Associate Professor and HOD

From

Dr. Babu Varghese, MD, DNB

Associate Professor and HOD

Department of Physical Medicine and Rehabilitation

Govt. Medical College Hospital

Thrissur

To

The Director of Medical Education

Thiruvananthapuram

Sir,

(Through The Principal, Govt. Medical College, Thrissur)

Sub: H&FWD – WP (C) - No. 36941/2010 filed by Kerala Association for Physiotherapists Coordination State Executive Committee – judgment – reply reg.

Ref:Endt. No. B3/19031/2011/DME dated 1.8.2011.

In the health care delivery system treating the disabled and the chronically ill patients is always a team work. It has to be supervised and lead by a qualified modern medical doctor who is capable of diagnosing, planning treatment, prescribing medications and managing complications during the treatment programme.

This comprehensive Rehabilitation team work is lead and supervised by a qualified medical specialist and is supported by various categories of paramedical personals like rehabilitation nurse, occupational therapist, Physiotherapist, speech therapist, lab technicians, social workers, psychologist and vocational councilor.

To give an example a patient reaching the emergency wing of a hospital with an impending amputation of the upper limb following a trauma, is immediately assessed and managed by a team of surgeons, orthopaedicians and physicians, followed by an amputation which is carried out by the orthopedic surgeon. Further rehabilitation is planned and supervised by the physiatrist (specialist doctor in PMR) who directs the prosthetist, a paramedical person to fabricate and fit the artificial limb. Occupational therapist trains him to use the artificial limb and physiotherapist, a paramedical person gives mobilization exercises to the limb under the guidance of the specialist doctor. Psychologist gives counseling to the patient and Vocational counselor guides him to get a job depending upon the disability to become an earning member. This is what is rehabilitation.

The qualified medical doctors have 8½ to 11½ years of course duration, of which 5 ½ years is the duration of MBBS. The course duration for Bachelor of Nursing, Bachelor of Pharmacy, Bachelor of Physiotherapy are all same in India (ie. 4 year academic + 6 months practical training) and hence the physiotherapy course is not unique in regard to the course duration or structure as Physiotherapists falsely claim.

Scope of clinical and non-clinical subjects taught to physiotherapy students is only relevant to the scope of imparting physiotherapy education and not to the diagnostic and therapeutic aspects of ailment. Hence a Physiotherapist cannot apply the limited knowledge he has gained for diagnosing the disease and they are not at all qualified for treating patients independently.

In Kerala, no Govt. Medical Colleges conduct UG and PG courses in physiotherapy. Almost all physiotherapists are trained in private institutions which has no adequate staff pattern and clinical facilities. These students have no exposure to emergency medications and management which is very essential in dealing with the emergencies which occur during rehabilitation of chronically ill patients.

The physiotherapist in spite of the graduate and post graduate courses will not be able to differentiate and distinguish between diseases for which therapy is required and cases for which therapy should not be administered which might result in the life threatening complications like death.

Physiotherapists are not doctors and therefore should not be allowed to prefix “Doctor” in front of their name. This is the strict warning issued by the MCI. They are qualified technicians who follow prescription of doctors and no medication can be prescribed by them.

No country in the world has given any legal right to the physiotherapist to practice medicine. The physiotherapist even in the most developed countries like USA, UK, Canada etc. are only entitled to administer therapy under medical direction. In the said countries, physiotherapist cannot administer therapy without medical consultation and are categorized as Allied Health Professionals and is not under the medical category.

A few of the physiotherapists who are indulging as a medical specialist by prefixing ‘Dr.’ before their name are desperately attempting to get an independent physiotherapy council with independent practicing rights for physiotherapist only to legalize their illegal medical practice in Kerala. An independent council for physiotherapists with independent practicing rights will pave the way for the back door entry to the medical profession. Independent right to practice will create a short cut method to become Specialist Medical Consultants and will affect the health care quality in the State and is against medical ethics.

A few category of paramedical (allied health professionals) including physiotherapists, by using their influence and political clout at the final stage of approval of Kerala State Paramedical Bill – 2007 got themselves deleted from the proposed Kerala Paramedical Bill – 2007.

The Govt. of India vide Notification 13.10.1998 included PT, OT and ophthalmic technicians as rehabilitation professions under the Rehabilitation council of India Act, as the same was rescinded without reason vide as subsequent notification date 30.6.1999. There is no bill or Act passed by the Central Govt. as on today fixing the legal status of physiotherapists.

The claim of treating a patient without medication by physiotherapist is a false statement. In any disease which requires physiotherapy, medication is needed along with exercise programme.

Regarding the 7:1 ratio and request for 100:1 ratio for patient : therapist, it may be taken into consideration that even in the health care system in Kerala, which is considered the best in India, doctor: patient ratio is only 1:5388. Of the total patients attending the Physical medicine & rehabilitation department in Medical College only 20% require physiotherapy and occupational therapy. Hence, the demand to increase the opportunities is not acceptable. Physiotherapist has no role in the primary care of the patient.

Recently as a reply to a question in Parliament regarding the salary of physiotherapists, Hon. Minister of health and family Welfare Mr. GulamNabi Azad has categorically mentioned that physiotherapists cannot be included in medical category as they are not the first contact person in the diagnosis, treatment and prevention of various diseases and disorders which in fact being done by physicians registered with MCI. Further their demand for parity is merely on the basis of duration of course, and the courses of study of physiotherapy doesn’t have any similarity with that of physicians and dental surgeons. In addition duties performed by various categories of employees, ie. Doctors, Dental Surgeons and physiotherapists are different and no equations can be drawn on this basis.

Conclusion

1. Issues raised by the Association of Physiotherapists should be considered as a false claim.

2. There is no need for a separate physiotherapy council. They should be part of the proposed paramedical council like other paramedical persons

3. The physiotherapy course should be headed by a qualified physiatrist / orthopaedic surgeon.

4. At present there is no need for increasing the therapist patient ratio in medical colleges and district hospitals.

5. Military trained therapists and diploma holders can be used as paramedical person for physiotherapy management under medical supervision. Military trained therapists are well experienced and disciplined ex-servicemen. They should be given preference in Govt. services

6. Govt. should start BRT, DRT, CRT courses which are recognized by the RCI in Govt. institutions and ban or properly control physiotherapy colleges in private sector with no qualified teachers, no facilities and no patients.

7. Govt. should ban all the illegal practice by the therapists and prevent them from prefixing ‘Dr.’, strict action should be taken against quacks who practice in the name of doctor.

8. Any rehabilitation unit which the Govt. starts in schools should be supervised by a medical officer , preferably a physiatrist and the main paramedical person should be an occupational therapist who is trained in developmental therapy and not a physiotherapist.

Note:

(1) Physiotherapist are paramedical persons having the required qualification detailed in the schedule appended to the Act, who are required to administer physiotherapy to the patients strictly under medical prescription and supervision of a modern medical practitioner.

(2). Physiotherapy is a medically directed therapy using cold, heat, water, electricity, and manual exercise etc with an aim of preventing disability, to be administered strictly under medical prescription and supervision of a qualified medical practitioner of modern medicine.

Thanking you,

Yours faithfully

Dr. Babu Varghese, MD, DNB