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Eldridge 1 Nicholas Eldridge October 10, 2013 English 112 Ms.

Melissa Mohlere

Where's the Beef? Dr. Boissonnault begins his article by stating his and other Physical therapists (PTs) objectives in obtaining unrestricted patient direct access to physical therapy services. Direct access allows patients to see a physical therapist or another alternative medical facility without having a referral from a physician. Dr. Boissonnault has multiple Doctorate degrees, one of Health Science and one of Physical Therapy. He also holds a Master of Science in Orthopaedic Physical Therapy plus a Bachelor of Science in Physical Therapy. He has also been the recipient of numerous honors and awards. Currently Dr. Boissonnault is the President of the Board of Trustees for the Foundation for Physical Therapy (William). The author boldly states in the first paragraph of the article that he is focusing on the Chiropractor's opposition. Further he adds a list of societies, academies, associations and chiropractic organizations that he feels have been the primary source for opposing our legislative efforts. Throughout the article you find that many chiropractors believe patients should not have direct access to physical therapy clinics. As an example, he quotes the chiropractor's opinion "A patient coming to physical therapy with back pain and an underlying occult colon cancer, without being able to make a medical diagnosis-how

Eldridge 2 would they know a patient referral is warranted?" (Boissonnault) The author is able to immediately state the main thrust of his article, his objective and who specifically he opposes. Dr. Boissonnault briefly supports the organizational challenge but reiterates that their motives are in question. He justifies his attack on their ethics by quoting a document called The Future of Chiropractic Revisited"-which states, PTs are considered THE primary economic threat to the future of chiropractic practice" (Boissonnault) I feel this is a direct, emphatic reprimand that engages the reader to formulate their own opinion regarding their (chiropractors) true motives. The term "direct access" refers to whether or not a patient may walk into a physical therapy clinic or other alternative clinic without a referral from a physician. Shouldnt all patients have the right to receive care from a specialty clinic on their own without having to spend extra money and time seeing a physician first? From the beginning of the article Dr. Boissonnault assumes his readers are currently familiar with the ongoing issue on direct access. When he states that the issue is direct access in the first sentence of the article and chooses not to go into much detail about the meaning attached to it, you can speculate that his readers are more educated on the topic and that he is most likely appealing to a narrow audience. While reading this article, I found many context clues as to what direct access means and how it affects physical therapists whom the author is trying to communicate with. A good example in the article is as follows; "What better way to help "hamstring" a competitor than limit access to their services?" This statement allows the reader to determine for themselves what reasons chiropractors have to limit access to physical therapists. Before this statement he asks a key question; Lastly, is the chiropractic organizations motive really patient safety? When the author asks this rhetorical question he isnt expecting an answer. This question is here to engage the readers thoughts and

Eldridge 3 allow them to decide for themselves regarding the chiropractor's argument against PTs and the issue of direct access. It seems this question is mainly for legislators so they are more informed on the topic and they know the possible negative motives behind those who are opposing the effort. The author also purposely saves both of these heavy and thought provoking points for the paragraph right before his summary, no doubt this is to create impact. In the last sentence of the opening paragraph the writer states "What's questionable is the credibility behind the arguments and their motives" (Boissonnault). I believe this is the authors main argument with chiropractors, their credibility and their true intentions. In the article, Boissonnault reveals the main argument against his thesis in the second paragraph. "Chiropractic organizations consistently point out the risk to patients coming to physical therapy without a referral, the inadequate physical therapy education related to diagnosis and pathology and the inability of physical therapists to make a medical diagnosis" (Boissonnault). From this quote you see the author is acknowledging the chiropractors main argument and is giving his audience more information. By providing this opposing view, we know what this article will be addressing. After the first two paragraphs, the article is split into titled sections used to counter balance the chiropractors negative attack. I would like to summarize, using quotes, the key statements of each titled section. Patient safety is known to be the number one concern of all health care professionals. Physical therapists make no exception to that fact in their services or ethics. The author quotes a local state statute as follows; "DUTY TO REFER. (a) A physical therapist shall refer a patient to an appropriate health care practitioner if the physical therapist has reasonable cause to believe

Eldridge 4 that symptoms or conditions are present that require services beyond the scope of the practice of physical therapy" (Boissonnault) Under the topic of "Physical therapist professional education" there is a standard of "minimum required skills" and "curricular guidelines" which physical therapists must adhere to that are "clearly articulated" (Boissonnault) The statements being made here seem to indicate that PTs are duty bound to uphold this standard. In association with "Physical therapists can't diagnose-patients at risk!" I feel it's a logical conclusion that PTs cannot go outside the "scope of their educational training and practice guidelines." Many alternative health clinics including physical therapists "routinely collect patient health history information, detailed descriptions of presenting complaints, review of symptoms and conduct a comprehensive physical examination" (Boissonnault). The need for specialized testing becomes a protocol often when its associated with complicated family history and noticeably severe symptoms such as infection and disease. In my opinion the author makes a convincing case for allowing PTs to demonstrate their ability to recognize what a sense of duty is in regard to "patient safety" and also to recognize their limitations or lack of training connected to more serious conditions. The author uses a modern, popular expression, "where's the beef?" to sum up his evaluation and a true lack of evidence.

Eldridge 5 Works Cited Boissonnault, William. "Direct Access: Where's the Beef? The Challenge From Chiropractors." APTA. N.p., n.d. Web. 12 Sept. 2013. <http://www.apta.org/StateIssues/DirectAccess/ChallengeFromChiropractors/>. "William Boissonnault." University Of Wisconsin Orthopedics & Rehabilitation. N.p., n.d. Web. 10 Oct. 2013. <http://ortho.wisc.edu/Home/DoctorofPhysicalTherapy/FacultyandStaff/WilliamBoisson nault.aspx>.

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