Allied Health

Practice Issues and Trends into the New Millennium

Kevin Lyons, Pedro J Lecca, Peggy Valentine

• Publisher: Routledge
• Year: 2013
• eBook ISBN: 9781136614798
• Topic: Medicina
• Subtopic: Atención sanitaria

Make the most of your contribution to health care delivery!

Allied Health: Practice Issues and Trends in the New Millennium is a comprehensive look at present and future concerns in the allied health care field. Leading experts in allied health practice and education address practice and policy issues that have developed as technology and a changing health care environment have created new and expanded roles for allied heath professionals. With the allied health field projected to add an estimated four million new jobs by 2005 in the United States alone, this book is an essential resource for maximizing the knowledge and skills necessary to deliver safe, efficient, effective, and equitable care.

Allied Health: Practice Issues and Trends in the New Millennium presents an overview of the concerns facing the largest and most diverse pool of health workers in the United States as they provide disease detection, prevention, dietary, health promotion, rehabilitation and health management services at all levels of health care delivery. This unique book addresses critical issues that affect allied health practice, including managed health care, computer technology, drug information, and demographic trends in society, with an emphasis on implications for education. The book also includes appendices listing allied health organizations, accrediting agencies, and descriptions of federally recognized allied health professions.

Allied Health: Practice Issues and Trends in the New Millennium presents information on:

• public policy
• research needs
• new directions for accreditation
• interprofessional collaborative alliances
• employment opportunities
• practice directions
• and much more!

Allied health professionals play a critical role in health care delivery, comprising a significant portion of the health care work force with tremendous potential for addressing issues of health care cost, quality, and access within the health care system. Allied Health: Practice Issues and Trends in the New Millennium is an essential resource for the future of health care in the United States and a must read for allied health care educators and students, and health care policymakers.

Chapter 1

Historical Overview: Evolution of the Allied Health Professions

Harry E. Douglas III

INTRODUCTION

Modern medicine, considered by many to be the foundation for the allied health professions, is rooted in ancient traditions of healing. Indeed, some aspects of those traditions are relevant and complementary to modern medical practice. The allied health professions are included in the ancient traditions of the healing arts. This is an important point because the general populace has shown deep reverence for the esoteric and special skills for healers of all types since the early dawn of humanity. Contemporary society continues to revere the health worker, including the allied health professional. While there has always been a central figure who ministered to the physical, mental, spiritual, and social conditions of people, such as the medicine man of shamanistic folk tradition, the physician in primitive society was physician, priest, magician, and philosopher in one person. In addition, other healing types were concerned with what was perceived to be the spiritual and emotional causation of illness. In the ancient world, it was commonly accepted that a function of religion was to heal disease.¹ Magicians and others were called upon to handle the mystical dimensions of life, e.g., ancestral spirits, evil spirits, and witchcraft. They were traditional folk healers who were familiar with the mental and psychological needs of individuals and communities. Such health providers could, in a real sense, be construed as a community working within the community. As such, each provider played a defined role within a system of community service that addressed the needs of the whole person.

Thus, to fully appreciate and understand the evolution of allied health professions one must study the evolution of the healing arts within the context of society while recognizing that the allied health sciences have always been an essential partner in the delivery of health and mental health services around the world.

THE CHANGING MEDICAL PARADIGM

The medical paradigm has undergone considerable change since its early beginnings. The most significant of these has been the manner in which the health care profession, especially in the Western approach to medicine, viewed the patient and ultimately organized the delivery system to respond to patient needs.

The Early Approach to Medicine

The early formative stages of medicine evolved around the concept of holistic health. Ancient medicine integrated mind-body medicine and was rooted in a social and religious matrix of a culturally defined people within a definite belief system.² Most societies had their shamans, magicians, and witch doctors who possessed psychological influence over individuals and the communal health belief system. Family and community were the basis for social healing. On the other hand, many cases of illness never reached a physician or professed healer. Such maladies were often treated by the sick person or by relatives. Early communities were organized according to tribal traditions of protection, social support, pooling of resources, expertise, and family. Each community had its elders (leaders), but more important, they had village social organizers who ensured that rituals and cultural events ministered to the social health of the community. Each of these, and other approaches, were the focus of early practice of individual and community health.

