"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Thursday, January 12, 2012

Do We Need Physical Therapists or Algorithms?

"Do you use Treatment Based Classification algorithms?" I asked my friend in Florida. 
"No", she replied.  
"Why not?" I asked. "
If I use an algorithm, where's the need for the physical therapist?" was her final answer.
My friend is a busy, private practice owner who is well-respected for her focus on the patient and her clinical skills.

Physicians, too, resist using computer algorithms to inform treatment decisions for similar reasons.

I've discussed this trend before, most notably in response to the surprising results at the Oxford Debate at the 2011 American Physical Therapy Association Annual Meeting in Washington DC where student physical therapists lead the room AGAINST clinical decsion rules.

Now, Vinod Khosla, tech investor and CEO of Sun Microsystems, questions whether Do We Need Doctors or Algorithms?

Essentially, Vinod's argument boils down to the fact that computers and computer algorithms are faster, cheaper and less likely to make a mistake.

Humans, on the other hand, are non-perfect and non-perfectable.

The odds are against physicians and physical therapists if we try to pit human productivity and human efficiency against machine productivity and machine efficiency. But, healthcare is NOT just productivity and efficiency. Healthcare is also caring.

According to Jeremy Rifkin in The End of Work:
"...the role of humans as the most important factor in production is bound to diminish in the same way that the role of horses in agricultural production was first diminished and then eliminated by the introduction of tractors".
I think physical therapists are in good position to incorporate decision algorithms into our practice WITHOUT losing jobs.

Humans still prefer to be cared for by other humans. Chris Anderson author of The Long Tail, describes algorithms, like Wikipedia or Google as:
"…operating on the alien logic of probabilistic statistics - a matter of likelihood rather than certainty....our brains aren’t wired to think in terms of statistics and probability. 
We want to know whether an encyclopedia entry (or a doctor) is right or wrong. We want to know that there’s a wise hand (ideally human) guiding Google’s results. We want to trust what we read.”
Physical therapists are among the most trusted of healthcare professionals. Besides, we work with our hands and we still touch the patient.

I don't think Vinod has an algorithm for that.

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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

"Make Decisions like Doctors"

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