Shakespeare’s ‘Romeo and Juliet’ famously tells the tragic story of two ill fated, star crossed lovers who meet their untimely demise due to their families long standing bitter feud. However, out of this tragedy comes hope as it eventually leads to their familes reconciliation. Much like the Romeo and Juliet story I am hoping that some of the feuds I have had with many other therapists with different names will eventually lead to some reconciliation around the confusion and stupidity of the many different names we use.
Now there are many well known scenes in Romeo and Juliet, one of the most well known is where Romeo is famously wooing Juliet on her balcony, and Juliet says down to Romeo below…
Oh Romeo, Romeo, where art thou Romeo…
After some singing and romatic discussions Juliet goes on to say to Romeo…
What’s in a name? That which we call a rose, by any other name would still smell as sweet.
What Juliet is referring to is that Romeo’s surname belongs to her families arch enemies the and how this does not matter to her.
Nowadays this rose saying is often used to imply that the names of things or people do not truly reflect who, or what they are, or even what they do!
So what is in a name for therapists?
As you may be aware I was involved in a VERY long, and VERY frustrating debate on the topic of names and titles we use within our profession with a physical therapist in the US called James Dunning. It began when I saw a retweet from one of his followers about some training he runs in something called ‘Osteopractic manipulation’ that leads to a qualification to become an ‘Osteopractor’.
Now not being aware of the title of ‘Osteopractor‘ or what they are, or what they do, or how their treatment differs from other therapists, I asked this simple question…
What followed was a confusing, frustrating, and difficult ‘discussion’ with the James, the originator and founder of the title ‘Osteopractor‘ which lasted for THREE days! Yes that’s right THREE days. Now to be fair this was because we are on different sides of the planet, so time differences did delay our ‘discussion’ and of course talking in 140 characters takes its time.
However, I use the term ‘discussion’ very loosely here, as from the start this chief ‘Osteopractor‘ evaded, misdirected, and deliberately misrepresented my questions and replies. He also used so many logical fallacies that my head is still spinning, in fact, at times, I actually forgot my original question, and ultimately I never did get an answer, or find out what differentiates an Osteopractor from any other therpaist.
However, what I did find out is that this title ‘osteopractor‘ seems to be only used by physiotherapists in the USA, thank god, and they seem to do nothing different from any other therapy but have merely bastardised the names of osteopaths and chiropractors to generate a new title.
Why they have done this is beyond me! Why a physiotherapist or physical therapist as they are called in the USA, who has invested years of dedication, study, hard work, energy and finances, to earn the right to use the professional title of physiotherapist, then feels the need to replace this with another ridiculous made up title just seems ridiculous to me.
The ‘discussion’ with the James however was constantly redirected by him to us talking about the right to use other titles and names in our profession. James was quick to defend his right to use the title of ‘osteopractor’ by comparing it to the fact that many therapists also use titles other to define our roles.
For example he stated that many therapists, including myself, use prefixes before our titles such as sports, neuro, paediatric, or cardio-respiratory, and this James felt justified his use of his ‘unique‘ or rather made up title of Osteopractor.
However, this is a false analogy, a bit like comparing apples with oranges. For starters prefixes are used to help describe what a therapists specialism is and helps direct a patient to the best therapist for them. For example as a sports physio I would be of NO help to a cardio respiratory patient. Also prefixes before titles are real words that can be found in the dictionary, not made up, confusing, bastardisations of two words that no one will have a clue what it means or describe what they do.
This is my biggest concern with this ‘Osteopractor‘ title and many others, confusion, both for other healthcare professionals, but mainly for the public. These title can be misleading for patients by confusing them that physical therapists are chiropractors, or osteopaths. But also it can confuse the public and other healthcare professionals as no one will have the faintest idea what these Osteopractors are able to do or not do, just like I still am after three days of trying to find out from its founder!
Titles should clearly and simply describe what the person is and does, not confuse and confound.
But does it really matter?
Many people today can not tell you what the difference is between a physiotherapist, an osteopath, or a chiropractor. I often can’t, with the boundaries between these professions becoming more and more blurred. I’ve seen osteopaths practice more like physios, and physios practice more like chiropractors, and I’ve seen the brilliant and bad in all professions fairly equally.
But adding yet more titles into this already confusing situation of therapies, will only confuse things further for patients, and where will it stop, will we have physiopaths™ or chirotherapists™ next?
When I tried to voice my concern about this confusion I was quickly called a hypocrite by James for questioning his title and not other confusing ones such a Mckenzie, Maitland, Mulligan, McTimmony, therapists, and he has a fair point, and is actually something I’ve thought about before. Why are there so many ridiculous titles and prefixes in our profession usually named after some guru?
