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HEALTH, HEALTH EDUCATION AND PHYSIOTHERAPY PRACTICE: SOME IMPLICATIONS FOR PHYSIOTHERAPY PRACTICE
Some of the implications of adopting Seedhouse's philosophy need to be identified. These seem to fall into two broad categories: those associated with personal attitude change; and those related to the practical aspects of health care and the manner of its delivery. With reference to the former category, it behoves all of us to undertake a regular re-examination of our metaphysical and ethical beliefs in relation to our role as health care workers. How we conceive of health and health education will determine the quality of our service. For example, many of us regard the therapist/patient relationship as central to clinical practice without ever questioning either the underlying assumptions associated with these concepts or, more fundamentally, our own frame of linguistic reference. That language reflects ideological beliefs and attitudes is confirmed by the periodic need to revise dictionaries. The language we use to describe the world, however, also determines the parameters within which we perceive that world. Thus the very use of the terms 'therapist' (agent) and ‘patient ’ (passive recipient) dictates how we conceive of this relationship, and may, indeed contribute to the perpetuation of that attitude.
The fact that these terms continue to be used supports the contention that many professionals wish to preserve the inherent inequalities which characterize their relationships with members of the general public. Had there been a genuine wish to eliminate this inequality and establish a relationship founded on egalitarian principles, the traditional nomenclature would have been replaced by terms deemed to reflect these ideals. It therefore seems to be necessary to introduce a new linguistic frame of reference in order to precipitate an attitude change which has hitherto been slow to evolve. Interestingly it has been suggested by a music therapy colleague that the terms 'researcher' and 'co-researcher' deserve serious consideration as contenders. Within this frame of reference 'education' for health would be a socially shared goal, a collective enterprise, with each participant demonstrating mutual respect for personal autonomy reflected in a willingness to engage in the processes of both teaching and learning.
To focus briefly on the second category concerning the various aspects of health-care delivery, physiotherapists currently seem to encounter numerous extrinsic as well as intrinsic barriers to good practice. Lyne and Phillipson (1986) catalogue a number of these barriers and identify 'the pressure of acute referrals' as being 'the most significant barrier to health education'. They cite other problems relating to 'Workload and Work Organization' (see also Leathley and Stone, 1986) and report that 'Problems of Professionalism' and 'Communication between Professionals' further mitigate against educational activities. Whitehead (1989) echoes these problems and identifies additional obstacles to good practice. The first of these 'is almost certainly inadequacies in pre-service and in-service training' which is often 'treatment orientated'.
Whitehead (1989) alludes to the unsatisfactory practice of '"crises" treatment' and the fact that some professionals do not consider 'educational work' as 'their role', some report 'lack of confidence in educational skills and lack of support from managers who may give the impression that it is not a legitimate activity for their staff'.
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