There are several examples of role blurring with (or due to interaction with) physiotherapists in the British Association of Occupational Therapists' internet discussion forum[1,2,3,4]. Currently, National Health Service physiotherapists seem to be moving away from 'physiotherapy' in musculoskeletal settings towards biopsychosocial treatment. One even suggested scrapping massage as a physiotherapy modality[5]. I believe that physiotherapists are now addressing problems with treatment approaches that would be better addressed by occupational therapists, or perhaps clinical psychologists. This may be detrimental to all of the concerned professions as well as patients, so I wrote a letter to express my opinion[6]. Unfortunately I feel that the editing took some of the weight out of my argument, so the original e-mail is copied below:
"----- Original Message -----
From: Venth
To: frontline [at] csp [dot] org [dot] uk
Sent: Monday, March 30, 2009 9:31 AM
Subject: For the letters page

Dear Sir/Madam

Please do not let the National Health Service destroy our profession.

I am writing in response to various current issues and Julia Squier’s letter in Frontline 18/3/2009 regarding massage and evidence-based practice. It seems to me that there is a bandwagon within healthcare following the belief that “randomised controlled trials are the best way of establishing clinical effect”[1]. Perhaps clinical effectiveness in physiotherapy depends on choosing the best combinations of techniques for individual patients[2], treating whole people rather than reducing them to easily measurable physiological parameters. If so, randomisation will not always be a valid tool for physiotherapy research. I personally believe those that do not recognise massage to be a clinically effective tool may simply not know when or how to use it.

Thirty years from now, if physiotherapists have not reversed the trend towards hands-off biopsychosocial musculoskeletal treatments and generalised exercise classes, what will the public perception of us be? I fear they will gravitate towards osteopaths and chiropractors because they will have no idea what physiotherapy is. There is a big need for psychosocial interventions in primary care today but I do not believe physiotherapy is the best profession to fill that need. Role blurring could be professional suicide. The occupational therapy profession made a similar mistake in the past, which is why they are commonly mistaken for a profession of discharge facilitators today[3]. Perhaps we should learn from their mistake before it is too late.

References:
1. Clemence M. (2009) energy medicine-does it belong in physiotherapy? Available from: http://www.interactivecsp.org.uk/network/viewTopic.cfm?item_id=00C8440EB... Accessed: 8:21 30/3/2009
2. Hunter P.A. (2004) Is physiotherapy any use for back pain? Available from: http://www.bmj.com/cgi/eletters/329/7468/694#75659 Accessed: 8:30 30/3/2009
3. Venth (2008) What is in a name? – Why non-holistic interventions should not be termed ‘occupational therapy’. Available from: http://www.metaot.com/blog/what-a-name-%E2%80%93-why-non-holistic-interv... Accessed: 8:50 30/3/2009

Venthan J. Mailoo BSc (Hons) MCSP CertMgmt"

Are physiotherapists where you work using up their clinical time counselling patients on life satisfaction, lifestyle, stress management, relaxation, pacing and pain psychology? If so, have you ever asked yourself or your therapy services manager why those problems are not being referred to occupational therapists, to free up physiotherapists’ time for the specialised interventions they can offer, that few other professions can?

V

References:
1. ukblonde (2006) role confusion with physiotherapist. Available from: http://www.cot.org.uk/members/phpBB2/viewtopic.php?t=1279&highlight=phys... Accessed: 13:00 27/5/2009
2. Student (2006) In hand therapy are we moving towards a generic role? Available from: http://www.cot.org.uk/members/phpBB2/viewtopic.php?t=1512&highlight=phys... Accessed: 13:03 27/5/2009
3. Basic grade (2007)sort them out then. Available from: http://www.cot.org.uk/members/phpBB2/viewtopic.php?t=2237&postdays=0&pos... Accessed: 13:11 27/5/2009
4. Rebecca (2009) Amputee withh anoxic brian damage. Available from: http://www.cot.org.uk/members/phpBB2/viewtopic.php?t=3340&highlight=phys... Accessed: 13:14 27/5/2009
5. Squier J. (2009) Consign massage to history. Frontline 15(6):19
6. Mailoo V.J. (2009) Identity crisis. Frontline 15(9):20

0. Introduction: I am currently studying autoimmune soft tissue pathologies and unfortunately there is so much overlap between them they all seem to merge into a fuss in my mind. In order to set some concrete divisions I am looking from a medical model approach at antigens and antibodies specific to particular conditions. It is not much practical use to an occupational therapist, but knowing what these tests are used for cannot hurt academically or when interpreting medical notes, and you never know; the knowledge could earn some MDT brownie points. Once again, I am not a biochemist or immunologist so do not take any of this as gospel.

Hello,

As a Masters of Occupational Therapy student, I am undertaking a project exploring benefits and application of Yoga for post stroke clients. There is lot of research supporting the benefits of applying Yoga for various disabilities but there seems to be lack of literature on how to adapt Yoga for post stroke clients. I wish to evoke a discussion on how yoga is being adapted and applied with stroke clients and with what therapeutic gains.