While the aforementioned approaches were not necessarily integrative or cross-disciplinary in approach, nonetheless, the health services consumer was insulated by a complex web of alternative and complementary services bound by a culturally defined community and belief system. In addition to the physician, this complement included, but was not limited to, folk healers, magicians, masters of the occult sciences, pharmacists, druggists, psychologists, neighborhood activists, and religious leaders, each of whom offered their services to the ill.

The concept of a culturally defined belief system is rooted in a number of traditional health systems. For instance, traditional healers in southern Africa treat illnesses mainly with plant products and some animal products and use spiritual resources to augment the healing process.³ In the system, the traditional healer is concerned with relieving suffering, controlling symptoms and restoring physical functioning, and social and psychological connection. In Asia, traditional Chinese medicine is a healing art that includes both acupuncture and herbology as major components of therapy.⁴ Other dimensions of traditional Chinese therapy include exercise and nutrition. Both are concrete examples of the healing arts ministering to the health of the whole person within a culturally defined system.

Toward a Modern (Western) Approach to Medicine

Over the years, Western concepts of medicine, which “rest on the axiom of Cartesian dualism or the separation of mind and body,”⁵ have evolved and wholly displaced the ancient view. Only recently have we returned to the concept that health is a function of the physical, spiritual, mental, and social aspects of life. However, to minister to the physiological, psychological, social, and spiritual aspect of a person and/or community at the same time is an extremely difficult and time-consuming task. Through a process of professionalism, reductionism, and specialization, twentieth-century Western medicine evolved into a fragmented system of health care that distinguishes physical health from the mental, social, and spiritual aspects of health. In this paradigm, allied health personnel emerged as one of a number of individual support and complementary healers in a specialized and compartmentalized health care system. This is the tacit operational model for the allied health profession.

TOWARD A DEFINITION OF ALLIED HEALTH

As a singular profession, allied health has struggled to define itself for a number of years. There have been numerous attempts to define allied health and to categorize the health workers who should be included in a universal definition. In 1980, the National Commission on Allied Health Education defined the field as “… all Health personnel working towards the common goal of providing the best possible service in patient care and health promotion.”⁶ A shortcoming of this definition, as cited in a 1989 Institute of Medicine report, was that it does not define boundaries for groups of health care providers, nor does it describe commonalities of task or education that identify the fields to be included.⁷ In effect, this definition leaves it to each occupational area to decide for itself whether or not it would be listed under the allied health umbrella.

The U.S. Department of Health and Human Services’ 1995 “Report of the National Commission on Allied Health” defined allied health professional as written in the Health Professions Education Extension Amendments of 1992, section 701 of the Public Health Service Act:

A health professional (other than a registered nurse or physician assistant) who has received a certificate, an associate’s degree, a bachelor’s degree, a master’s degree, a doctoral degree, or post baccalaureate training in a science relating to health care, who shares in the responsibility for the delivery of health care services or related services, including (1) services relating to the identification, evaluation and prevention of disease and disorder, (2) dietary and nutrition services, (3) health promotion services, (4) rehabilitation services, or (5) health systems management service, and who has not received a degree of doctor of medicine, a degree of doctor of osteopathy, a degree of doctor of veterinary medicine or equivalent degree, a degree of doctor of optometry or equivalent degree, a degree of podiatric medicine or equivalent degree, a degree of doctor of pharmacy or equivalent degree, a graduate degree in public health or equivalent degree, degree of doctor of chiropractic or equivalent degree, a degree in health administration or equivalent degree, a doctoral degree in clinical psychology or equivalent degree or a degree in social work or equivalent degree.⁸

This definition excludes those allied health fields that have specific federal legislation for programmatic funding. The physician assistant occupation is widely acknowledged as falling under the allied health umbrella; however, it is specifically excluded from this definition because it has a federal line item for funding. Other occupations may or may not regard themselves as allied health but are nonetheless included in Health and Human Services’ definition. The lack of a consensus on how to define allied health contributes to the confusion about which fields fall under the Allied Health rubric.⁹ An approach to staking out the boundaries of allied health is offered by Schloman.¹⁰ She brings together four definitions and organizes them into a typology that can aid people to decide what allied health is. The following are Schloman’s four definitional areas:

• Broadly defined (U.S. Division of Allied Health Manpower, 1969) “All those professional, technical, and supportive workers in the field of patient care, community health, public health, environmental health and related research who engage in activities that support, complement, or supplement the professional of administrators and practitioners.”
• Vaguely defined (American Medical Association [AMA], 1995) “A large cluster of health-related personnel who fulfill necessary roles in the health care system, including assisting, facilitating, and complementing the work of physicians and other health care specialists.”
• What it is not (Pew Advisory Panel for Allied Health, 1992) “Allied Health includes all health related disciplines with the exception of nursing and the MODDVOPP disciplines … medicine, osteopathy, dentistry, veterinary medicine, optometry, pharmacy and podiatry.”
• Avoiding the issue (Institute of Medicine, 1989) “The benefits of making the term Allied Health more precise are less clear than the benefits of continued evolution.”

