The Therapist-Advocate: Transcending Knowledge and Skill to Address Societal Needs
By Xavier Alexander Gibson, SPT
Congratulations to Springfield College Doctor of Physical Therapy Program graduate student Xavier Gibson, SPT, a finalist in the annual physical therapy student essay contest co-sponsored by the ACAPT Consortium for the Humanities, Ethics, and Professionalism (CHEP) and the JHR. This writing competition is designed to encourage deep thinking by students about the role and value of humanities, ethics, and professionalism in academic training and professional life. The fourth in an annual series, the CHEP-JHR essay contest offers a creative opportunity to ignite critical reflection in PT students across the nation, to support holistic approaches to patient care. This year’s essay prompt was, “2020 is defined by crises and uncertainties related to the COVID- 19 pandemic and racial tensions. These impact the moral, social, political, and economic foundations of our world, nation, and the profession of physical therapy. Navigating one’s professional identity and formation during this time is undoubtedly challenging, and you may have had unexpected, yet impactful interactions as a result. Describe an experience that significantly impacted your professional growth and identity as a future physical therapist, with respect to the public health crises of racism and/or COVID-19. What about this encounter was instructive? In what ways did this experience enlighten your perspective on one or more of the core values of our profession?”
As a student of color entering Doctor of Physical Therapy (DPT) studies this summer, I could not have imagined a more turbulent social environment in which to learn. This year has made people look a little longer in the mirror and question their values and beliefs. For me, these beliefs were initially self-pitying. I would think, “Am I smart enough to be in this program? I am the only Black kid here.” To add to this self-doubt, I felt guilt for not being at more Black Lives Matter protests—instead staying home to memorize muscle attachments. Was I supposed to prioritize studying or was I needed to march in the streets, amplifying the cries for justice? Important muscles and important social movements; how could I possibly weave a life as a future healthcare provider while being an advocate for change?
Finding a Way
In September I found an opportunity that coalesced my roles of DPT student and advocate. Our campus organized a week of programming called “S.E.A.T. at the table,” dedicated to learning and growing as a community. Social justice, Equity, Accountability, and Transformation were the week’s focus, aimed at “deconstructing oppressive systems across disciplines to transform our community toward equity for all.” A faculty member, two other students and I decided to do our part as vessels of change. In addition to jobs, school, and the 100 tasks in young adults’ lives, we dug into this question: “Why are diversity, equity, and inclusion in the health professions important for everyone’s health?”
The outcome was monumental—an informative and honest presentation. Student perspectives, patient perspectives, research, and professional input were captured in our multimedia presentation. The most instructive element for me was the journey of putting the pieces together. Through conducting interviews, conversing with lay people and patients, and hours of reading, I arrived at the following conclusions.
For starters, the demographic makeup of providers could not be further separated from the diverse populations we treat. Increasing overall diversity throughout healthcare should be of focus if our end goal is to, in fact, maximize comfort and trust within the patient-provider relationship.
Secondly, for many, healthcare in the United States is classified as a human right, yet the healthcare system in which it operates benefits the privileged and presents healthcare as a limited resource to those less fortunate. Access to healthcare is heavily reliant on healthcare coverage, and until universal coverage and access to healthcare are available, accessible, and affordable, healthcare as an inherent human right remains aspirational.
With our presentation completed, I saw the term “health disparities” in a new light—no longer a memorized concept from a class, but a dire issue that must be addressed. As physical therapists, we should recognize that the goal of universal coverage is still a work in progress.
Insights From a Pandemic
Let’s take COVID-19, for example. One of the hardest-hit areas was the Bronx in New York City, a borough with a large population of Latino and Black individuals living in packed, poorly-ventilated buildings. This population has high rates of comorbidities including hypertension, diabetes, and respiratory conditions. I recall the day my father asked me reflectively, “Xavier, why are Black men dropping like flies from COVID?” I replied, “It’s from the cards so many Black people have been dealt. It’s the effects of oppression and the resulting life circumstances that have come to affect so many communities of color.”
Certainly, one answer to his question is found in research residing in that list of comorbidities that predispose an individual to a more severe COVID infection. But the truth is far more complex: institutionalized racism; years of systemic oppression; lack of access to healthcare, housing, clean air, food sources; let alone inadequate health insurance; and high rates of chronic stress, are all intertwined in how COVID-19 plays out in marginalized, at-risk communities. Plainly speaking, by being Black in America, you not only have to worry about racism but also racism’s trickling effects on the social determinants of health, and today, COVID-19.
As for the core values of physical therapy, we take pride in urging ourselves to exhibit integrity, and to be accountable, altruistic, compassionate, caring, socially responsible, and professional in our actions. Our obligations transcend individual patient care to address extant social inequities of healthcare access for the underserved—such as migrant farm workers who do not have access to physical therapy but continue to do back-breaking work every day. As a profession, if we advocate healthcare as a right, then we have an obligation to optimize accessibility to all populations that need care.
I have come to realize that it is not solely having intelligence that produces an excellent physical therapist. True excellence comes from being caring, compassionate, and acting on the root causes of injustice, as embodied in the APTA Code of Ethics. Holding a higher standard in the realm of social responsibility is something that I now strive for in myself and in others—in order to be the change I wish to see in our profession. Being educated on the social determinants of health is the first step. Now I’m prompting my peers to take the next step and do something about it—to write to officials in government and professional organizations. This work is part of our identity as physical therapists, as healers.
The year 2020 has held many lessons for me, both in the realm of academia and personal growth; these lessons will guide me on my journey of striving to be a respected, well-rounded therapist-advocate.