“Let’s not forget our Raison d’etre”
Dan Vaughn
Grand Valley State University, USA
The Editor respectfully dedicates his final editorial to a man who exemplified utmost integrity and dedication in his every endeavor; my brother and physical therapist, David Vaughn (1939-2015).
This is my final editorial after three years as Editorin- Chief of JMMT. I will fondly look back on the opportunity to serve this community of manual therapists. It has been an interesting, challenging, and exciting time for me. I want to sincerely thank so many who have provided support in a myriad of ways, but especially Dr. Chad Cook, who capably enabled me when the journey began and Dr. Jean-Michel Brismee, who skillfully assisted me for the final mile. Dr. Brismee will capably carry JMMT forward. It is a transition that I feel especially good about. His leadership, as editor-in-chief, will serve the journal and the manual therapy community very well in the years to come.
I thought a great deal about my topic for this final editorial. In the end, I decided to come back to the crux of what we do; i.e., to provide optimal care in the context of a patient-centered approach. Recent changes in the healthcare environment and consequent adaptations on our part are not necessarily getting us to a better place, from the vantage of our patients. So, I intend for this final editorial to be a call to the members of the manual therapy community to recommit to making the patient the centerpiece of our practice.
Many [hopefully most] of you will scoff at the notion that your patients are not already positioned thusly. I acknowledge that that is most likely the case. But, let me invite you to perform a self-examination in the context of my own experiences in the past few months.
Given the multitude of factors that ‘‘impose’’ upon our workdays, I believe that there is an elusive intrusion upon our intent to provide patient-focused care on a daily basis. After all, there are productivity standards, calls to provide evidence for the efficacy of what we do, electronic medical records to update, patients with complex histories and medical concerns, and students to instruct (just to name a few), which can subtly erode the quality of time spent with our patients. I would suggest that the combined impact of more than one of those factors has an exponential effect on the quality of our interaction with, and service to, our patients.
I imagine that none of this is news to the reader; yet, the problem is so understated that you may already have fallen victim to its infringement. I think that it had influenced me when I was in fulltime practice. In fact, I am certain of it. I became a prisoner of time without noticing it. Productivity concerns overwhelmed my employer and trickled down to me. The patient lost out.
This is a true story. It will test the reader’s diagnostic skills and offer him/her an example of my point. The names are changed to protect those actually involved. I accompanied a friend, Bill, to his doctor this year. Bill was worried about his symptoms and wanted me to go along to ‘‘ask the right questions’’. Bill had been essentially healthy for most of his life and was a regular exerciser now, in his early 60’s. He worked out with a combination of weights and aerobic activities (treadmill, primarily) five days/week. Bill is a non-smoker and never had surgery. He developed a cough for no apparent reason. There was no illness that accompanied the cough and no constitutional signs or symptoms. His only complaint was a dry, persistent cough that had gone on for 3-4 weeks prior to this medical office visit. There was no weight loss and no loss of appetite. The only complaint was the cough and a recently detected drop in his treadmill performance. Bill noted that he had to hold onto the treadmill to keep up with speeds that he had done for years. Finally, the day before his doctor visit, he got on the treadmill and just could not run at all. ‘‘Fatigue’’, is what Bill thought. He works 60 hours/week and is an insomniac. The lack of rest finally caught up with him.
To keep this brief and get to my point, it took three visits over 6weeks to establish the diagnosis;meanwhile, the coughing never stopped. The day on the treadmill when he absolutely could not run occurred the day before his third visit to the doctor, when the correct diagnosis was finally established. However, the general decline in pace was reported at the initial visit.
The story provides an example of my point. Bill had noted that his doctor was less attentive during his recent visits than he was accustomed to over their 10z years together. This was evidenced by the fact that the physician would ask questions that Bill had just answered during their discourse. It seemed to Bill that his physician had becomemore focused on his computer and filling in all of the blanks on the forms embedded there. The doctor wasn’t paying attention any more. The physician also bemoaned the pace of his schedule on Bill’s two previous visits.
Bill had a perspective on this; he is a healthcare providerhimself. Hehad been diagnosed 6 years previously, by the same doctor, with the same diagnosis. It is not a diagnosis you want to miss. But this time the physician was compromised by the encroachment of productivity and process (EMR). The centerpiece had become displaced.
As manual therapists, we deal with these insidious encroachments. There is no question that we must tend to the ‘‘bottom line’’ of business and that procedure must be followed in the systems where we are employed. But, we must not compromise our focus on the patient as our raison d’etre. To do so is to seal our fate as healthcare practitioners. Patients will find their way to someone who does listen and does demonstrate, explicitly and implicitly, his/her commitment to the patient.
Bill had pulmonary emboli; misdiagnosed as a virus first and as atypical pneumonia on the subsequent visit. We are all capable of making mistakes. We are, after all, human. But let’s check ourselves to make sure that we continuously dedicate ourselves, first, to our patients and their needs. We have to establish their trust and that starts with an unremitting focus upon the patient. Anything less is unsatisfactory, if not unethical.