of physical therapist practice.
- Professional ability to refer to other professionals:
The physical therapist has the professional capability and ability to refer to other professionals for identified or patient/client needs beyond the scope of physical therapist practice.
- Professional ability to refer for diagnostic tests:
The physical therapist has the professional capability and ability to refer for diagnostic tests that would clarify the patient/client situation and enhance the provision of physical therapy services.1
The definition of "autonomous" that we have put forth not only is out of sync with the dictionary but remains vague to the point at which we could endanger our futures. Do we, for example, truly want to have the power to order any and all diagnostic tests (per attribute #4)? The word "autonomy" has an attraction, but that attraction can be like a siren's call, bringing us into peril.
At the Transplant Games, I am reminded how we often learn from our patients (a form of interdependence that only a fool would forgo). It's not really autonomy that we as a profession seek. We seek what the people at the Transplant Games demonstrate and what our patients and clients show us every day. We seek unfettered practice that allows us to use our skills, knowledge, and compassion to our maximum potential. On behalf of patients and clients, we seek unfettered access to our services, free from unnecessarily restrictive laws and reimbursement policies. Like those we serve, we want to remove barriers.
People who have shared the transplant experience can teach us an important lesson. Interdependence is not a sign of weakness. Interdependence is a badge that civilized people wear to reaffirm their humanity, their capacity for kindness—and their competence.
References
This article has been cited by other articles:
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  E. Domholdt Invited Commentary Physical Therapy, January 1, 2007; 87(1): 106 - 109. [Full Text] [PDF]
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R. W Sandstrom The Meanings of Autonomy for Physical Therapy Physical Therapy, January 1, 2007; 87(1): 98 - 106. [Abstract] [Full Text] [PDF]
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 R. C. Sneed, W. L. May, and C. Stencel Policy Versus Practice: Comparison of Prescribing Therapy and Durable Medical Equipment in Medical and Educational Settings Pediatrics, November 1, 2004; 114(5): e612 - e625. [Abstract] [Full Text] [PDF]
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L. L Swisher, J. W Beckstead, and M. J Bebeau Factor Analysis as a Tool for Survey Analysis Using a Professional Role Orientation Inventory as an Example Physical Therapy, September 1, 2004; 84(9): 784 - 799. [Abstract] [Full Text] [PDF]
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J. M Rothstein Autonomy or Professionalism? Physical Therapy, March 1, 2003; 83(3): 206 - 207. [Full Text]
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