Question paper setter should start reading other than WhatsApp forwards

 

I wanted to write a elaborate blog on how ridiculous these questions are. however i think most of them are self explanatory. just full of nonsense and tribble with fancy words.

The first rule of assessment is - it is done for a "problem", why else do you want to assess? so we will take questions like TUG, assessment of MS, TB spine or some obscure reflex. what does the question ask the students to write about? assessment of what is MS? by the way MS? TB spine- what are they to write in this one word question. The extremely intelligent "professor" cant even make a sentence of what is a question? 
Some of them are better- but still poorly written- as you know a sentence should have a object, subject and a verb- and what is assessment of mile stones? for what- to find out is the child is in risk of development of  neurological symptoms or .....? just pathetic  

The cherry of the question paper is the first question. What the hell is that got to do with neuro-rehabilitation? I understand you need to understand lymbic system, heck even today i went to a college and taught about that - but do we have a method to assess them in PT? Brainstem issues are complex and needs hype specialist to assess- well the question is not about that anyway in a paper on assessment. who the hell is the "professor" who thinks this should be in assessment paper.

Please if you asked to set a paper- take your time. it is a huge responsibility. dont just words like fine motor assessment- write clearly in what dimension in ICF you want the student to describe, what for? in what condition?. you may be a genius but for other we need those to answer a question. 

if it is TUG- ask us if you want to use that for balance risk assessment, its advantages and disadvantages or for gait prognosis? something specific. 
learning disorders- well i hope i dont see this genius - what the hell is that? some useless therapist some years back wrote about this now every one with a swiss ball is a expert in learning disorders- just, hmmm. learning disorders are complex problems which any OT or PT are poorly educated to handle. I know some people are going to be angry with it- but well i dont care- they have not educated for that. 

please teachers of PT show some self respect for the profession take your time and prepare a question paper.

Questions to ask yourself and "association officials"

 Questions to ask yourself and "association officials"

I know I am going to be in a minority and going to get flack, but who the hell cares.

    From time immemorial from the first human got a low back pain and another human gave IFT, the predominant problem is what should the human call that person? should he call her/him a  doctor or the greatest doctor. It was not an issue she/he was not paid, she/he was worried about how she/he was called. 

2021, the same problem. what should we call a PT? not can we make a living practicing PT?  after 20 years of service can we get a promotion? we cant even move our table in many places without someone telling us - leave alone making a independent decision about patient management. I know people will say, well we do in our department, well for them I say, good for you- but is that the rule or exception?      

    If you join the government services- most of the places including one of the best medical college in India- MMC- you will do traction and ift for patients with LBP. you will do that until you retire. 
In private hospitals- autonomous practice (not independent practice) is a mirage. most of them drudge under a "ortho" who has a blotted ego and poor education on pain management or even the word evidence based physiotherapy.  In city I was born, I know hospitals wherein you need to work for 12 hours- 8 hours is uncommon. I am quoting my city because I have seen it- other places I am sure it is there but I am unaware. For all this- we are paid 10 thousand and a good salary is 18 -20 thousand. just try to rent a house in a city and live in that salary. 

    what it leads to is after you finish your job- you start working- home visits- otherwise we will be poorer than -well most of people in health care other than "doctors". we end up working for 14- 16 hours, for us to make a living income. compounding this many corporate hospitals have started home care for "their" patients employing PTs. and then there are home care companies like portia- which is eating into our source of income. Well that is the nature of market economy.

it just leads to us all feeling as though PTs working in India are just waiting for his/her visa to greener pastures. I once worked in a college, with a bunch of wonderful dedicated PTs- none of them are "here". because, we hardly had a increment, and a selfish bitch as a principal. well I am sure the feeling is widespread in many "colleges". you think-wow they are paying 45 thousand rs. 5 years goes by you are drawing a salary of 45000. 

