Intensifying a turf war between physiotherapists and medical doctors, a parliamentary standing committee is exploring the possibility of upgrading physiotherapy from a paramedical discipline to an independent system of medicine.
If physiotherapists' claim to have the competence to provide diagnosis and prognosis for medical problems is accepted by Parliament, physiotherapy will attain the status of an independent system of medicine. Doctors fear that the disruption of the existing hierarchy of healthcare may compromise the interests of patients.
One of the common causes for low backache, for instance, is the spread of cancer to the spine. Says S L Yadav, associate professor at the AIIMS department of physical medicine and rehabilitation: "Since he is not equipped to detect cancer, the physiotherapist may routinely administer traction or a heat modality, which could aggravate the problem and cause paralysis."
Ali Irani, president of the Indian Association of Physiotherapists (IAP), refutes the suggestion that greater autonomy to physiotherapists would undermine the health care system.
"Given our own expertise, we are as capable as general physicians in noticing the pathology of a patient and referring him to an oncologist for cancer treatment," says Irani, who was the Indian cricket team's physiotherapist for 10 years from 1987.
"It is just that doctors are unable to come to terms with the fact that our science has developed to an extent where we too could refer patients to them and they can't demand cuts from us any longer."
Irani adds that since IAP is not asking for any power to prescribe medicines or to perform surgery, "nobody can accuse us of encroaching into their domain".
What has caused alarm in the health ministry is a note prepared by the director general of health services, R K Srivastava, on February 12 after representing the health ministry at a closed-door hearing of the standing committee dealing with the Paramedical and Physiotherapy Central Council Bill.
The note, a copy of which is with TOI, begins by expressing surprise at the fact that the questions put to Srivastava were "focused only" on the proposed central council for physiotherapy, although it is just one of the three councils envisaged in the bill, which had been introduced in Parliament in December 2007.
The "salient points" of the discussion before the standing committee headed by Samajwadi Party’s Amar Singh included, according to director general of health services, R K Srivastava's note, a review of the very "definition" of the profession in order to pave the way for "equivalence to the medical doctor" and "recognition of physiotherapy as a system of medicine".
In his note, written within a day of the standing committee's hearing, Srivastava told other "concerned officers" of the health ministry that before the minutes of the meeting were sent by the Parliament secretariat, they should keep their responses ready so that the issues could be "disposed of quickly".
Health ministry officials are exercised over the issues raised by the standing committee as they see the hand of the physiotherapist lobby, which has been at work since the early 1990s to counter the proposal of setting up an omnibus council to regulate over a dozen different allied health professionals including radiographers, medical lab technicians and operation theatre technicians.
But thanks to the pressure mounted by IAP, the bill that was eventually drafted had accommodated their demand for separating them from other paramedical personnel. The proposed omnibus regulator was accordingly renamed as the Paramedical and Physiotherapy Central Council Bill with a provision to constitute sub-councils for various disciplines.
In September 2004, the cabinet of the UPA government cleared the bill in that form. But the bill was diluted further when it was introduced in Parliament after a lapse of more than three years. Instead of an omnibus body, the 2007 bill provided for three separate councils, including one for physiotherapists and occupational therapists.
Equally significant, the 2007 bill also gave up the idea of allowing medical specialities to have a say in the regulation of their paramedical disciplines.
Despite the concessions extracted in 2004 and 2007, IAP discloses in its latest website update that it is trying to get more changes in the bill by being "in contact with all top politicians and parliamentarians".
Drawing support from a couple of state legislations, IAP's most ambitious demand is that the standing committee should recommend a radical change in the definition of physiotherapy. This is because the bill defines it as a "medically directed therapy", thereby implying that physiotherapists will continue to work under the supervision of doctors such as orthopaedicians, physiatrists and neurologists.
In a bid to gain more autonomy, IAP proposed that their subject should instead be defined as a "physiotherapeutic system of medicine" involving "treatment modalities which have a diagnostic, prognostic, preventive and rehabilitative dimension".
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