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As Professionals, As People—We Must Be Activists

Now, without the frivolity and triviality of forced celebrations, the millennium and the century are truly coming to an end. For physical therapists, this is a good time, despite the proclamations of naysayers. We have the opportunity to redefine who we are and to offer our patients, clients, and society a profession that welcomes change and is not afraid of accountability—a profession so certain of its value that it does not fear dialogue or challenge.

This should be a time to consider the birth and growth of our profession and the path that lies ahead. Although many of our treatments are rooted in antiquity, our profession itself is primarily a child of this century. Out of necessity, much of our profession's history has revolved around the need to undo the misdeeds that humans have visited on one another. Our colleagues continue to work with people who have been battered, people who have been damaged by war, and people who simply did not have the resources to avoid preventable illnesses and disability. Sisyphus was condemned to roll a stone up a hill, only to see it forever roll back down again. Our profession has within it a Sisyphean element that might as well be considered part of our collective DNA. But in an era of genetic manipulation, we might be able to purge this vile, seemingly immutable curse.

For me, the curse is even more ironic as we face a world of limited health care resources. We celebrate the abundance now shared throughout much of the American economy, but we still argue about who gets health care and how it should be administered. On the good days, we examine critical questions and begin to consider issues that have for too long been ignored. On the bad days, health care professionals look like hyenas fighting over who gets first pick of the remnants offered up by profit-driven, valueless systems that seek primarily to control expenditures. Because we too often participate in this behavior, our moral authority—which comes from being the health care professionals who are closest to patients—is lost. For example, too many therapists offer treatments that will be reimbursed regardless of effectiveness. The humanity seems to have been taken out of health care, and often we argue about who gets paid, not who needs service. We seem to forget that the two can and should be linked.

As I ponder the ending of the century and the millennium, a unified vision seems difficult to achieve, but then I remember the dichotomy of language offered to humanity in the Ten Commandments and elsewhere in religious writings and thought. We were told what to do (eg, honor thy father) and what not to do (eg, covet thy neighbor's wife). What is it that we physical therapists should not be doing, and what is it that we should be doing? I suspect there is a great deal that we should not be doing. But as a passionate believer in our profession, I think there is far more that we should do. That is one reason why I so fervently seek research that will provide the wisdom to know the difference.

Must we spend all of our time undoing the cruel deeds of our fellow humans? Must we accept the premise that there are insufficient resources to provide meaningful health care to all those who need it? Perhaps our problem is not only in the care we provide, but in the way we relate to the broader community. We can fight to lift the caps on reimbursement under Medicare, and we should do this with all the strength we can muster, but what about helping our senior citizens get the prescriptions they need? It does not matter whether we prescribe medications. What matters is that our patients and clients need medications. As health care professionals who see what happens when a person has a stroke, who could speak more eloquently about the need to make certain that people can afford, and therefore take, antihypertensive medications? Active participation in a society's political processes is no longer an optional activity—and I do not mean participation only in self-centered political action committees.

Many of us chose to become health care professionals so that we could more directly interact with those who could benefit from our efforts. A ubiquitous cynicism about politicians and lawyers can often be observed among us. This holier-than-thou luxury can no longer be justified, nor can it be maintained without a tacit acceptance of the harm it does to patients and professions. This may be one of the great lessons we can take forward from the 20th century. Even though our political involvement may, to some extent, be derived by necessity from self-interest, it still must go beyond the parochial. As health care leaders, we need to be up front and visible in the struggle for a health care system that works, instead of being present only when our interests are at stake.

Recently, I traveled to British Columbia to give a workshop on how to review manuscripts. While I was there, a colleague took me on a tour of Vancouver, one of the world's most beautiful cities. The soaring cliffs meet the Pacific Ocean in that place, and salmon leap in and out of the dark blue water. The evergreens are pointed skyward, as if to pay homage to the powerful forces that created them, forces that control life and death.

My Canadian colleague is a survivor of breast cancer who has learned that being a therapist requires both compassion and passion. Through her experience as a patient, she has learned that, as a professional and as a person, she also must be an activist. And as an informed, scientifically responsible activist, she transcends the limited role that physical therapists have played in the past century. She has shown me the power that we professionals can exert.

As we drove through the mountains of the great Northwest, my colleague and I talked about access to health care, and I found myself thinking about a different Canada. Among the starving, ghostly inmates who walked the grounds of Auschwitz, there was often talk of "Canada"—the name they gave to the giant sheds in which the Nazis stored the goods that they had plundered from those they would soon kill. To the inmates at Auschwitz, Canada was a bountiful country with vast resources, much like those sheds whose riches were so inaccessible to them. Among the dead and the dying, there was an abundance of unimaginable proportions, a harvest of cruelty.

As I think of the resources needed for a reasonable health care system, I often think of those giant storage sheds. I am haunted by our priorities. If we could diminish throughout the world the cruelty that we visit on one another, and if we could reap the unused resources for good, health care would not have to cost more. A reasonable health care system will never become a reality, however, unless health care professionals lead the way, not only in a technological revolution, but in a moral crusade. That should be part of our mission—and may be our only means to exorcise our Sisyphean curse.

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This Article Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Rothstein, J. M Search for Related Content PubMed PubMed Citation Articles by Rothstein, J. M Related Collections All Editorials Jules Rothstein Social Bookmarking                      What's this?