I work in a private practice setting in Kuala Lumpur, Malaysia where I usually have financial targets to meet. Most practitioners working in private settings would advise their clients to sign up for a physiotherapy package and that would also make the client commit to their treatment visits.
Some questions that often goes through my mind are: How frequently should I see my client for him to improve? Do I need to see him long term or short term? 30 mins or 45 mins? Will it burden my client? Will I learn from seeing him? Does he need Physiotherapy? Is my company doing well this month?
I am always in a dilemma because I have to protect my client's interest, my own interest and my company's interest. Let me elaborate. My definition of interest here means benefit.
Client’s benefit: recovery, pain free, resume normal ADLs, self-management
My own interest: learning, reputation, commission if any, my conscience
Company’s interest: revenue So, how do I determine if this client needs Physiotherapy? 1. Will I be able to help him within my scope of practice? 2. Will my intervention improve his QoL?
3. Does he have an impairment, activity limitation or participation restriction?
If the answers is no then I will not recommend any physiotherapy for the client.
So, how do I make my recommendations? So far, I have held firm to my principles and have not recommended physiotherapy to people who did not need it. I believe that it is the sick that needs the Doctor and not everyone that sees the Doctor is sick. I often offer some advice/education to my clients that visit me and I give them the assurance that they are well and fine. People assume they have a problem and may have been told as well but I see them as healthy and fit individuals after my Ax. Why? Because these people could perform a full squat or had FROM at their "problematic" joint. They may have had a one off pain experience and they thought that it was the end of the world.
Some may argue that I take my client’s concern too lightly but will I be doing my client a disservice if they do not have an impairment, activity limitation or participation restriction. Should I treat the person just because they want treatment? I think this is my professional dilemma and ethically I think it is not right.
I'm being honest. This is a constant challenge for me. I have to generate enough revenue yet not short change anyone or use nocebo. As a physiotherapist, I want to find joy in treating “real" clients, be blameless and be acceptable by my God. At the end of the day, I will be judged for my actions and I want to please God and find a way to survive as a physiotherapist.
Thanks for reading, drop me a comment if you have any!
