24 - 30 May 2001
Issue No.535
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Al-Ahram Weekly Online 24 - 30 May 2001 Issue No.535 |
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Medics in revolt
Doctors are up in arms as physiotherapists claim they are overqualified to be mere technicians. Dena Rashed unfurls the controversy over who is entitled to be called a doctor
19 May, The Faculty of Physiotherapy, Dokki: "We will not move even if they continue to beat us," cried a defiant student from the midst of his demonstrating colleagues. Baton wielding policemen surround the area. Terrified parents stood outside of the police barrier screaming in support of their children. Five ambulances waited in vigil.
Students at the Faculty of Physiotherapy take a stand
photos: Khaled El-Fiqi
Students who joined the Faculty of Physiotherapy in recent years had every reason to believe they had a bright future ahead. They had graduated at the top of their class and they were studying for a specialised, rewarding profession. Today, that future is uncertain as frustrated students continue to demonstrate on campus over the status of physiotherapists in the nation's hospitals and clinics. For seven weeks now, students have refused to attend classes or sit for exams, to the exasperation of their dean and the parties concerned: the Ministry of Health, the Doctors Syndicate and the Physiotherapists Syndicate.
The crisis has no sign of abating, however, and has its roots in a long-standing quarrel between medical physicians and physiotherapists. Physicians claim that physiotherapists fancy themselves doctors, going so far as to examine patients themselves and prescribe medication, which, they charge, is illegal. On the other side of the debate, physiotherapists claim that their training is equivalent to a specialised medical degree, and that they are capable of monitoring their own activities and initiating a therapy programme without the explicit direction of a medical doctor.
Although physiotherapists have their own faculty and syndicate, doctors say they are only trained to be medical assistant and are incapable of making decisions on their own.
"The physiotherapists are called 'paramedics', meaning that they assist doctors and are not specialised in any branch of medicine," Hamdi El-Sayed, chairman of the Doctors Syndicate, told Al-Ahram Weekly. El-Sayed pointed out that there is a rheumatology and rehabilitation branch at the Faculty of Medicine, noting that physiotherapists should ultimately have the upper hand when it comes to the technical part of the medical practice. "They [physiotherapists] can be administratively independent, but when it comes to technical work, they should not be independent at all," El-Sayed maintains.
This contention is the crux of an issue that has galvanised physiotherapists and the medical profession. Even though the Ministry of Health and the Doctors Syndicate insist that physiotherapists should always be supervised by a medical doctor, this actually goes against a law (No. 159) passed in 1987 that says physiotherapists have the right to maintain separate physiotherapy departments at the offices of the Ministry of Health and in teaching hospitals. These departments should legally be headed by a physiotherapist, not by physicians specialised in rheumatology and rehabilitation.
Though the law was never implemented, it has resurfaced following an incident at the Qasr Al-Aini Hospital last month. According to one of the student demonstrators, Abul-Yazid, students of the Faculty of Physiotherapy normally received their training at Qasr Al-Aini under a physiotherapist in the hospital. But when a number of students reported to the hospital to begin their internships last month, the head of the department told them that the person they were looking for had been transferred to another department and that they would have to work under the supervision of medical physicians. They refused and were, therefore, "kicked out," as Abul-Yazid put it.
The students went into an uproar and the Physiotherapists Syndicate, seizing the opportunity and citing Law No. 159, brought a case against Minister of Health Ismail Sallam and Doctor's Syndicate Chairman Hamdi El-Sayed. The Administrative Court ruled that the law should be implemented, but El-Sayed has contested the ruling in a higher court. "The verdict was handed down in the absence of a representative of physical medicine. Our viewpoint was not heard," he argued.
Amani Rashid, another student protester, believes that physiotherapists should not be supervised and headed by physicians. "I refuse this practice simply because the nature of our work is different from theirs. We don't want to be called doctors, but we should have our own departments," she said angrily.
"We have not attended our classes, and we are not going to sit for our final exams until this law is implemented and we are treated fairly," Gohar, an active member of the student union of the Faculty of Physiotherapy, told the Weekly.
Naguib El-Hilali, president of Cairo University, has tried to persuade the students to resume their studies, telling them that the controversy is between the Doctors Syndicate and the Physiotherapists Syndicate, but this argument has failed to pacify the students, who recognise that how the matter is resolved will certainly affect their future careers. They have been told -- by their families and their professors -- that they are studying to be more than mere technicians implementing programmes spelled out by physicians. The faculty only accepts students with grades totaling 96 per cent, close to the total which qualifies for the Faculty of Medicine -- and those who enrolled evidently considered themselves on the same level as medical students.
Early this month, at a meeting held at the Doctors Syndicate, rheumatology and rehabilitation physicians discussed the future of their profession, denouncing the demands of physiotherapists as absurd and dangerous. "The laws passed in the 1980s gave them [physiotherapists] rights they should never have been given," says physician Samir Badawi. "All over the world, any medical team must be headed by a doctor. What they are asking for does not exist in any country."
Fahmi Imam, also a physician, said that doctors have every right to be furious. Physiotherapy, notes Imam, was once part of the Institute of Physical Education. It was then separated into an institute of its own, and lately, it became a college. "Even their former dean was a Physical Education graduate, so how are we supposed to think of them as doctors?" Imam said.
"Their work is very important," said Azza Abdel-Rashid, a physician at El-Demerdash Hospital, "but if their demands are fulfilled, that means that nurses could become doctors, and technicians in all medical branches could be doctors."
Physiotherapists believe the debate is really about money -- that doctors do not want physiotherapists to be able to make a doctor's salary, but physicians deny the claim. "It can't be about money; it is about the patients and their health. This is our primary goal, the one we vowed to work for," El-Sayed said. "Besides, we are talking about public hospitals, meaning there is no gain to speak of," he added.
For years physiotherapists have been allowed to run their own centres and practice their work without the supervision of doctors. But now doctors are complaining about what they call the "unrestricted rights" given to physiotherapists. "The situation is deteriorating, because we know that some physiotherapists examine patients and even prescribe medicine -- and that is defined by law as a crime," Badawi said.
Physicians have demanded quick and firm action by their syndicate and have urged colleagues to send their patients to rheumatology and rehabilitation physicians, not physiotherapists. The Doctor's Syndicate meeting was concluded with more demands; first, that physiotherapy centres should be regularly supervised by physicians and, second, that physiotherapists should not be allowed to initiate programmes of their own for patients, but only execute what is prescribed by a physician.
Although Kamal Shoukri, vice-dean of the Faculty of Physiotherapy, opposes the demonstrations staged by the students, he supports their demands. "We, too, as professors, want what the students have been demonstrating for, and our syndicate has demanded the implementation of the law for years now, but all in vain," he said. Parliament's health committee has met several times since the debate erupted, but physiotherapists believe that the committee's recommendations would certainly be biased since it is chaired by El-Sayed.
In the meantime, physiotherapy students say they are determined to continue their demonstrations until their case is settled. "I can't study any more. I am aimless, because I just do not know what my profession is going to be," Rashid said.
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