with Dr. Hutoxi Writer
How do you think the field of physiotherapy has changed over the years?
I have witnessed the profession growing in various areas- scope of practice, education, research, technological advancements- like the growth of a tree, roots digging deep into fundamental research and branching out staggeringly into various specialities.
When I joined the field of PT in 1975, I was from the post tenth degree batch. I have been taught by professionals who were diploma holders, I have had students with a longer course duration of 3.5 Years, then 4, then 4.5 years, I witnessed the starting of the postgraduate course, right from its outset.
Initially this two year degree course had PT under only 2 headings- PT in Medical Conditions and PT in Surgical Conditions. We were there when the two year course became three and a half years long. When the course became 3.5 Years long, the base subjects of kinesiology, life sciences, mathematics and medical electronics were added.
It was realised that when the foundation subjects are taught well, especially biomechanics and kinesiology, that students have a better understanding. However, they were not getting adequate exposure to the practical experience, which is when a fourth year and internship were dedicated for hands-on clinical training
The medical foundation of our course now is much stronger than it is in the countries abroad, with a strong base in the knowledge of pathology, pharmacology and prescription. We are training to pick up subtle symptoms, an eye for flags of all colours.
But therapy has always been both- a science and an art. It requires the honing of professional as well as personal skills- not only your hands, but the mechanics of people. The art of dealing with somebody at their most vulnerable, the art of dealing with the various factors that affect treatment.
It also stands that a therapist-patient relationship is usually longer in duration, something that takes much more time than taking a tablet, so it necessitates the building of a special rapport with the patient.
An art and a science, which is why a lot of art subjects are taught as part of the course. Psychology, Sociology, an introduction to anthropology have been a very important foundation of this course.
We have grown tremendously in research.
As a student , we had a few lectures of statistics, but now we have an entire course on research methodology, we have projects in the fourth year, and a lot of time and effort is dedicated to understand the system of scientific enquiry in our clinical setting.
Early on, we can now establish the importance evidence based practice
What were clinics like when you started out?
When we started out, we learnt most at the bedside. In a 2 year course we hardly had any lectures, we always learnt with our faculty and seniors in the wards, what we learnt was what we saw when we were with our patients.
Though you could say it was a small course, but it was hands on from the get-go, and we spent time with our patients. But the current length of the course was necessary to build up the foundation and give good clinical exposure
Initially we had referred practice, where physicians would refer patients to us. These are the days when Physiotherapy is becoming first contact practice. Our aim should be to train so well that we can help patients coming directly to us, justify the need or redundancy of investigations and refer to specialists, if required.
Do you miss any aspect of practice?
When we were students, we used to have rounds with the surgeons, residents, staff, occupational therapists, speech therapists, psychologists. The whole team took a round together, went from bed to bed.
All patients were evaluated in a multidisciplinary fashion in the wards at the same time, now the Residents, PT, OT, psychologists all have separate rounds
Why do you think that is?
Those days honorary doctors spent 1-2 days every week in specific hospitals. Now we have full time employed physicians, paid for by the corporation/institutions. As full timers, the lack of time is alarming!
The whole system of involving a team has disappeared. I think it should continue: when
multidisciplinary specialists can see the patient together, draw their own goals, share these goals, the benefit to the patient is marked.
There is a lot of force to start this approach again. Multidisciplinary clinics – knee, shoulder clinics, arthroplasty centres, fitness centres, where specialists can come together for the common goals of the patient.
How has the student-teacher dynamic changed over the years?
I think teachers and students are more open to each other now. Teachers are more approachable, the presence mentor mentee programs gives you the opportunity to speak your mind to the teachers, give your feedback. Now students enter the staffroom like its their own classroom!
We were terrified of our teachers.
The changed dynamic has made a lot difference now that the gap between teachers and students has been bridged, there is a lot of communication between the two. I find it to be a positive aspect of the current teaching program.
When you started your journey, what was the perception of the field?
I was not allowed to cross the city limits to pursue further study, so I took up an admission in a course of micro biology. I was not very happy sitting in a lab and looking at slides, and I thought this is really not for me. I had applied for physiotherapy not knowing what it really was, and when I got a call I went to my general practitioner for guidance. He said it was a very good field, ‘you’ll be with your patients’ and ‘you’ll have to learn a lot of subjects of medicine’, there will be no emergency calls and that it’s a very lucrative opportunity.
Back in the day, a four figure salary number put a twinkle!
When I stepped into the field I did not know what it really was. Initially PT was limited to orthopaedic conditions, focused solely on musculo-skeletal problems.
In my student days saw a large number of poliomyelitis cases. The profession grew beyond orthopaedic and medical conditions to include anything that involved “movement” dysfunction.
What was your first job like?
It was that of a junior demonstrator where I was teaching practical skills, after which I took up the post of a clinical therapist and private practice.
With that, I began to understand what happens to a disabled person at home, what are the problems he can have, I got an insight into the plight of people beyond what is seen at first glance.
At such home visits one works without any specific equipment- you have your hands and the furniture around you. It is here that you learn the importance of improvisation
Then I joined a BMC hospital, a tertiary health centre and learnt more about the general public in a corporation set up
When you witness the hardships faced by the poorest of the poor with movement dysfunction, is when you understand what cannot
Is there any marked deficit that you’ve noticed in our field, over the past few years?
Compared to my early years, students now want to be spoon fed- they want notes and study guides, focus more on theory, less on skills.
Our only resource was the patient; we couldn’t rely solely on books.
What has improved is our clinical reasoning, since we are headed towards first contact practice and our strong medical base is put to use.
Another thing that troubles me is how the busy schedules have disrupted treatment timings. Therapists have sessions as late as 10pm in the night. It is then difficult to accommodate important parameters like patient’s arousal status and his medication and dosage timings. School going children are being treated in evenings, after a full tiring day of school and play, which reduces the productivity of the session.
What do we need to do, to improve ourselves as first contact practitioners?
Apart from sharpening our CR skills and base of knowledge, I think we need to work on this: Dividing ourselves by speciality reduces our competence in multiple disciples, and as a ‘general health’ care provider makes the healthcare delivery complicated.
For example- I have mostly treated adult neurorehab patients, and if I get a paediatric patient, I would refer him, as I don’t think I can do complete justice to the child, ‘as it is not my speciality’
Specialization has many benefits, but this compartmentalization of patients and therapists affects the treatment of the individual as a whole.
We thank Dr. Hutoxi Writer for her insight and time.
Glint 2020 