The people who work in a clinic are just the most pathetic. we either don't pay them or pay a pittance you cant even fill petrol with that. I do understand, it is difficult to pay if you run a clinic to your employees very well, as running a clinic needs serious money, especially in bigger cities. that is that.
      no wonder, every one wants to go into government service, but for 10 thousand PTs there is hardly 500 jobs. PTs get frustrated and move to other avenues, coding and such work. PTs who want to be in health services after few years get a epiphany - fuck it I have to go abroad.

well now the questions:
    

1. is calling ourselves as doctor so important than all our problems?

why is so important to call ourselves that? well other than the ego trip it provides- i dont see any value. are more patients going to come to me if i call that? is your hospital going to pay you better? if your college going to treat you better? are they going to pay you when you  were unable to go to college during a pandemic? is your ortho going to stop writing IFT and traction for every poor guy who comes with pain? has any country moved to autonomous practice then to independent practice by calling themselves something other than PT or by something else? have we asked them how they changed there practice?  

2. have you every fought or raised your voice for "autonomous  practice" ?

3. is our syllabus objective written with autonomous practice as the objective?

have any us talked to or lobbied for changes in the syllabus which are meaningful rather than adding "advances like rubbing and sticking". 

4. have you every gone and referred "cash" or "dena gardiner" when you had doubt in treating a patient?

is not why the do we call it as "basics"  why are we not afraid to change ourselves?  
5. Has any of our associations raise there voice about salary or they always lobbying for "government jobs" and council

I am not against lobbying for that, but remember- we are in thousands and we cannot all get into service, 
about the council- ask Delhi, Gujarat, Maharashtra- have any of there life become better because of the council or some fat cats made money in the name of council.
Council will not change any our life- the medical colleges and Eng. colleges are an example of what will not happen even if you have council. It will have a impact but not everyone- some in teaching may benefit. 

6. is our associations to give a memorandum with a "politician" about the council alone?

from early 90s where i was also stood in line with others to have a audience with the then CM, till now that is what we do. give memorandum and take photo and say we have done something. as we say in my mother tongue- no hair was plucked by that. my salary did not change, my students still study the same nonsense i studied - IFT and traction, the hospitals still make us do what we are prescribed.

I know i have left out many things, i have left out why we think "doctor" is most important and much more. That was deliberate. I did not write about all the lazy idiots who join the Govt, services and sit and do no work, or the useless teachers who are not fit to teach kindergarten, the exploitation of "girl" students and much more. That is because i thought was obvious for everyone 

as i said at the beginning, i know you dont agree, that is alright - let me why i am a wrong and dont understand  

how to make our conference- a conference

How to organize a IAP conference

The last few months have shown us, IAP annual conferences are just bad- really really bad. I dont want to go into details of why it is bad, but this post is how to make it better. Please keep in my these will not make the conference "wonderful" just better.

The first thing to change is to have standard operating procedure (SOP). As this is not codified every organizes just does what the earlier person does and also uses it as an excuse.

So the first SOP should be- 7-6 months prior abstract should be invited and 2- 1.1/2 months prior.
The next date should be before 4 months- the program schedule and marque speakers should be released. before 2 or 3 months all the speaker list, workshop - everything should be completed. it should be like this year wherein we dont know who or what is the program other than where it is happening.

The important point to note is in a conference of 2-5 thousand delegates- we need to have concurrent sessions. so the conference starts every day with a plenary session. a plenary session will be under a specific topic- say for example upper limb stroke rehabilitation. The session should not exceed more than 2 hours. The plenary session is headed by a chairperson and 3-4 speakers- experts and researchers in that area. The plenary session is attended by all the delegates- i mean it is done in one huge hall.

