People are people are people.....

As a physical therapist, I am constantly surrounded by people of all shapes and sizes, from all different backgrounds and for a variety of reasons. In the PT clinic, all these people are equal - they all have disabilities, albeit to varying extents, and they all have to work to regain the abilities that they once took for granted. I love the fact that physical therapy is such an equalizing factor.

The clinic that I work in is an outpatient clinic - I see people after broken bones, surgery, or when they just have pain that refuses to go away. Most of these people have no disabilities other than what is caused by their injuries. They use a walker because their back hurts so much; they are unable to go up and down stairs because they had knee surgery; they need assistance with cooking because they cannot use their dominant arm. It is rare that I see a patient with cognitive limitations or congenital problems.

Within the last two weeks, I have begun seeing two different patients whose only pre-existing medical diagnosis is "mental retardation." They are in my clinic for orthopedic problems - back and knee pain, but their cognitive limitations are obvious, both to me and to other people in the clinic. This does not, by any means, indicate that they do not need physical therapy, or that they will not benefit from it.

My dilemma comes from the medical diagnosis of "mental retardation." I hate this phrase. I hate how people use it as an insult, with both appropriate and inappropriate targets. Yet in the medical field, my field, it is an appropriate phrase. "Retardation" literally means "slow," and with these specific people, it refers to a low IQ, and is appropriate. But I hate using it. In physical therapy, their is an unspoken understanding of phrases such as "mental retardation", "handicapped people", "disability." We do not use or condone these phrases. Many of us have difficulty using the terms "good" and "bad" when referring to a surgical limb, such as "lift your good leg up onto the step first", despite the fact that patients are much more understanding of the terms "good" and "bad" rather than "involved" or "non-surgical". So when it is medically appropriate to use the term "mental retardation", I still have a hard time using the term.

Unfortunately, it is the most appropriate term. These particular individuals don't have an underlying diagnosis. They don't have a history of cerebral palsy, or down's syndrome, or fetal alcohol syndrome, or any of a host of other diagnoses that would be appropriate for my written notes. They have no physical problems other than the pain that has brought them to my clinic. They simply are mentally retarded. Their cognitive abilities are very limited, and that is medically relevant because of how it affects their treatment. So how do I get over writing this phrase that is so abhorrant to me? Any ideas?