Overview of Professional Deficiencies and Rehabilitation

Introduction to Orthotists, Physicians, Physical Therapists and Clients

The definition and the goal of Rehabilitation are the same: to restore to a former capacity; to restore to a state of efficiency; to restore to a state of good health or useful and constructive activity. In order to provide solutions to physical deficiencies necessary to achieve the goals of rehabilitation, clinicians and clients alike must recognize the existence of professional deficiencies.

What is a PROFESSIONAL DEFFICIENCY? In general, it can be anything that hinders, impedes or otherwise interferes with the ultimate goal of treatment. ALL efforts must be directed towards that goal. Professionals must become part of the solution rather than part of the problem! The first step in avoiding this deterrent to rehabilitation is recognition of the problem. Education is the only way to understand the problem. The solution to the problem is more complex and needs to be studied further.

Examples of professional deficiencies include but are not limited to: misdiagnosis of the underlying problem or pathology; improper assessment of pathomechanics involving joints and musculature; treatment of compensations or secondary problems rather than addressing the cause or primary problem; failure to assess, plan and predict the outcome of treatment consistent with rehab goals; failure to set goals in general; insufficient or incomplete treatment; the use of inappropriate treatment and/or orthotic devices; failure to follow up in order to determine the effectiveness of treatment in terms of long term functional gains; the failure to substantiate and document results or solutions consistent with rehab goals; insufficient education and understanding of new and innovative technology. The list could go on but the ultimate test of any treatment approach is the outcome in terms of functional improvement.

The Evolution of Professional Deficiencies and Remedial Action

Professional deficiencies develop as a result of an evolutionary process. It is an inherent part of any Profession. True Professionals begin their careers as students having no preconceived notions concerning treatment. The desire to improve the lives of individuals with physical deficiencies stimulates the educational process. The mind is open to possibilities like that of a child. There is an innocence and dedication to purpose that makes learning fun. There are those who enter the rehabilitation specialties as business people who are not primarily motivated by these ideals. Theirs is a dedication to a different purpose!

The educational process can only provide an introduction to a profession and cannot teach the student everything. The most important educational goal is to get the student to think on their own! While this may be idealistic, it is not the norm. Students quickly become indoctrinated into established methods of treatment regardless of scientific evidence or long term function gains. Ultimately, every student enters the "work force." The demands and pressures of "earning a living" especially in a managed care environment become serious diversions to rehabilitation goals. Students must question "standard treatment" methods and approaches in order to understand them and possibly improve upon them. Questions are indeed more important than answers.

Any significant medical breakthrough in history has been challenged by the established experts of the time. New and innovative ideas are a threat to a profession! This paradox raises the question regarding the definition of a professional. Is it simply someone who engages in a profession? This definition is consistent with the fear of change and innovation inherent in an "established group of experts!" A professional is an individual first and foremost! The term professional does not apply to everyone equally.

At Dynamic Bracing Solutions™, we look at professionals from a different perspective. A true professional is a perpetual student. The desire to learn and improve is motivated by the ultimate goal of rehabilitation which is to restore the client to optimal efficiency. Learning is a never-ending process. There must be a dedication to purpose and a commitment to finding a better way. Solutions need to be provided in order to obtain the goal of rehabilitation for each individual. Results must be demonstrated. Is the professional providing solutions to physical deficiencies that can be substantiated or is the treatment an accommodation that can be considered professionally deficient! This is the only true test! There are those who are simply unprofessional. There are pseudo - professionals who talk rather than act. There are professionals that have temporarily lost their way as they have become followers rather than leaders. A "systematic approach" exists whereby categories of pathologies are treated rather than individualized and comprehensive treatment. This involves a complete assessment including a functional performance profile, the orthosis, training, treatment and follow up.

True professionals need to be critical of their own treatment and outcomes. It is easy to fall into a comfortable routine. When a professional becomes an "expert" and learns all there is to know, it is time to learn something new! Our "experience" can teach us what not to do which can provide the most valuable lessons! It is not what we know as professionals that make us important or intelligent but rather what we have not yet learned! Prior experience and expertise are merely practice for what we are about to learn. The true professional is excited by the challenge rather than threatened by the thought of change. The following is a list of ten attributes that distinguish true professionals from any others:

1. Caring
2. Desire to help and/or solve problems
3. Positive thinking
4. Flexible thinking
5. Patience
6. Perseverance
7. Skill
8. Experience
9. Confidence
10. Ability to appreciate, comprehend and apply new technology in order to improve functional outcomes
    

The Team Approach

Much has been said over the years about the team approach to treatment. While this may have existed in the past it most certainly does not exist today! Specialists work in a professional vacuum independent of other specialists! There is no communication or sharing of information. Everyone has an opinion whether or not it is based on scientific fact. Inter-professional rivalries and jealousies persist. Clients are treated without regard for the necessary integration of the specialists involved. This is not consistent with the goals of rehabilitation and in fact is an inter-professional deficiency! Clients need a unified team in order to succeed.

We at Dynamic Bracing Solutions™ want to create the team that will provide for comprehensive treatment and total service to clients on an individual basis. Physicians need to take back their clients and assume their leadership role. The physician should be the coordinator of treatment as multiple medical factors need to be considered. Managed care and the growth of other professions have diminished this traditional role of physicians. Orthotists need to re think the methods that they have used in the past and look at new and innovative technology that offers demonstrable solutions. They must re assess their treatment and their goals as well as the orthosis itself. If there is a better way, it must be sought out, studied and mastered. Physical Therapists need to appreciate the interplay between the orthotic device and treatment. They are not the team leader. The biomechanics of the orthotic/human interface must be understood as well as the underlying pathomechanics and how to treat it. Separate specialists must become clinicians with a unified purpose. It is impossible and counterproductive to delineate each professional role into separate categories. The team is greater than the sum of its parts!

The client is the most important team member! While the physician may start out as the team leader, the role should give way to coordinator. All team members must educate the client on a consistent basis; in other words, there can be no conflicting opinions, instructions or suggestions given to the client by team members. The client is ultimately responsible for the outcome of the treatment. After the treatment is completed, the client must have the knowledge, experience and confidence to continue to improve. This is the ultimate goal of rehabilitation and should be the primary purpose of every member of the team.