…in some states unlicensed personnel are legally allowed to administer modalities and provide some level of care. The problem is that other states do not, and aside from legal issues, all PTs should operate under a professional code of ethics stricter than most laws…In some states, then, it may be perfectly legal for PTs to delegate an unethically high level of care.
From Advance for Physical Therapists and PT Assistants June 12, 2000
In The Sand Pebbles, a movie made in 1966 and nominated for 8 Academy Awards, Steve McQueen plays a veteran sailor in China in 1926. He’s just been assigned to a new post, a gunboat that sails endlessly up and down a river in the interior of this teeming and chaotic country. Their mission is to make a show of American military presence and power. The captain (Richard Crenna) takes this task very seriously, and insists on daily drills of military tactics in full view of the locals.
McQueen is an engineer who for the first time will be allowed full control of a ship’s steam engine and he makes no effort to hide his delight at the job ahead. When he arrives on board he heads below immediately, caresses the machinery. He even talks to it.
The next morning he wakens to find that Chinese coolies perform all of the actual work of the ship. It’s explained to him that this is simply something that kind of happened over time, that it was a consequence of their enormous presence and the captain’s tacit permission. They do a good job for the most part, and it certainly makes the crew’s life a lot easier. He takes this in silently and heads toward the boiler room. There he finds things running smoothly enough, but his efforts to alter the routine of maintenance are immediately resisted by the head coolie. He complains to the captain that unless he oversees an overhaul of the engine something dangerous might occur. “They think there’s ghosts in there,” he says. The captain rejects this citing no previous problems and emphasizing that he is needed for “topside watches” like the rest of the Americans aboard. He wants the sailors to be seen, not hidden beneath decks.
I suppose you can imagine what happens next, and how the McQueen character is proven correct in his assessment of the situation. A basic misunderstanding of the machine’s inner functioning and tolerance leads to a coolie’s death, further fueling the political unrest surrounding the ship. Eventually the American presence is violently rejected. In a sequence symbolic of this, McQueen’s Chinese protégé defeats a much larger American in a boxing match. “He’s big,” says McQueen, “but he’s all blubber.” The relationship that this coolie eventually has with McQueen, a relationship born of mutual respect and patient, persistent teaching grows as they remain together below decks, both of them caressing the engine that they treat as if it were alive.
There’s more to this movie of course. There’s a love story, and even a small part for a very young Candice Bergen, but it was the situation on the ship that came to me when I read the quote in Advance.
I should say here that the racist remarks uttered by the crew were, to me, simply a depiction of Western attitudes in 1926. Personally, I reject them, but I realize that this was not a Disney movie. What interested me was the situation aboard the ship and how it in certain ways mirrors what many clinicians find today when they first come “on board” a department that has fallen into a routine of service that might not be as ethical as it is legal. I’ve met many therapists struggling to get back to their original intent, the one they had when they first fell in love with the work, and I know they don’t always succeed