Then the delegates break up for concurrent session. so if you have 2000 delegates we should have at least 10 concurrent sessions. concurrent session can be- 1-2 hours programs- which can be paper presentation, skill workshop (say for example how to search for literature, how to write an abstract, or clinical topics like update on OA knee ) or short CMEs. For presenters of these workshops- we need to invite proposals from all the members or all over the world. These session again are done by a group of people (2-5). again inviting proposals and selecting them makes it transparent- as organizers have to tell us why a proposal has been rejected.

the concurrent system also allows for more interactive sessions as having 2000- 3000 people in a single auditorium is not conducive for listening or participation. 

How to select speakers and scientific committee members:

I believe if we have 10 speakers- 4 of them should be from the area where the conference is held. that said or selection of all speakers we should have a set of criteria.
say for example- they should be researchers with some publication (other than predatory journals) they should have extensive clinical expertise in a specific area. well we have anything- but we should have some criteria

why- well otherwise the same idiots will talk, stay, travel and drink in our money and we will all keep on bending over.

Travel grants

Other important aspect of annual conferences is identifying new good researchers. For that one of the ways to do it via making sure they come to the conference and present there study. For that the association should form a travel grant. which will act as an incentive. 

I am not found of having international faculty, as it is very expensive and very limited value. However, if we want to do, again they should be sellers of products, but researchers, who can through light on areas in which we are lagging.   

The abstract should be revived in 5- 10 themes. so if we assume- we get 500 abstracts we should have a scientific committee which at least has 10 people. Abstracts should be written in a common pattern and the authors should be amend it in accordance with recommendations of the committee findings. This in turn will and should be published in the national journal.

please keep in mind- all of these are just what i think, it has to be debated and a particular SOP has to be adopted.

love


K hariohm

OA knee naa- Non-specific knee pain

1.       Stop taking x-ray to diagnose OA knee- it is just silly- well-read theory of when to use diagnostic test
2.     We now know – there is no correlation between cartilage damage and pain and disability. – so stop looking at the x-ray as though it is giving you some insight into your patients3.       Stop telling your patients not to sit on the floor or walk less – please understand the patient accesses health care to become less disabled not made more disabled by us.
4.       Remember it is exercise therapy- it means exercise is given to reduce pain and disability – so please tell them exercise should be done when they come to you- not at the end of 10 days or when the pain is gone.
5.       Exercise –works and one the few conditions we have high quality evidence to prove it
6.       Waxing and waning are part of diseases like these- educate your patient about  it not knee anatomy and x-ray finding- these can help them in not catastrophsing about the condition.
7.       Remember we are a quasi-mechanical system, even though we cannot run away from physics the biology adapts- so don’t make clinical decision based on mechanics- they are always inadequate- well see what has happened to manual therapy
8.       Don’t use nocebo terms – collect the term which harm them in your vernacular and try to use alternates for that
9.       If you get a chance to write in vernacular don’t – please don’t write – the joint has worn off (or in Tamil thengupochu)- the joint is not a cycle tyre
10.   I believe just like- how we are calling back pain as – nonspecific back pain we should call OA as non-specific knee pain

Love
Hariohm

Things we need to stop in the coming years

I love making a list, even though no one care- I usually post it:

1. ·         Read a book other than Facebook post, YouTube video or a whatsapp forward. And for god’s sake don’t forward videos of some white guy doing a manual technique.
2. ·         Stop saying- “I have seen it” – well I have not seen gravity, o2, atoms, even hormones like serotonin, insulin and much more. So you see, seeing or not seeing is not the hallmark of science. Many therapists are infatuated with the idea of “seeing is believing”. Remember even a carnival magician can fool us all into thinking he just pulled a rabbit out of a hat.
3. ·         Taking as though the non-contractile elements have ability to undergo plastic change makes us look like fools among the medical community. You don’t have to believe the evidence for K-tape, or many variation of fascia osteopathic nonsense- use your elementary knowledge of physiology, and some physiology of pain and think whether whatever the “expert” vomited makes any sense. So, stop talking gibberish!  
4. ·         Stop calling each other us experts- most of us or in the 40s and 30s it will take another 20 years to know we don’t know much- then we can call ourselves as “legends” and other adjectives
5. ·         Ooo please no more awards- it is well ….. I don’t want to say no more
6. ·         We should stop talking gibberish like muscle release, reorganization of non-contractile elements, moving mountains like Hanuman- I am talking about moving the cranium etc
7. ·         Stop posters and paper presentation on things we have never done, conditions no one has ever heard and exotic technological mumbo jumbo
8. ·         Stop writing “research” paper on the SPS and stop being proud of publishing in IJOPT and other OA journals
9. ·         We should not get into an echo chamber, where all of have the same bias
10. ·         I should stop making list and stop cribbing about things