I even dislike the title ‘manual therapist’ that many physios like to call themselves. Why do some therapists need to do this, why call yourself after a technique? Physios don’t only use manual therapy, and all physios can use manual therapy, just as they do with exercise, electotherapy, taping etc, yet you don’t get some physios calling themselves, ‘electro therapists’ or ‘tape therapists’ do you. So I agree with James, if we are going to be critical of one ridiculous title, then we must be critical of them all.
In my opinion therapists who use confusing, complex, made up titles, or who list alphabet soup behind their names, do it more for their own benefit and inflated ego’s rather than for any patient benefit. I see no rationale or reason why ANY therapist has to define themselves with meaningless letters or names of methods that a patient has absolutely no idea about, nor do they want to!
Whats wrong with simply calling yourself a physio and perhaps highlighting your area of specialism or interest with a prefix of sports injury, cardio-respiratory or neurological.
However, the next shift in James’s argument was that I must want all prefixes before professional titles to be abandoned. This is a ridiculous straw man arguement. Prefixes before a therapists title can and do help patients, and can and do help them to the appropriate clinician.
The next argument that James came up with is what qualifies someone to be able to use these prefixes, with certain titles not requiring any formal accreditation or post graduate qualifications. For example the title I use as a Sports Physiotherapist is not actually an ‘official’ accredited title in the UK!
This again is a fair point, and is something that needs to be addressed by our professional and governing organisations in the UK. However, I have recently found out that even the title of physiotherapist, or any other HCPC protected title are actually NOT protected by the quango Health Care Professions Council (see more here). I have also found out that ANY one can call themselves a physio as long as they use a disclaimer that no physio services are offered (see more here)…. I know it’s fucking ridiculous, so much for the public being protected hey!
I’m an ESP me!
Finally whilst we are on the subject of confusing and nonsensical titles, I also want to talk about another confusing title I am the shamful owner of. That is an ‘ESP’ which sounds more like I have some sort or supernatural pyschological power, but actually stands for an Extended Scope Practitioner.
To those outside of the UK who are unaware of what an ESP is, let me explain. An ESP is a physiotherapist who works outside their usual scope of practice, and usually means they work along side consultants and doctors in orthopaedic, rheumatology, neurology and cardiorespiratory clinics triaging patients as a first point of contact.
ESP’s are tasked with the same remit as consultants and doctors, that is to assess, diagnose and triage patients appropriately. ESP’s are able to request investigations and tests, such as X-rays, MRI’s, CT’s, blood tests etc. ESP’s are also able in some posts list patients for surgery, and are trained in other skills such as sonography and injection therapy.
Now as exciting as these posts are for the future of physiotherapy, the title is, in my opinion, not the best. First because patients have no idea what the title means, I know this first hand as I am more often than not having to explain it to patients when I introduce myself.
The next issue and far more important one is that, in my opinion, many ESP’s lose sight of the fact that they are physiotherapists. I have seen first hand many ESP’s acting, behaving, and masquerading like doctors, forgetting their foundation as physios. This is not only sad, but also annoying.
An ESP is a post that is supposed to offer a different dynamic to any medical or surgical team. An ESP is supposed to bring a different skill set, thoughts and opinions into the clinical decision making process, not to just act like a medical doctor or surgeon.
There has been a call to change the ESP title to Advanced Practitioner recently, which although I think is a slightly better title, it still is not that clear that the individual is a physiotherapist. I am proud to have achieved an ESP post, and proud to be given the responsibility that this post comes with, however I am also proud that I am a physiotherapist and so I think the title needs to reflect this.
I have a vision!
So in summary, clear, concise, and most importantly simple professional titles are important. They allow patients to understand and be able to choose and decide which therapist is best matched for their needs and issues. However, confusing, lengthy, or made up titles like ‘Osteopractor‘ add nothing and their utility needs to be questioned.
I have a vision that one day all the current titles of therapist such as physio, osteopath, and chiropractor will become obsolete, as all the therapy’s become more aligned in their philosophy, training, and practice, and eventually we will see the emergence of a new unified neuro-musculo-skeletal therapist.
What they will be called, who knows, as long as its clear and simple I don’t care. But I am hoping that just as Shakespeare’s ‘Romeo and Juliet‘, the death of some loved ones, will lead to the end of the feuds and fractions within our professions.
Finally, it is also good to remember that the most important title you have, and one that ALL your patients NEED to be aware of, is simply the one your parents gave you… your name, ALWAYS USE IT FIRST!
As always thanks for reading
Adam, the physio!