I invite your participation in the discussion about Yoga and stroke at my blogsite, http://strokeofyoga.blogspot.com/. What is likely to emerge out of this is a real-time, practice-based information on the topic. So, please come and share your experiences, ideas, and suggestions about the topic and join in an open & healthy discussion with other like-interest practitioners.

Please share any information along the lines of what type of Yoga is used, how often, how is it adapted, which specific Yogic concepts are used, and how long it takes before the results are seen.

I project to start summarizing the blog site activities by May 15th 2009.

I sincerely appreciate your time and consideration. Your contribution is indispensable to the success of this undertaking and for future growth of knowledge in this area.

Sincerely,

Rashmi Bhatia, OTR/L

Abstract: This blog entry reflects on my personal feelings of occupational alienation and how they were stimulated by the use of occupational alienation and occupational injustice as weapons in a foreign country. It provides examples of politically and internationally generated occupational risk factors. Finally it describes my self-treatment using the limited means I have. Luckily for me, those means are far less limited than those available to people in the country that inspired this blog. THIS BLOG INCLUDES PICTURES FROM WAR, INCLUDING DEATH. YOU MAY THEREFORE WISH TO AVOID READING IT. The pictures in the referenced material are much worse and are likely to shock most people, so think carefully before looking at material from the reference list. Thank you.

These are some mnemonics that some friends and I made up or found when we were revising for an anatomy exam. They really helped us learn the muscles of the hip. Hope you find them useful.

Extensors

Genetically Modified Ham
Gluteus Maximus
Hamstrings

Adductors

Three little ducks Peck Grass
Adductor Longus, Brevis & Magnus
Pectineus
Gracilis

Abductors

Two Sores on two small bottoms
Tensor Faciae Latae
Sartorius
Gluteus Medius & Minimus

Medial Rotators

Two small Tense Infected bottoms
Gluteus Medeus & Minimus
Tensor Fasciae Latae
Iliacus

1. Introduction:
Some years ago while I was working as a health care assistant in operating theatres a student nurse from Ireland consumed alcohol excessively during her 21st birthday party. The next day she attended the accident and emergency department but was sent away diagnosed with a hangover. Normal doses of self-administered paracetamol overloaded her liver due to her dehydrated state and she subsequently underwent a liver transplant. Unfortunately she then had a stroke and died in the intensive care unit. Her 18 year old sister who was also a student nurse went back to Ireland in a state of distress. My last shift in theatres before I departed to University ended with an alcoholic man bleeding to death. I still remember the distinctive smell of blood which at first could not be seen. The surgeon tried to look for the source of his bleed with an endoscope, but there was so much blood that his view was obscured. As his blood pressure dropped we put him in a head-down tilt. That was when I first saw the blood as it gushed out of his mouth looking like chopped liver. I was at his waist level when we turned him on his side to clear his airway and I found myself covered with blood as he was bleeding from his rectum too.

I soon forgot these experiences while at University, where I myself resorted to getting drunk to escape the huge mismatch between my achievements and what I knew to be my potential. It was an easy way to escape the feelings generated by being underestimated and disrespected. With the luxury of hindsight I know I was foolish for risking a good life for a few moments of escapism. I chose to moderate my alcohol consumption after a couple of near misses. I woke up one morning face-down in my own vomit, with no memory of having been sick. I must have vomited while unconscious, and if I had been lying on my back, perhaps I would have died of asphyxiation. Shortly after I started my current University course there was news of a man being beaten to death in the city[1]. I wonder whether alcohol played any part in the killing. I know a student nurse here that has been to hospital twice so far in a state of intoxication though we are still only first year students. The first time, it was due to unconsciousness after a drunken person sat on her head and the second it was due to the intoxication itself. I also know a lesbian woman that flirts with men when she is drunk and a student occupational therapist that wanted to sleep with me while she was intoxicated but changed her mind when she was sober (this has also happened to me once before with a student occupational therapist that is now qualified). During my first year of training, a fellow student occupational therapist jumped fully clothed into the river Thames on a winters night because in a drunken state she decided she wanted to get away from her date. She is lucky to be alive. Only yesterday one of my flatmates suffered bereavement. His friend had been missing for a few days[2]. A Facebook memorial states he “lost his life all because of a few to many drinks”[3]. As I type this there are several drunk people in my flat, seemingly oblivious to the suffering of our absent flatmate and the cause of his unfortunate loss. Condoms were left out for people to make use of and in their state of drunken stupor they opened the packets and threw the condoms on the floor needlessly wasting British taxpayers' money during a time of recession. Those condoms were worth more than I can afford. My humility is being tested to its limits and I find myself judging those around me. I believe life is too short and valuable to lose moments in intoxicated stupor. I now see my disregard for life as an undergraduate and the behaviour of those around me as a symptom of social disease; an occupational disease with potential occupational cures.