Therese, a Canadian physiotherapist, is involved in a pediatric
rehabilitation program in a developing country. The health care system
in this country is very hierarchical. In particular, the role of
physiotherapists is much more of a technician who carries out a very
specific treatment plan established by a physician. This contrasts with
Therese’s role and training in Canada where she is very involved in
evaluating patients and contributing to developing treatment goals and a
treatment plan. Therese has particular expertise in working with
pediatric neurology patients.
Therese is referred a 9 year old boy. The medical order is to work on strengthening. Therese interacts with the patient and his mother through a translator. Upon evaluating the child Therese is worried that the boy has a degenerative muscular disorder. When she goes to speak with the doctor about her clinical impression and concerns, the physician dismisses this possibility and insists that the child will improve with strengthening exercises and is simply deconditioned.
Therese is returning to Canada in one week and she is very worried that an important opportunity to help this family may be missed but she is unsure what, if anything, she can do in the situation.