The Loss of Care

Barrett L. Dorko, P.T.

The referral is simple enough; "Evaluate and treat for knee pain, 3 times a week for 4 weeks."

Heck, that's a money-maker. And I should be grateful that I don't have to worry about following any specific protocol that the doctor prefers and isn't interested in discussing with me. I know in fact that this doctor doesn't really have a clue what to order, and is glad just to have this patient burden someone else with her complaint.

But once I get some history and find that this is hardly the kind of problem that could possibly require any prolonged treatment, I begin to wonder why any doctor would expect resolution to take so long.

When I came into the profession, problems with pain as a primary concern elicited from us something I refer to as "care." Now, I don't mean to be flippant about this, but I mention it because I have watched as the practice of simply caring for our patients has practically disappeared in favor of our new passion; training.

The doctor sending me this patient with no weakness, no traumatic onset and pain primarily when she rests has simply assumed that if she needs physical therapy she must need a whole lot of instruction in and supervision of exercise. After all, isn't that mainly what therapists do?

But I recall learning something in school about a unique connection between an individual therapist and one patient at a time. This connection was possible only when there weren't many insulating layers of machinery and generic protocols between them, and the therapist had an opportunity to attend to the patient's story and not just to their diagnoses.

When caring is the primary mode of treatment, the therapist is willing to allow the stew of symptoms, frustrations, fears, denial and bargaining emerge from the patient in no particular order. When caring is present, the patient is allowed to speak uniquely of the disruption of their life that forced them toward help. When caring is present, measurement is replaced by acknowledgement and judgement by acceptance.

But I've noticed that it seems no longer possible to expand any clinic or private office without turning it into a place where mainly training is available. Training takes place in a space full of effort, repetitions, charts of progress and goals. An imagined future is as important here as the present, and the present is unacceptable.

I can't recall seeing many promotional brochures for any practice of physical therapy that emphasized the techniques of caring, of quiet non-judgmental listening. A place where someone without an injury, without a weakness, without the need for a month of regular measurement and monitoring could go and not be expected to alter their lifestyle in ten different ways.

Well, as it turns out, my patient with the knee pain was fine very quickly and understands what she needs to do to avoid further pain.

Not much to it, really. Just some individual attention, a little unique handling and some effortless exercise. She didn't come to me asking for anything more and if she wants a hardbody like the ones on the exercise videos, she'll have to go elsewhere.

I'm too busy trying to run a practice that emphasizes care.