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The Opportunity to Inject MADAM -The last six months have seen an ongoing discussion in the Journal regarding the scope of physiotherapists’ legitimate practice. Prompted by the article by Hockin and Bannister (1994) showing the favourable results of having a physiotherapist with the additional skills of injection acting as a clinical assistant, the CSP has reaffirmed that injections are not related to core skills: in short, they are not physiotherapy. It is a strange decision in a discussion that has become increasingly bewildering. I think it also touches on a deeper problem within physiotherapy which, unless resolved, will seriously hinder our development as a profession.

To address this, it is first necessary to get several things clear:

The injection of local steroids and anaesthesia would undoubtedly be a potent addition to the physiotherapist’s therapeutic armoury and potentially of enormous benefit to the patient. The success rates in the Hockin and Bannister study in relation to elbow and shoulder lesions, areas commonly not fully responsive to physiotherapy, are testament to this.

Physiotherapists, with their excellent knowledge of anatomy, good palpation skills and general ‘feel’ for the musculo- skeletal system engendered by their daily observation and hands-on experience of patients, are more than capable of administering injections and are arguably the logical choice to do so.

Furthermore, in this ever more critical political landscape we are being repeatedly asked to justify our practices. The administering of injections of local anaesthesia and steroid is a treatment system which is well researched and the effects of which are broadly known. The possible deleterious effects are compre- hensively documented and the technique requires a considerable degree of skill in diagnosis, selection and actual administration.

Contrast this to the practice of electro- therapy, which we are told is one of our core skills, yet it is an area where there is, ultrasound apart, widely contradictory research, and very little unanimity of opinion as to the efficacy of the various modalities, the correct treatment regimes, the precise therapeutic effects and the possible long-term deleterious effects. Moreover, it requires so little skill in its administration that other health profes- sionals, such as former remedial gymnasts, can become fully qualified in all electrotherapy modalities in a two-week course (remember this is one of our three core skills) and ultrasound machines are on sale in Boots. Which one is the more powerful and persuasive justification of our worth?

Yet we are told that injections are beyond the scope of physiotherapy. One can hardly imagine the medical profession having a similar debate over doctors practising massage or dishing out advice on rehabilitation. Their responsibility is to patients and if they have or can acquire the knowledge to help them effectively and safely, then no professional barriers are considered to be breached. Chiropodists regularly use injections of local anaes-

thesia in their work; it makes them mcire effective practitioners, so they have acquired the skill.

The truth is, there is no sensible reason for not allowing physiotherapists to inject. The excuses regularly trotted out -- physiotherapists’ lack of knowledge of pharmacology, the current need for a doctor to prescribe the drug - would in other circumstances be seen as minor problems to be overcome, not permanent obstructions. The real reason, I fear, is thal despite our enormous steps over the last two decades to establish our practitioners as autonomous clinicians able to accept patients directly, and independently to examine, diagnose and treat, we still labour under a medical subordination made heavy and immovable by years of tradition; and injecting people is seen as being just a little too like playing at being a doctor.

And there is the irony, for in my experience it is members of the medical profession, particularly general practi- tioners, who request injections from physiotherapists whom they have come to acknowledge as having particular skills in the treatment of the musculoskeletal system. On several occasions I have had to describe to general practitioners the sita to inject, the type and quantity of steroid, the correct injection technique and the pertinent after-care advice, everything but insert the needle and push the plunger lest I should wander carelessly outside the scope of my profession.

It is time consuming, detrimental to the patient and, frankly, little short of a professional embarrassment. We cannot ask our peer groups to recognise us as experts in the conservative treatment of musculoskeletal problems and then display a lack of will to take on the responsibility of employing one of the most effective therapeutic tools available.

Are we experts or are we not? Are we skilled, autonomous and responsible practitioners or do we sit at the right hand side of medicine like a favoured son, patronised but subordinate? I do not believe we can have it both ways. Whether the administering of injections falls within the scope of physiotherapy does not depend on therapeutic considerations, but on how broad and bold is your vision of the profession itself. Tony Wilson MSc GradDipPhys MCSP Chichester

References Hockin, J and Bannister, G (1994). ‘The extended role of a physiotherapist in an out-patient orthopaedic clinic’, Physio- therapy, 80, 5, 281 -284.

MADAM - I couldn’t agree more with Wendy Blythe’s letter ‘The opportunity to inject’ (October).

I too was taught by Dr Cyriax to give injections on the various courses he ran in orthopaedic medicine and I am proud to have been one of the early members of the Society of Orthopaedic Medicine when Dr Cyriax was at the helm.

Doctors frequently request injections

for their patients and prescriptions are provided accordingly.

It is my belief that all physiotherapists should want to extend their clinical skills. Broadening one’s knowledge and clinical abilities can only enhance the status of the profession and be advantageous to the patient. Why should the Society put a restriction on our clinical skills?

I have just completed a paramedics course in which we carried out intravenous cannulation and intubation.

In January I start a phlebotomy course at the pathology laboratory of the local hospital, which includes the taking of blood for culture.

These skills are available for those who wish to improve their clinical abilities.

I would, however, strongly urge those who do take up parenteral therapy, always to have resuscitation equipment at hand as well as anti-anaphylactic medication, though in 20 years of injecting, I have never been obliged to use them. Kevin J Mullally GradDipPhys MCSP DO Leamington Spa

Contact Point Aromatherapy A Clinical Interest Group for Aromatherapy is in the process of being set up. The Chartered Society of Physiotherapy sets certain criteria for recognition which include that there must be a minimum of 50 chartered physiotherapists subscribing to the group.

