#3: Leadership and Hierarchy

Description: As mentioned in an earlier reflection, I was brought up with a physician-led, authoritarian healthcare environment as the norm.  Again, as earlier mentioned, while my experiences in healthcare have not nearly approached this level of regimentation and rigid authoritarianism, I have certainly observed physicians predominating in positions of overall managerial authority.  The common organisational structure I have observed consists of other AHP department heads in a rough circle of equals answering to one or two doctors, who tend to be regarded, at best, as first among equals.  Though I did not personally witness this, I was told by long-serving AHPs that some senior doctors still subscribed to the older authoritarian system and were prone to wielding whatever managerial powers they were vested with without compunction.

Personally, I did observe that, while doctors were responsible for the overall management of patient treatment, they were very conscientious about seeking input from AHPs in their respective fields of specialty – particularly ones with which the doctors themselves were not intimately familiar with – and were careful to not conflict with an AHP over matters pertaining to their respective field save in rare instances.  While I did not personally witness anything quite so dramatic as non-physicians being given overall MPD team leadership for situation-specific interventions, as suggested by Atwal & Jones(2009),  Manday & Broadbridge(1998),  Perryman & Hardwood(2004) and Rosenbaum(2006), they were generally given final veto regarding determining treatment direction in their respective fields.

Feelings: While I was thankful to have missed the era of rigid regimentation under fierce authority figures, I did actually find myself thankful for the presence of clear chains of command and accountability.  I was also mildly daunted by the prospect of being thrust into a position of overall leadership myself someday, as I felt distinctly unprepared for that position of ultimate responsibility.

Evaluation: I was lightly reprimanded in my first full placement for consulting with the nursing staff over patient mobility status, which was a matter for the PT department.  This drove home to me the individual responsibility to be competent and thorough with one’s own field.  Prior to that, I assumed that AHPs taking full leadership for their respective fields of specialty was more optimistic naïveté than reality, and I only began to appreciate its existence following that episode.

Analysis: Literature exists suggesting that PTs have the potential to assume overall charge of MPD teams for a variety of specific outcomes.  Rosenbaum(2006) indicates that PTs are best-suited to team leadership in treating sexual dysfunction by way of pelvic floor rehabilitation.  Manday & Broadbridge(1998) propose that, with their expertise in therapeutic exercise, PTs should take the lead in long-term anorexia nervosa treatment through body dysmorphia and anxiety management by way of carefully-planned exercise therapy.  Perryman & Hardwood(2004) propose that PTs have significant roles to play in rehabilitating secondary pathologies and improving quality of life in haemodialysis patients through electrotherapy to relieve pain and restore mobility and exercise therapy to restore the ability to perform activities of daily living(ADLs) through improved muscular strength and control.  

Conclusion:  Referring back to PT roles in acute care in Reflection #2, it can be seen that PTs not only have significant roles to play in a wide range of care settings, but are eminently suited to take overall leadership in many such settings.  This has significant implications for the CPD of all PTs, especially new PTs such as myself, who can expect their knowledge to be insufficient for any one field we may be thrust into upon leaving school.  With such potential for weighty responsibility to fall upon us without warning, the onus is on each and every practitioner to be eminently familiar with the fundamental science and state of research pertaining to their given field and prepare to take overall charge of patient treatment on short notice.

Works Cited

 

Atwal, A. & Jones, M., 2009. Preparing for Professional Practice in Health and Social Care. Chichester: Johns Wiley & Sons Ltd.

Manday, A. & Broadbridge, H., 1998. The role of physiotherapy in anorexia nervosa management. British Journal of Therapy & Rehabilitation, 5(6), pp. 284, 286, 288.

Perryman, B. & Hardwood, L., 2004. The role of physiotherapy in a hemodialysis unit. Nephrology Nursing Journal, 31(2).

Rosenbaum, T. Y., 2006. The role of physiotherapy in sexual health: is it evidence-based?. Journal of the Association of Chartered Physiotherapists in Women's Health, Volume 99, pp. 58-62.