Donya Nena used to go to a clinic everyday for her arthritis. Everyday, she spends 2 hours starting with hot packs and electric stimulation before having needles stuck on her thighs. When she feels like it, her therapist also pins the electric stimulator onto the needles, yielding a soothing sensation. Oh the joy! Afterwards, she was instructed to do leg raises for 100 repetitions per leg in different directions. Then she will ride the stationary bike, followed by a bicycle ergometer. This is her daily routine. She loooooves it! She does not see any changes in her pain level but it has been an integral part of her typical day for years now. No one explained her why she had to do everything but she is happy to pay for each modality as an add-on to her bill. Retirement fund on fleek!
To each her own, sure. However, health care should advocate for improvements in patients' holistic well-being. If patients are not guided as to how to improve their condition more effectively, the health care providers and facility are not staying true to their mandate.
Here are 5 signs that your current therapy provider is not taking you to where you could be.
# 1. Combo Meals are on the Menu
Name a Filipino who doesn't like Jollibee. It's tasty, it's juicy, it's in the core of our Pinoy genes. Not only does that sweet Spaghetti sauce run in our blood, this joint is actually offering value for money! Getting your money's worth is only fair. Not having to think about what to add on to a meal to have a satisfying experience is convenient. There is no thinking involved, just go. Fast food.
Take that mindset to a health care facility and you will be scammed. You will be offered treatments that you do not need, making you feel like you get the most value out of your time and money. That is the biggest ongoing lie in some facilities. In health care, a la carte works best. Thinking has to be done. Do you really need those fries? Can you live without the upsize? Is a 20-minute hot compress with electric stimulation really doing anything?
Like any other service establishment, physical therapy clinics have to issue receipts for reimbursement from health insurances and PhilHealth. This reimbursement system allows these "Standard Physical Therapy/SPT" add-ons which include the use of hot moist packs, therapeutic ultrasound and transcutaneous electrical nerve stimulation (TENS) among others. Not everybody needs these treatments, however since health insurance providers pay for it, some facilities just charge for them since it is quite convenient.
Do you like the breast or thigh part for your Chickenjoy? The best part in this whole shebang is the well-concealed "Physical Therapy Application Fee". Most people are not aware that in some facilities, they are also paying a premium for a service that they should already be getting anyway. These fees rarely go to the professionals themselves. Take a guess where it funnels into!
Next time you get a combo meal, you can question why you need these add-ons. If your inquisition is not appreciated, you might want to try other food providers around you.
# 2. Negativity is in the air
"You can never do that again!" If you are welcomed with a claim on a permanent disability, you might want to question who you are talking to. Patients who acquire injuries due to sports or a hobby they like are traditionally encouraged to stop the activity completely without the regard for how it is important for them. This mindset is belongs so well with Motorola phones, diskettes and cassette tapes. Shoutout to 90's kids and boomers! The world is fast changing. Health care has to keep up. The role of a therapist is to help someone do something they like, again - in a safe way that they can avoid the recurrence of the injury.
Fear is also a traditional Pinoy culture element that does not fit in with the era of smartphones and AirPods. The world is a lot more empowering now, more options should be offered. If you feel like you are not listened to, find someone else who would.
# 3. No pain, no gain
Yes, but actually, NO! There is a kind of pain that should not be tolerated but there are ones that are ok. When stretching a tight muscle, it is normal to feel stretch pain along the muscle fibers. After a bout of exercise, it is normal to feel muscle fatigue or soreness on the muscle group you worked out. Those are the kinds of pain that are healthy to endure! The others cause more harm than good.
# 4. You keep coming back for more!
Unlike retail shops and food and beverage outlets, healthcare is not supposed to string you along. A facility that stays true to its mandate of looking after your well-being should want to see their patients not wanting for more.
Physical therapists undergo rigorous training to assess, diagnose and formulate a roadmap towards their patient's long-term healing. It will be a shame to not use this training for the sake of keeping a customer in the shop. That is not ethical, nor humane.
Progressive PTs also consciously usher their patients towards a more active lifestyle to minimize the recurrence of the injury they sought help for. So if your PT wants you out of the door soon, you are probably in good hands!
# 5. There is no assessment involved
"Salpakan mo!" ("Slap it on!") is a common phrase in typical PT clinics, pertaining to the 20-minute passive treatment involving any of the combo meals expounded on in #1. These 20 minutes that barely helps anyone recover long term, is an element of a toxic culture of employees not wanting to be there and simply counting hours 'til the clock runs out. Unhappy staff just really want to go home and process their visa applications. Sometimes, the 20-minute combo treatment it is a way to manage multiple patients at a time to maximize facility revenue. The last thing this is about is the patient's best interest. There are times that a patient does not need a hot pack or electric stimulation, but due to multiple factors, sometimes PTs are compelled to treat their patients using treatment templates passed on to them through generations without questioning its relevance or need.
Another factor that leads to this sad reality is the hierarchical nature of Philippine culture. Overseas, PTs are regarded as independent healthcare practitioners whereas at home, they are expected to follow orders from a sheet of paper. In ideal circumstances, the referral process from a doctor to a PT is meant to keep things in order. However, if the working relationship between the therapist and the referring doctor is not as open as it should be, patients might not be getting the best possible care that they deserve. Considering the workload of health care professionals in the hospital setting, coupled with the low salaries that are inherent to the local working environment, plus a traditionally pedagogic top-down hierarchical professional relationship among colleagues are barriers for critical thinking that PTs are much more capable of, the vicious cycle breeds on. Surely, not all PTs are comfortable to not think, but unless these toxic environmental factors are addressed, five years of grueling academics plus a board examination is pointless. Movement experts must be allowed to do their job well.
The 5 signs discussed above should make physical therapy patients question if their current set-up is truly the kind of environment they want for their healing. Is that really what they deserve? Otherwise, there could be other progressive service providers out there, wanting to be given a chance to make a lasting impact on their lives.