Wednesday, 8 October 2014

Like It Or Loathe It

By Andrew Harrison

Like it or loathe it, “physiotherapists” are part of the armory that horse-owners use routinely for the treatment or maintenance of their animals, whether it is an elite athlete or a much-loved hack and in my opinion they will continue to be so.

In this statement, I use the term “physiotherapists” generically – how often do you hear an owner say, “I got the physio to have a look first”.  The term physiotherapist and chiropractor are protected titles; however, if they are pre-fixed with the terms veterinary or animal, they are not.  The term physiotherapy and chiropractic are also not protected and are used in the Veterinary Surgery (Exemptions) Order 1962: 4(a) any treatment by physiotherapy given to an animal by a person acting under the direction of a person, registered in the Register of Veterinary Surgeons or in the Supplementary Veterinary Register, who has examined the animal and has prescribed the treatment of the animal by physiotherapy. 

Now, does that mean treatment administered by a Physiotherapist, a Veterinary Physiotherapist, an Animal Physiotherapist, a Chiropractor, a Veterinary Chiropractor, an Osteopath, a McTimoney Chiropractor, a McTimoney Animal Associate, a Sports Massage Therapist, a Bowen Laser Therapist, etc., etc.  And therein lies the rub:

-                      How well qualified is the person who you referred the animal to - if in fact you did refer the patient?
-                      When did you last enquire about the qualifications and competence of the therapist that you referred the horse to or more commonly, the person to whom the owner wanted the horse to be referred to?
-                      When you signed the veterinary fees claim form for insurance recommending complementary therapy, did the therapist fulfill the criteria set out by the insurers?
-                      What are the insurer’s criteria?
-                      Are members of the McTimoney Animal Association, who perform chiropractic able to call themselves Chiropractors?
-                      Etc., etc…

According to the Veterinary Defence Society, even though you may have (unwittingly) referred the case to the “physio”, who may or may not have their own professional indemnity insurance, you are still deemed to retain “care & control”.

Arguably there are some musculoskeletal paraprofessionals, whose gait assessment, palpation and diagnostic skills are infinitely superior to our own - although of course they’re not allowed to diagnose.  I am not ashamed to admit it that I have learnt a lot about gait analysis and abnormality whilst working with some of these individuals.  However, we often only call on them as a last resort; when we cannot make a diagnosis and “hospital-pass” it to the “physio” saying, “I’m not sure what’s wrong with him, you’d better have a look!”  Isn’t that somewhat patronising and dismissive of these paraprofessionals?  On the other hand, I think it would also be fair to say that they often treat us with a similar amount of indifference and won’t always ensure that there has been adequate communication both before and after any consultation.  Regardless of who’s to blame, this is a 2-way street and I think that we need to ensure that we, as a profession, are not found wanting. 

Currently the mysterious and murky world of “musculoskeletal paraprofessionals”, which is shrouded in acronyms, lacks boundaries and clarity.  In my opinion, this has resulted in the majority of veterinary surgeons viewing the majority of them with a mixture of suspicion and contempt.  However, these various groups are in the process of attempting to establish a regulatory framework, which will define education and training requirements so that we can be assured of the level of competency of the individual that we are referring our patients to.

Having recently been enlightened about the somewhat onerous education and training, which physiotherapists, chiropractors, osteopaths and some others have to undertake, there is no doubt in my mind that many of these individuals are well worthy of a place at the veterinary table.  Furthermore, in my opinion, it is our responsibility to engage with them if we want to do the best for our patients; and by that I do mean active responsible engagement, which is in the past may have been lacking.

“Physiotherapy” is integral to the success of any elite sportsman or woman, not to mention the important role they play to keep us all “on the road” with our numerous aches and pains; we need to embrace it for equestrian sport and leisure.