In health care, there is much talk of control. One of the biggest issues is controlling the spiraling cost of care.

In the same breath, we have become transfixed by outcomes for any given episode of care. This is thought to help control costs – the costs that are faced right now, what I call the upstream costs.

But over the long-term, the control we need to discuss is locus of control. This is the control that will ultimately provide health care with true, epic reform.

August is always a month of anniversaries and times of reflection. I am not quite sure why, but August seems to have accumulated a lot of life events, seemingly more so than any other month.

This year has been no different. It has been a nostalgic couple of weeks since my last installment of the Report. As a matter of fact, this week marks my 23rd anniversary of moving to Austin, inching me ever closer to having lived as many years here as I did in Canada. Just for the record, the day of the 50/50 split will be July 29, 2015, assuming that Austin is still home. I don't see that changing any time soon.

In this episode of the Rhubarb Report, I go back in the time machine for a few of those August moments in time. Gretzky, Erving, and Peralta - any of those names ring a bell?

It may have been one of the worst value propositions ever made. I know you've heard it before - 

"Hands-on care is quality care".

I have heard it more than once, be it in a clinical environment, educational program, or on social media. What makes this scenario even worse is how the public has been snowed into believing it. Clinicians have, over time, skillfully trained the public to believe this. While doing so, clinicians continue to perpetuate a myth - that quality care is inherently related to the laying-on off hands.

Clinicians like to think they know what is best for the patient. And oftentimes, that is true. I mean, isn't that why patients come to see us?

But there is a fine, yet distinct, line between patient-centered care and paternalism. You know, the "father knows best" mentality that pervades our health care system right now. It might have been fine in the 1950's, but patients of the 2000's are becoming consumers when it comes to their health care. And rightfully so.

If we don't start paying attention, paternalism will be the demise of health care as we know it. And maybe that's a good thing.

Physical therapist education is something that I have been involved with for many years. I have seen both sides of the coin - the didactic educational side, and the clinical instructional side. I have also experienced the process of accreditation, albeit with a physical therapist assistant program.

There is always talk of "preparing students to take the licensure exam". However, the sad reality is that accreditation and licensing exam standards don't always reflect the current status of research and/or clinical guidelines in the profession.

So here's the question: is the goal of physical therapy education to get graduates to pass an exam, or is it to train competent clinicians - or both?

It's amazing how connected we are these days. We update our friends online. We share our photos and videos online. We get our news online.

So imagine my disconnectedness after being in Denver for five days at a conference. It's not that the Internet doesn't exist in Colorado - it just exists in the hotel at about $12 per day. A little fiscal demand, combined with a busy schedule, countless face-to-face interactions, and some sleep wedged in there somewhere, and you are suddenly unplugged from the universe. Or so it seemed at times.

For 5 days, news from the outside world didn't really exist. It was, admittedly, quite nice.

But a few things did make it to my attention over the past couple of weeks. With that in mind, here is the next episode of the Rhubarb Report.

This past weekend, the city of Denver hosted the McKenzie Institute Americas Conference. I made the trek to Denver to take part in what was, according to my calculations, my 14th McKenzie conference. Where has all the time gone?

As has become the norm over all of those years, the conference was chock full of current research and insightful presentations. Add to that the thought-provoking and insightful discussions after hours with colleagues from around the world.

Sadly, the 2013 edition was the first conference since the passing of Robin McKenzie. Though the conference began with a moment of silence and tribute to Robin McKenzie, it ended with a powerful reminder that there are a dedicated group of clinicians poised to forge ahead with his legacy.

When clinicians bring up the phrase "Mechanical Diagnosis And Therapy" (MDT), they will often mention things like diagnostic classification, centralization, and directional preference. You might even hear mention of self treatment.

I would suggest that we can add one more phrase to the mix: public health.

MDT clinicians are uniquely qualified to contribute favorably to a public health initiative. Though that may sound like a pretty significant value proposition for the future of health care, it comes with some substantial rationale to support it. There are a number of reasons why MDT can provide the foundation for a public health initiative that could truly be a game-changer.

The logical fallacy exists on a daily basis in the orthopedic world. Perhaps more importantly, it costs the health care world millions of dollars and a tremendous unnecessary burden psychologically.

Orthopedic patients are referred for countless imaging studies as a first line of assessment. An MRI is a detailed image which patients are told will provide all the answers to the diagnosis of their problem.

Technology is a wonderful thing, right?

But there are some significant problems with this that begin with the initial line of thinking.

Should we trust pathoanatomy?

It was another example of truth being stranger than fiction: rain, in Austin, in July. As I looked out the window, I had a double-take. I had to pause to realize that no, Chicken Little, the sky was not falling, and yes, it was actually real, honest-to-goodness rain. And buckets of it.

While the northeastern part of the country bakes, we have actually experienced the wet stuff and a (fingers crossed) only-modestly-blazing summer thus far. I am not sure what you call all of these strange weather patterns, although some might actually call it "global warming" - but I digress.

So while the sky is falling, grab an umbrella, enjoy the rain, and dive right in to the next episode of the Rhubarb Report.