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Editor's Notes |
Health care is a massive industry today. As such, it is prey to the wizardry of marketing geniuses. Hospitals and health care organizations in every major market trumpet their excellence in pompous and pretentious advertising. Even when the advertisements are "folksy," they retain a tone of hubris.
In an advertisement shown here in the Chicago area, two white-coated folks wander among trees and grass and eventually sit beside a pond, where one of them breathlessly lists the accomplishments of the medical staff. As ducks swim by, she somehow manages to retain her composure (and not laugh hysterically) as she asks her colleague, "Why would anyone want to go anywhere else?" "To escape the pomposity," I shout whenever I see this commercial. I will spare you the details about the advertisement that shows two golfers discussing their hip replacements and the one that touts the number of Nobel laureates affiliated with the institution.
The shameless marketers of health care would have us believe that you can choose your "savior," the place where your health care needs can be uniquely and perfectly met. If such a nirvana exists, I have yet to hear about it. We mere mortal health care providers try the best we can, but truth be told, we often do not do as well as we wish we could. Spending time and money on marketing is not the answer (though I grudgingly have to admit to the necessity of some marketing).
When the sick seek health care they know what they want: They want to get better. They know the symptoms they want to have alleviated, and they know the prognoses they want to hear promised to them. Health care today, however, is not "just" for people who are sick, and to marketers, this is like red meat to a lion—too tempting to pass up. We now offer better health both in the here and now and in the future. We promise that what isn't will never be! In other words, if you are not sick enough to need our services, we beckon you to come learn how to prevent diseases through lifestyle changes and risk-factor reduction; that is, to join the wellness bandwagon. This idea, like so many ideas that seem intuitively obvious, is hard to ignore and impossible to dismiss. Unfortunately, it can lead to the uncritical acceptance of certain premises.
As physical therapy faces a new millennium—with workforce changes apparent and the structures of health care organizations as stable as a house on the Pacific palisades during the rainy season—physical therapists have joined the wellness bandwagon with new vigor. For those who believe that wellness and prevention efforts should result in more than advertising, however, the news is not good. The more we tell people what to do, the less they seem to do it. Smoking rates—particularly among women and young adults—and the increased numbers of persons who have sexually transmitted diseases remind us that knowledge alone does not change behavior.
This month, the Journal launches a series of articles on wellness and prevention. Kennon Francis, PhD, examines how well our society has met the US Public Health Services goals for the year 2000. We have not done as well as we should have done. Given that we failed to meet the previous set of goals established by the PHS, no one should be surprised.
Talking about prevention and wellness and using them as a marketing device apparently are a lot easier than actually doing something about them. In the end, human beings will pay in spirit, health, morbidity, and mortality for squandered opportunities. Those of us in the physical therapy profession have yet to define our role in solving the problem. Many among us have been loud and clear in joining in the marketing efforts but less clear in determining how to get the message across to our patients and clients and, most importantly, how to help them see the need to change.
Some suggest that our future and survival as a profession will depend on how well we engage in prevention and in translating wellness from a concept to an action. With our expertise on the musculoskeletal system, exercise, and cardiology, we are among the health care professionals who are best-positioned to help people develop healthier lifestyles. The traditions of our profession, particularly in the area of rehabilitation, also indicate that we are used to working with people who need to adjust their lifestyles. The opportunity exists, as does the societal need. The question remains as to whether we will become promoters of wellness because we know we can do it well, or because it is fashionable and economically desirable to join the bandwagon.
When it comes to musculoskeletal injuries, physical therapists seem to be almost unanimous in the opinion that we can prevent bad things if we intervene early. Unfortunately, there is little evidence in this area. Proving that our actions led to something not happening would be an almost impossible task—unless of course we know the incidence and prevalence that would occur without our interventions. In some areas—such as heart disease and diabetes—our interventions designed to prevent disease or disability can be justified, because there is overwhelming evidence that problems are likely to occur without those interventions. The same cannot be said for many of the other disorders that we say we can help prevent, such as recurrence of low back pain, pain associated with repetitive injuries or overuse, and orthopedic problems in children with cerebral palsy who have a limp that appears to place stress on joint structures.
As the ghost reminded Scrooge in Dickens' A Christmas Carol, the future he saw was not fixed, but rather a representation of what will happen unless someone chooses to change that future. So it is with prevention and wellness. We hope that the dialogue offered in the coming months (a dialogue suggested by Drs Kennon Francis and Claire Peel of the University of Alabama at Birmingham) leads physical therapy to embrace wellness and prevention in an effective manner—and in a manner consistent with scientific practice. When we believe prevention may be possible but we lack data, we should be more candid with our patients and payers, all the while expending necessary resources to seek evidence about what might be prevented.
As the health care industry slowly accepts the wisdom of prevention, let us use this not as an opportunity for self-aggrandizement but as a part of good practice. We can best serve both our profession and our society by not promising more than we know we can deliver.
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Physical Therapy 1999 79: 405-414.
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