Wednesday, July 30, 2014

Do we need more schooling, or just re-tooling?

In a conversation on the OT Connections Forum Dr. Pam Toto stated "These other professions - PT, Pharmacy, Nursing - whether you think they are comparable or not, have evolved to a point where they feel a need for that additional training for competent entry-level practice."

I think these comments are interesting.  Dr. Toto is not the first to make these kinds of observations.  Others have stated that we need to prepare practitioners for the complexity and demands of the future.'  I have been wondering what that really means.

First of all, I would like to acknowledge that in some instances our practice tools have gotten more complex.  I can think of a few examples.  It would not surprise me if pediatric standardized tests were more complex than they were when our profession was founded.  I am actually wondering if any even existed!  I think that you could make a strong argument that splinting and prosthetics have also gotten more complex.  Of course we can say that our health care delivery systems are also more complex, although those are not practice tools.  There are other examples, but I think those are good ones where we can say that some things have gotten more complex over time.

The question to me is whether or not the practice tools and systems that have gotten more complex have hit some critical level of complexity that we can justify a need for more training or schooling.

Even if they are non-parallel examples, lets look at nursing and medicine.  Let's compare professions at the time of our founding (~1917) to today.

In the early 1900s here are 5 things that were in use that illustrate the sophistication of medicine at that time:
1. Mrs. Winslow's Soothing Syrup - a heroin concoction used for teething babies for over 50 years, finally denounced as a "baby killer" by the AMA in 1911.
2. Doctors began experimenting with lobotomies at this time, and they became increasingly common and it was as recent as 1949 Nobel Prize in Medicine was given to the originator of the procedure.  Amazing.
3. "Female Hysteria" was a very common condition and the some of the recommended "treatments" are not suitable for discussion on this board.  Trust me.
4. Mercury as a cure-all!  Mercury was used for everything.  People realize how insane the use of mercury was now, but even I remember Mom's bottle of Mercurochrome that was pulled out and used as an antiseptic every time we got a cut or scrape.  Maybe that is what is wrong with me?
5. No antibiotics!  Lots of people had tuberculosis.  Effective TB antibiotics didn't appear until 1949 with Streptomycin.

Even based on these simple examples we can see how much change has occurred in medicine in the last century.  The few things I listed don't even come close to more recent scientific advances like understanding blood chemistry, development of imaging diagnostics, and the explosion of genetic knowledge and how that has accelerated our understanding of diseases and pharmacology.  There is no question that medicine as a field has lots of reason to state that higher levels of training are needed in order to keep pace with needs of the future, whatever those are.



But what about occupational therapy?  Has it also changed?

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As comparison, I would like to quote from Elwood Worcester's recounting of his first "treatment" session with George Barton.  As we now know, Barton was so astounded by his recovery that this sparked the creation of our profession when he invited other leaders to form a society for occupational therapy.  Here are Worcester's comments:

"While engaged in erecting a great sanatorium for consumptives in the mountains of Colorado, he was suddenly affected in a strange manner... When he awoke the next morning his right arm was paralyzed... his right knee was ankylosed... In consequence of his constrained and unnatural position the right foot had begun to mortify and Dr. Mumford had amputated two of his toes.  When I first saw George he was in the spiritual condition of a mad dog... He said "What is the use of talking to me?  My life is utterly ruined, my health, my power of movement, my beautiful profession, my wife and child, my home, my capacity for earning money are taken from me.  All that is left for me is to sit in this chair, a beggar, a pauper and to suffer like hell..."

Using a combination of spiritual counseling, relaxation techniques, and suggestion, Worcester "treated" Barton.

"If this were all, the story would hardly be worth telling.  The next time I saw George he was in Boston.  He ran up my stairs two steps at a time and seized my hand with his once paralyzed hand in such a blacksmith's grip that I was obliged to remind him that I had no fingers to spare.  He was perfectly able to return to his architecture, but by this time he had discovered a new form of architecture which he greatly preferred to the old - building up again the broken lives of men and women who were suffering as he had suffered, under the eye of Dr. Mumford and the physicians of Clifton Springs.  With the help of a few rich friends he built his "Consolation House" and equipped it with splendid workshops where, through the sweetness of his new personality, and his knowledge of crafts and arts, he did a wonderful work for years."

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What impresses me about this early accounting of OT is that it even though it happened in 1914, it could have happened in 2014.

This makes me pause whenever I hear people saying that the occupational needs of people have changed and are changing so radically.  I don't know if that is really true.  Although some tools and systems change, the fundamental nature of occupational therapy does not.  In this sense it is nothing at all like medicine.  Medicine has changed.  Has occupational therapy?  In many ways we understand occupational needs the same way that Worcester did and the same way that Barton did.

So do we need more schooling, or just re-tooling?


References:

Worcester, E. (1932). Life's Adventure: The Story of a Varied Career.  New York: Charles Scribner's Sons.

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