We are physical therapists. We are in the health care business. Most of us are drawn to this profession because we find joy in helping others "feel better." COVID-19 has impacted most of our patients’ health whether or not they’ve contracted the virus. As we resume our clinical practice, we need to consider the implications of this virus on the patient’s mind, body and spirit.
The North American Institute of Manual Therapy believes in treating the WHOLE person. What does that mean? It means we sit and we listen. We listen intently, making eye contact, as if their story is the only thing that matters. We show them we are here for the long haul -- we will be their advocate. We show them they can trust us to report even the little things, the symptoms they feel are too insignificant to mention. The patient finally admits issues in these moments that often help us piece some of the puzzle together. These are moments when the patient, who has seen five doctors over the course of three years for back pain, says sheepishly, “Doesn’t everyone leak a little when they laugh?” or “I flipped a 3-wheeler 30 years ago and had a head injury, but that was far too long ago to contribute to the ringing in my ear, right?” We assure them that these bits of information are quite common with “real” musculoskeletal dysfunctions that can be helped through physical therapy… and they look at us, as if to say, “You are the only person who truly listened, without your eyes glued to your computer.” They begin to expound, “The leaking didn’t happen until I had my fourth baby. He was a stubborn little guy and needed a forceps delivery.”
“Well, if you think the ringing in my ear can be related to that 3-wheeler accident, maybe I should tell you that I have also had a root canal on the same side without any relief.”
We show each patient that we will show up each day to assist them in this rehabilitation journey. We, quite simply support them, free of any preconceived notions. They trust us, and through that trust, they help us help them!
When making difficult career decisions, some physical therapists (PTs) gravitated to this health care profession because of the luxury of more time allotted with patients. Even in the busiest of clinics, PTs typically see the patient at least twice a week for three or more weeks. That is certainly more than most dentists, ophthalmologists, orthopedists, dermatologists or family physicians. We provide a strong support system for them. We socially include our patients and promote social cohesion. Why is that even more crucial now?
Davidson et al, stated “The improvement of women’s health and well-being hinges on a detailed understanding of the social determinants of health and their interaction. While socioeconomic status plays a large role in health and well-being, social networks and individual factors are also important.” (1)
Marmot reports many factors when considering the social determinants of health. COVID-19 has impacted many of the mentioned factors.
Here is the list in the entirety:
- Preventing people from falling into long-term disadvantage
- Addressing the social and psychological environmental effects of health
- Ensuring a good environment in early childhood
- Addressing the impact of paid and unpaid work on health and well-being
- Addressing the problems of unemployment and job insecurity
- Promoting friendship, social relations, strong supportive networks, and social cohesion
- Addressing the dangers of social exclusion
- Addressing the effects of alcohol and other drugs
- Ensuring access to supplies of healthy food
- Ensuring access to healthier transport systems (2)
Sadly, COVID-19 has impacted most of our patient’s health by altering many of the above listed social determinants. Since mid-March the US Department of Labor has reported 40.8 million file for unemployment. (3) According to Newsweek, “Spirits sales increased by 75 percent compared to the same dates in 2019. Beer is the next most popular drink, with purchases up by 66 percent, then wine, up 42 percent year-on-year.” (4) Social exclusion has taken on a whole new meaning, as 43 states issued a “Stay at Home” Order, many lasting for greater than two months. Many have been nervous to go to grocery stores to buy healthy food, and if the fear itself doesn’t keep them from the purchase, the lack of finances may. Social cohesion is difficult, at best. Anxiety and depression, as well as suicides are on the rise at a predicted increase of 2135 suicides due to COVID-19. Social support in times of crises save lives.(6)
Physical Therapists are facing an unprecedented need to RISE UP to a whole new level! Our patients need us to show up to treat the whole patient or nothing at all, perhaps like never before. They deserve our full empathetic attention. COVID-19 may greatly affect the health of our patients, without ever actually infecting them.
- Davidson et al. The Health of Women and Girls Determines the Health and Well Being of Our Modern World: A White Paper From the International Council on Women’s Health Issues. Health Care Women Int. 2011 October ; 32(10): 870–886
- Marmot M. Social determinants of health inequalities. The Lancet. 2005; 365(9464):1099–1104.
- Kawohl, W et al. COVID-19, unemployment, and suicide.The Lancet Psychiatry, Volume 7, Issue 5, 389 - 390