“Disparity” – Barrett Dorko, PT

This article by Physical Therapy Web featured writer Barrett Dorko is entitled “Disparity.” Please leave your comments at the bottom of the page.

You can find an extensive collection of Barrett’s writing at The Clinician’s Manual.

There’s something about disparity that attracts me, and I’m not the only one.

The entire genre of surreal art compels me and I wrote about that here years ago. Just yesterday I heard someone on a podcast talk about how someone very large playing the ukulele has always attracted the attention of many, to say nothing of how some can make this tiny, simple instrument into a vehicle for expressive and intricate music. I play the harmonica every day and know something about that.

The attention we pay to that which is novel and unexpected is found at the root of comedy, magic and art and it reflects our brain’s need for such things. We’re drawn to them despite the fact that these ways of being aren’t always efficient. Today as I practice I often think about what I call “the suits.” “The suits” usually work in an office distant from those places I now provide my care and have become essential to the provision of therapy most places in the US. I doubt that will change. They are a major reason I no longer have my own office to practice in but I guess I’m over that. Maybe not. Had I been able to monetize my every moment in the way they prefer I’d still be working alone and happily – but those days are over. Numbers dominate the sensibilities of those who pay me – numbers representing productivity, and return on investment. I can certainly understand that, even if I don’t like it.

But when the unexpected occurs the numbers may become problematic, sometimes because too much care is required and at other times because not enough can be justified. When dealing with purely orthopedic disorders (understand, I don’t really think such a thing exists) predictions regarding provision of care and recovery are fairly easy to make. When nervous irritation is in the mix, all of that may fall apart – and they always are. In my opinion, these problems are both easier and harder to treat effectively. This is primarily a function of the therapist involved and their knowledge of neuroscience. This varies wildly.

My personal experience has been that this realization (whether consciously or unconsciously realized by “the suit”) has resulted in practices driven by form, protocol and repetition of generic exercise that has no actual relation to the patient’s unique presentation. It’s easily documented though and can be offered by any warm body with a therapy license.

I don’t happen to be one of those.

Into the consciousness of someone in an office distant from clinical reality I float like a cloud that changes its shapes inevitably and irresistibly, rather like those surrounding Magritte’s La Chateau des Pyrenees; one of my favorites. I have the sense that those who provide therapy have retreated to the castle upon the rock, but that many patients live amongst the clouds. No wonder they don’t understand therapy.

I hope this short essay hasn’t confused you. My intention is to make you pause and think about what’s before you; a patient full of surprises and a way of being that might not easily progress as you predict, especially in the hands of another without an appreciation for surrealism. Those sorts just look away and wait for the clouds to pass.

The suits love employees like that.

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