I will be delighted to hear from anyone who is interested in joining. Please let me know by January 16, 1995, so that a meeting may be arranged in March to discuss future action regarding recognition. Elisabeth Jones OBE MCSP Blakes House Upton, Andover Hampshire SP11 OJW

Kenya Aid The Rehabilitation Centre for Victims of Violence in Kenya, a non-governmental organisation, is planning to establish a physiotherapy department. There are no funds for apparatus and we are appealing to anyone who could donate equipment.

As a trustee of the centre and a private practitioner in Nairobi I would be pleased to co-ordinate offers and seek means of transport.

Any help for this worthy cause would be greatly appreciated.

Hilary Ahulwalia PhD BSc MCSP

PO Box 60329 Nairobi Kenya

Care Pathway I am involved in setting up a multi- disciplinary integrated care pathway (anticipated recovery pathway) programme for cardiothoracic surgical patients and would be very interested to hear from any other physiotherapists who have

(n6e Watson)

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experience in their use, especially in the management of respiratory and cardio- thoracic patients.

Heather Montgomery MCSP Physiotherapy Department Papworth Hospital Papworth Everard Cambridge CB3 8RE

Regional Secure Units Do you know of any physiotherapist working in a regional secure unit?

I am researching into the value of physiotherapy in a regional secure unit. I would like to contact any physiotherapist who has such experience or who could put me in contact with a physiotherapist who has opinions on the subject. Amanda McKenzie MCSP Clinical Manager Physiotherapy Mental Health Chantry Day Hospital Stanley Royd Hospital Aberford Road Wakefield WF1 4DQ

Yoga as Rehabilitation I am currently teaching yoga to patients with chronic musculoskeletal problems, mainly lumbar and cervical. Sessions are weekly and last 1% hours. Results have been very positive.

Are there any other physiotherapists teaching yoga as part of rehabilitation? Lesley Dike MCSP Park Rehabilitation Centre Badsley Moor Lane Rotherham South Yorkshire

Asian Languages A plea for help from any physiotherapy department who may be providing written information to their clients who speak Punjabi, and who read Urdu. I would welcome any help, advice or ‘poached documentation’.

I deal with adult out-patients and would like to provide the usual direction signs, and the necessary warning signs in a busy out-patient setting, regarding pacemakers, mobile phones, etc and with informative literature regarding ethnic background and cultural practices for departmental staff. Christine Graham MCSP Superintendent Physiotherapist Physiotherapy Department Buckingham Hospital High Street Buckingham MK18 I N U Tel 0280 813243

Although Centenary year is drawing to an end, there is still plenty of activity throughout the Society.

Recent examples of local events that captured the media’s attention include a meeting of the Lea Valley Branch with its MI’, Steven Norris, at the House of Ccimmons for lunch. The Waltham Abbey Gazette reported that more than 50 members had attended and been shown round the Palace of Westminster after lunch.

An open day at Stirling Royal Infirmary phiysiotherapy department was recorded in the Stirling Observer, while yet another talk to members of the public by private practitioner Elaine Atkins did not go unreported. The Chingford Guardian said she had traced the history of the profession in a speech to the North Chingford After- nroon Townswomen’s Guild.

The Cambridge Weekly News and Cambridge Evening News had, quite literally, splashes in late October when they reported on a 2,000 length sponsored swim by members of the local Branch. To mark the Centenary, chartered physiotherapists took turns to swim for half-hour stints in order to raise money for a medical charity. The accompanying pictures showed Anne fvlcDonnell in the water, watched by Ben

Centenary Study Tour The South East Thames Board organised a.n interesting and enjoyable study tour to Israel during October for ten physio- therapists. The aim of the tour was to mark Centenary year with a special holiday which also related to the physiotherapy profession.

Israel was chosen for its wealth of .historical sights in relatively close proximity (we had only six days), and more particul- arly to visit Lesley Dawson, chairperson, Physiotherapy Department, Bethlehem University, who was a travelling companion of several members of our group on two previous study tours.

Lesley arranged three excellent profes- sional visits for us in Palestine and the occupied territories. Both the physio- therapists and occupational therapists at the Spinal Injuries Rehabilitation Centre, the Children’s Orthopaedic Hospital, and

Duncan, Sam Dickson, Olivia Sharpe, Jayne Warrington and Isabel Hunter.

Physiotherapists at Sandleford Hospital in Newbury got excellent coverage for their open day to mark the Centenary and promote the profession. Members shown in two good photographs in the Newbury Weekly News were Brenda Bennett and Dorothy Dugdale. The Evening Express in Aberdeen reported on a four-mile fun-run and walk to mark the Centenary. Physio- therapists from the Aberdeen Branch strutted their stuff at the Beach Boule- vard. There was a good picture but, unfortunately, none of those shown was named.

At national level, media publicity for In Good Hands: The history of the Chartered Society of Physiotherapy, 1894- 1994 has just started. Two of author Jean Barclay’s local papers used that fact to write about the book; they were the Fife Leader and Fife & Kinross Extra. Therapy Weekly also covered the book’s publication while, at the time of going to press, Radio 4’s Woman’s Hour is considering doing something on the book. Coverage of the Society’s national exhibition in Birmingham continued, with reference in the Lichfield Post and Worcester Evening News.

to Israel the Residential and Out-patient Rehabili- tation Centre were impressive in their enthusiasm and dedication to their work.

We were made to feel most welcome by the managers who were justifiably proud of their units, all of which relied heavily on foreign sponsorship for their funding.

Everyone on the tour appreciated the discussions we had between fellow profes- sionals, some of whom were Palestinian (some having trained at Bethlehem University) and some European physio- therapists currently working in Palestine.

We also packed in a fantastic tour of the Holy Land, and even had time to float effortlessly on the Dead Sea.

I would recommend a study tour to add an extra dimension to a holiday, and enrich one’s knowledge of another country.

Janet McFarlan MCSP

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