In the southern sea-board state of Tamil Nadu (pop.62.1 million), a long-standing argument between physicians and physiotherapists over the use of the prefix ‘Dr by physiotherapists has intensified, following a state government order (GO) issued last September disqualifying physiotherapists from using this prestigious prefix. The GO issued by the health department announced a new Tamil Nadu State Council for Physiotherapists, and outlined its powers and functions. Moreover it defined a physiotherapist as a person who possesses recognised physiotherapy education and whose name has been entered in the register of the physiotherapy council. However the latest GO expli-citly states that he shall not use ‘Dr before his name and prescribe drugs.While several associations of doctors, including the Indian Medical Association and the Tamil Nadu State Medical Council, have welcomed the September GO, the Indian Association of Physiotherapists (IAP, estb. 1956), which has its registered office in Mumbai and claims a membership of 26,000 in India and 6,000 in Tamil Nadu, while welcoming the newly established governing council, has strongly protested the clause prohibiting qualified physios from using the Dr. prefix. IAP has appealed to the state health department to reconsider its decision and has threatened to move the high court.
The main problem is that doctors of other specialties are unable to come to terms with the fact that our specialisation has experienced tremendous growth over the past few years and patients consult us directly, instead of being referred by other medical practitioners. Physiotherapists across India use the Dr. prefix without opposition. Only medical practitioners in Tamil Nadu seem to be feeling insecure, says Dr. Ali Irani, president of IAP and head of the department of physiotherapy and sports medicine at the Dr. Balabhai Nanavati Hospital, Mumbai, who was also the Indian cricket teams physiotherapist for a decade from 1987-97.
However Tamil Nadus mainstream medical practitioners argue that they are obliged to study medicine for a minimum period of five years as against four-and-half-years for physios, and as such should be differently categorised. Physiotherapists work under the supervision of doctors such as orthopaedics, physiatrists, neurologists and paediatricians. They are not authorised to prescribe scheduled drugs to patients as they dont know how to counter side effects. They are only trained to provide rehabilitation services. When other paramedical personnel are content with their status, why are physiotherapists making such a hue and cry? We believe a doctor should have a distinct identity, as we face a huge problem of quackery in the state with traditional medical practitioners also using the prefix, says Dr. K. Prakasam, president of the Tamil Nadu State Medical Council.
Yet, while acknowledging the difference between fully-qualified medical practitioners and physiotherapists, the latter argue that it is not within the purview of the Medical Council of India or any other council to define the status of doctors. According to them the honorific ‘doctor is not mentioned even in MBBS certificates, or any other undergraduate medical degree. Hence, after completing a four-and-a-half-year degree course in physiotherapy and a six-month internship, they are also entitled to use the ‘Dr prefix. The use of the prefix inspires confidence within the public, says an IAP spokesperson.
But with mainstream medical practitioners insistent upon regarding physiotherapists as technicians under their supervision, rather than fellow professionals, the fracture in the medical profession of this caste and hierarchy obsessed southern state which likes to project itself as modern and liberal, will take more time to heal.
Hemalatha Raghupathi (Chennai)