Barrett L. Dorko, P.T.

          My father began buying alcohol and tobacco at the age of five.

          What I've just said is true, and I would like you at this point to do me a small favor - stop and think about what you're beginning to assume about his life, and perhaps about the people in it. Think of the possible consequences of his actions, and hold those thoughts until you finish this essay. It won't take long. You can actually see the end of the writing on this page.

          I've traveled across the U.S. and Canada teaching workshops for over twenty years. And what I've seen and heard from the clinicians attending my courses form the basis of my remarks here. I haven't done a carefully controlled survey, and I know that my conclusions might not be entirely true. But I'm just speaking of an impression I have formed, and, at the very least, my sample is pretty large.

          I'm often in a position to evaluate the attitudes of therapists toward patients prior to their actually examining them. I've gathered this information informally in conversation with a few thousand people, and I've found the themes to be predictable if not universally true.

          The circumstances surrounding the onset of a patient's complaint may be used to help the therapist determine the involvement of certain tissues, but I commonly see that these also influence significantly a therapist's regard for their patient's complaint of pain and disability. For many therapists, any work related history is immediately suspect, and the phrase "Well, he's a worker's comp, so..." is something I've heard countless times. It's not an indication that the patient is to be trusted.

          Last summer I was in charge of a carwash sponsored by the high school band. Several of us witnessed a fender-bender involving three cars that eventually made their way into an area adjacent to us.

          An older woman emerged from the center car and soon began to grasp the back of her head and neck. Her face displayed a painful grimace and she was moving tentatively, apparently trying to find a comfortable position.

          Within ten seconds I heard three of the high school students remark that this woman was obviously "faking" a whiplash - that she was probably going to sue the poor girl who hit her.

          I know these kids and they're not ordinarily prone to remark about others in a way that displays bigotry or overt prejudice. Had the woman been of a different ethnic group, nothing would have been said about that. But now that she was suffering from "whiplash," she was fair game.

          I hate to say it, but I often find therapists have the same attitude despite their relative maturity and experience. They come up to me at workshops and wonder aloud if my methods would be appropriate for "a motor vehicle accident." They begin their description of a patient by saying "Well, you know, he's a truck driver" with a derogatory inference in their voice, or they ask if "construction workers" actually respond to gentle care. These comments aren't isolated or rare in my experience, and they are no less prevalent today than twenty years ago. I can't imagine that the findings and treatment provided by these therapists isn't significantly altered by the assumptions that are made during history taking alone, and it makes me shudder.

          On the shelf near my father's chair at home is a package of Five Brothers tobacco that my brother Kevin found a few years ago. Like me, he had often heard the stories of our father's childhood, and he remembered the one about him taking a nickel and a small pail across the street to the saloon where he'd have it filled with beer for our grandfather. At other times, he'd be sent to the corner for some Five Brothers to fill his father's pipe.

          Kevin knew that this activity was nothing more than a fond memory for our father, something that might be stirred by the familiar package displayed on the shelf. Because Kevin's known him all his life, and has never seen him drink alcohol or use tobacco in any form, he never assumed that the task affected him in any predictable way.

          Don't our patients deserve the same consideration? Shouldn't they expect us to live with them awhile before we assume anything about their motivations or the intricate nature of their lives?

          Before you answer, consider what you may have assumed after reading the first sentence on this page.

"Reprinted from the June 1998 issue of PT--Magazine of Physical Therapy, page 120, with permission of the American Physical Therapy Association."