   Love
Hariohm

Happy new year folks

  

Wake up

The sad thing about physiotherapy in India is the lack of evolution in its scientific basis. When I went to college most of the teaching was –do what is say, learn by seeing probably by observing. Only few teachers and PT looked beyond “how to apply in my patient” giving less importance to the science behind it. The problem with this attitude is: it becomes difficult to understand whether the treatment is effective, am I harming my patients, and what happens when it is does not work and how I do it a different group of patients etc.  Beyond the obvious one, the problems are lack of original scientific thinking or stifling it and believing every “expert” or authoritative figure –either a PT or a surgeon who we perceive is more learned.    

This, I believe led us to our current conundrum. Every day I see someone teaching alternative magic to physiotherapist and poor idiots gobbling them. The current fade is Diploma in “O” or “C” or acupuncture.
So what is the problem?

Let’s take the obvious- if they can teach you in weekends or through online and in six months and you get a diploma in that “medical philosophy” – you should be either a highly gullible person or your UG education should have been very poor.

The next issue is – aren’t we the people who fought against diploma in PT taught in street corners and we don’t seem to have a problem with this? Diploma in “O” taught by some charlatans and a snake oil selling idiots from "abroad" and India? The hypocrisy is beyond words.

The third issue is- these courses are fraught with nonsensical science and from moving joints (which usually begs the question- so what or can you move it) to vital organs. Well if you education was so poor in UG you can’t discern the difference between a vital organ function and what the hell is manipulating it will lead to – you should not be allowed to practice the great science of PT. you should be locked up in Kilpauk.

I understand PT science is also many a times poorly understood and sometimes downright wrong but the comparing to alternate magic is just sad. shouldn't we be all trying to evolve our PT science rather than consuming the crap of the world? 

This begs the last question: why are these idiots allowed to corrupt and ruin PT science in India without any resistance.  Don’t some of the states have a associations, councils or something- why is everyone silent? Because we think well this is evolution? Or because well why do I care or well I don’t attend so I don’t care?

whatever your reason it is time to wake up and smell the shit in our neighborhood. 

  

Love
Hariohm

 

What next- 2017 world PT day post

When there is a lack imagination, poor understanding of health science and leadership- then the weeds grow. That is what is happening to us in the last few years. PTs are led to believe the next step is to wed alternative magic like osteopathy, dry needling, SI with PT. When a science has to grow it grow with incorporating other science not magic. So, you ask me “pray tell us what is next in PT”

Well my take on what and how PT is going to shape up in the next decade

1.       NCDs are a major health hazard and the numbers are increasing alarmingly in countries like India. All health care professional has to play are in prevention, management and rehab. I believe until now we have narrowed ourselves only to management or rehab. This should change- we should be actively involved in preventing diseases, especially NCDs.

2.       In spite what your certified instructor told you- we know exercise are good and works wonderfully in many conditions. What we don’t know is how to make our patients comply with the exercise program.  In the coming years we are going to borrow ideas and theories from behavioral science and evolve programs. These programs are going to have better influence on our patients to comply with our exercise

3.       As part of the earlier point- our education of patient in pain, post stroke, prevention of NCDs are going to better than what it is now.

Happy world physiotherapy day