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Finding the Balance

This weekend saw an article in the Daily Mail, titled Are thousands of patients being fobbed off with physiotherapy that doesn’t work – just to save the NHS some cash?

It is a pretty assertive, at times aggressive dig at ‘physiotherapy’, particularly within the National Health Service, whereby patients have felt UNDER-TREATED.

And it got me thinking.

I often meet people who are undergoing, or waiting for, or have “failed” physiotherapy through the NHS. And often they are equally as disheartened as the comments section on the above article. But they are often surprised that I, a private practitioner, do not agree with all of the criticisms.

There are more than five million physiotherapy appointments carried out on the NHS every year – who knows how many appointments Therapists in that setting would be expected to carry out per day. And in the time they are given, they are expected to meet, build rapport, take history, carry out assessments, carry out treatments, and design a rehab plan. Often in time slots of 15 minutes. It’s certainly not an enviable position, in my opinion, and not one I would thrive in.

Conversely, a busy private therapist may carry out 2000 appointments per year, of between 30 and 60 minutes, on their own timeline, often without the pressures of a system measuring their efficacy, and in which they can choose their own approach.

There is no comparison on what can be provided.

And there is an odd psychology with NHS treatments, whereby we think of it both as ‘free’, so a good option, but also that “we pay their wages” so should be entitled to what we want when we want it. It is of course neither of these things – it’s not free, and we should get what we need, not what we want.

The two most common complaints I hear are;

  • They didn’t even touch me!
  • They just gave me a sheet of exercises!

In my opinion, it is not “physio” – or the exercises – that are failing; it is the system. There is such a lack of time to really educate and explain the reasons for the exercises , or the lack of hands-on treatments. To build therapeutic alliances and rapport. And a crucial lack of time to really listen to the patient, validate their concerns and experiences.

But I am not convinced that private practice is perfect, either.

And actually, having spent some time recently on some market research, I believe that private practice can be just as guilty of OVER-TREATING, with one clinic proudly advertising that the average treatment package starts at £400, and all whilst offering hands-on treatments with an incredibly low effect rate.

I meet people who have spent £1000s on Direct Debits for treatments for conditions that they don’t understand, or who are years in to treatment plans with no exit strategy.

People who tell me they are rebooked by their therapist before they have put their shoes back on.

I see therapists telling people they are moving wrong, and breathing wrong, and sleeping wrong – going to the the toilet wrong!

I hear these stories and think, surely this is as big a barrier as any, particularly in a time where many are struggling financially?

So how do we find the balance?

Back to the 2 complaints I hear most often. There is actually solid reasoning for the lack of physical therapy in an appointment which lasts for 15 minutes. If I were doing 15 minute slots, I doubt very much if I would have time for hands-on therapy, as it does not sit at the top of the list of priorities when meeting someone in pain. But I do agree that simply handing over a sheet of exercises, with no “why”, and no “how” is not acceptable and will invariably end in a poor outcome.

But if the system is not allowing brilliantly trained professionals the time needed to got though this, then we in the private sector have a moral obligation to treat people honorably and ethically when we meet them.

We in private practice do not have to follow NICE guidelines like the NHS therapists do, and so can offer the treatments wanted by people in pain (massage, mobilisations, needling, cupping etc etc) but it doesnt give us carte blanche to abuse that position. The remit is the same; get people who have pain in less pain ASAP.

We should look to empower them, rather than build a reliance on us therapists with low effect treatments. Don’t worry about discharging people once they are doing well; there are a reported 9, 000, 000 people in pain – you wont run out of new people if you treat them ethically.

Exercise therapy does work, but we need to do better than stick men on piece’s of paper, or pre-printed sheets for everyone.

We need to make ourselves available for check-ins; online, via email, or in person, but we shouldn’t be ambulance-chasing – I certainly don’t believe that we should be texting clients every week to entice them back.

But we can afford to be led by the person in pain, and make considered, joint decisions with them – not simply for them (or for our bank balances).

As I say, there are big differences between what the National Health Service can provide currently, and what Private Practices can.

But I would argue that both can do better.

Not sure where I went with that, but now my coffee has gone cold 🙁

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