The Time Is Now

41st McMillan lecturer calls on profession to not be bound by the present when considering its future.

Andrew Guccione, PT, DPT, PhD, FAPTA, was the distinguished presenter of the 41st Mary McMillan Lecture, given on June 17. His theme, "Destiny is Now," stressed to attendees that destiny for the profession "is a moment in time that is before us, inspiring us to think 'what if.'"

Dr. Guccione didn't set out to become a PT, he said. He majored in philosophy at Boston College, graduating in 1968. It had to be "karma," he stated, that his lectureship this year is set in the same city. He said he hit a fortuitous bump in the road when he joined a drama society and worked with mime and movement--and ended up working with PTs to increase flexibility. "The experiences lingered with me and I got a job as a PT aide," he recalled. "My career might have turned out differently if I had set out to be a PT."

From treating patients, physical therapists know how life can be when disability impedes one's personal life, he said. People feel paralyzed, a captive of the moment. "PTAs never forget their first patients," he said. "They teach us the critical lessons of rehab--that in the end they are trying to just make it through the day and make it home. PT gets people home to their own private destinies every day."

No matter how well intentioned and learned therapists are, Dr. Guccione pointed out that the profession can find courage in confronting its mistakes. "The corrections our profession is willing to make only strengthen our field," he stated.

Rethinking PT

Perhaps reconceptualizing the profession as one of human performance and motion, rather than one merely of human movement, would help clinicians review underlying assumptions and revise the profession's vocabulary appropriately, he said. "People's lives are harder than they let us know," he said. "They deserve our approaching them with humility--and not as someone in a great white coat" who has all the answers, he said.

He said there are times when the profession "can't seem to figure out where we are and then move to where we want to be...We're approaching 90 years old, so we have arrived! There was a time not long ago when we really didn't know who we were or what we did. We spend too much time thinking about how appreciated we aren't. We waste too many resources solving identity problems of our own creation," Dr. Guccione said, to crowd applause.

"We talk about collaborative learning, but most of our primary care teams perfect their practice in outpatient care--not so in the hospital system. And we can't presume someone else won't be there to take our place. There are other players running to where we are," he said.

"We're often absorbed in academic insulation" with regard to the DPT and those considering the tDPT, without considering a revamped clinical master's program rather than "retrofitting" experienced clinicians into "new graduates," he said.

"The common denominator in this case is all practicing PTs...in our reluctance to consider other approaches (such as how law school awards doctorates), we allow this to alter and define us," he said. "We've been criticizing our clinical for more than 30 years, but we've divorced the context of learning from the very environment that is most relevant."

Working Past Limits

He praised the American Physical Therapy Association's (APTA) Science and Research division for its accomplishments and said he was honored to serve with them. "Science is the responsibility of our profession, and it is our obligation to exercise it...We can't let assertions go unchallenged. In that, we need to sometimes admit the limits of our own data...Do we back up a claim's effectiveness regardless of facts? A single mistake can destroy our credibility. Truth cannot be the casualty of ambition."

The APTA can't afford to be a bunch of "mini-associations," Dr. Guccione asserted. "We need to be one professional body with one voice. We're not an association that merely provides services segmented to an industry. Are we just a top-tier trade association?"

The reconstructionists of 1910--the forebearer of the modern PT--"had no 'reconstruction month' or anything to recognize their worth," he said. "They recognized their own worth, and refused to be bound by their current circumstances. Mary McMillan founded her own society of female aides...PT has a long history of not giving in and not giving up."

He praised the drive for advocacy from the APTA to demand direct access for physical therapists under Medicare as an example. "We see no need to back away from our imitators' attempts to become our equals. No group can be truly autonomous, but our aim can be for PT to be a fully self-determining profession. Our many rewards have been hard-won...Compromise without benefits to our profession is capitulation," Dr. Guccione said to more applause.

He declared physical therapy a "moral enterprise--creating an environment where hope survives. We're the ones who moderate justice when a person's life turns unfair. Our patients' destinies are in this moment now."

Lisa Lombardo is editor of ADVANCE.


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