One approach to defining the field not mentioned in the literature is that the term allied health refers to all health workers as caregivers who are allied with the patient.* Many health personnel and health professional organizations neglect or fail to consider this critically engaging, socially meaningful, and philosophically compelling point. In their 1977 report Health Personnel: Meeting the Explosive Demand for Medical Care, Goldstein and Horowitz noted:

This report will use the terms Allied Health or health personnel or occupation with no intention of slighting or disparaging any occupation or group. Our interest is to include all those persons in the industry who relate directly to the patient—“laying hands-on.” The terms allied health or health profession are intended to cover the whole range of health workers from physician and physician extenders (such as pediatric nurse practitioners and graduate registered nurses with four or five years of formal schooling after secondary school) to entry-level nurse’s aide or assistant (NA) and the laboratory assistant who may have less than a high school education plus on-the-job training, in-service education or both.¹¹

As we review the evolution of the allied health professions, it is clear that the definition of allied health is not universally accepted today. For the most part, this state of affairs is an outgrowth of the intense professionalization of medicine, the fragmentation of health care to manageable parts, and overspecialization of the health care workforce. These issues, coupled with the need to maintain a professional hierarchy within the U.S. health care system, one that is dominated by the physician and focuses on the patient, produces an extremely trying context for allied health and contributes to its current identity crisis. The following section reviews a few of the social epochs contributing to the identity crisis.

* In a number of professions meetings sponsored by the American Association of Schools of Allied Health and the National Society of Allied Health from 1972 to present, the relationship of health personnel has been referred to not as a pecking order in terms of education and professional hierarchy, but rather in terms of each health professions’ relationship with the patient. In this view, all health care providers should be considered allied with the patient.

THE EVOLVING U.S. HEALTH CARE SYSTEM

The history of organized medicine in the United States is generally acknowledged to begin with the founding of the American Medical Association (AMA) in 1847. The first invitation to an AMA organizational meeting stated that a national convention would be conducive to elevating the standard of medical education in the United States. However, it was not until many years later that improvement was achieved in medical education.¹² Many of the economic, social, political, and technological factors that contributed to the rapid development of medical education and the physician community similarly contributed to the evolution of the allied health community. The most compelling of these was the Shattuck Report.

The Shattuck Report (1850)

The Rep...

Table of contents

• Cover
• Allied Health
• The Haworth Press Titles of Related Interest
• Full Title
• Copyright
• Contents
• About the Edtiors
• Contributors
• Preface
• Chapter 1 Historical Overview: Evolution of the Allied Health Professions
• Chapter 2 Role of the Federal Government in Allied Health Education
• Chapter 3 Primary Health Care
• Chapter 4 Rehabilitative and Restorative Therapies
• Chapter 5 Health Care Management
• Chapter 6 Chemical and Dietary Therapies
• Chapter 7 Diagnostic Services
• Chapter 8 Psychosocial Interaction and Its Therapeutic Impact on Patients’ Physical and Mental Health: Implications for Health Care Providers
• Chapter 9 Interdisciplinary and Community-Based Health Care
• Chapter 10 Demographic and Health Trends in the Twenty-First Century
• Chapter 11 New Directions for Accreditation of Allied Health Education Programs
• Chapter 12 Allied Health Education in a Global Community
• Chapter 13 Genomics, Proteomics, and Allied Health
• Chapter 14 Interprofessional Collaborative Alliances
• Chapter 15 Impact of Technology on Allied Health Education
• Chapter 16 Allied Health and Public Policy: Making Change Happen
• Chapter 17 Gaps in Knowledge and Research Needs
• Chapter 18 Preparing Future Allied Health Leaders
• Chapter 19 Employment Opportunities in Allied Health
• Conclusion and Recommendations
• Appendix Allied Health Organizations and Affiliates
• Index