I spoke to a new parent recently who asked me – as a veteran survivor of two tweenager children – “does parenting ever get easier”. My answer to this question is always the same; “No. It just changes”.
And now I find myself as an experienced therapist, with well over a decade and thousands of hours behind me, this is exactly what I say when Therapists ask me the equivalent question – does the job ever get any easier?
No, it doesn’t – it changes (there is a huge caveat here, I should say, depending on what the therapist wants to achieve, or focus on).
The bread and butter of the job is always helping people that have pain that is simultaneously debilitating and scary, but also not sinister or life threatening. I love, and always will love, helping people regain control over this. It is where the majority of training in this industry is focused, and I take great pride in continually challenging myself, learning and developing in that area.
There is however another side to the job that is becoming increasingly more prevalent, and is less well documented.
And these are the cases that are arriving more and more commonly in my clinic, and which are sinister in pathology, and are potentially life-threatening.
I have always started every appointment (usually unbeknownst to the client) with a ‘worst case scenario’ – “what is the most dangerous outcome for this person” – and I think that that is something I would pass on to any aspiring therapist to consider. The answer is almost always nothing too bad.
However, since the beginning of 2021, I have helped (and often led) numerous people get diagnoses for tumors, cancers, sepsis, infections, life-threatening cysts and more. All of these conditions can present as musculoskeletal pain and can easily be dismissed as such. But there are subtle differences which can be missed. Please note they are needle-in-a-haystack cases and extremely rare. But if you see a lot of haystacks, you find a fair few needles. I recognise these conditions today because A) I am a relative dinosaur in this industry and have all those hours behind me, but also B) because I read, study and challenge myself relentlessly, and unapologetically, and I have an often-overwhelming drive to know what I don’t know, so that I limit my ability to miss these conditions.
There are a few potential reasons for these conditions presenting in my clinic, I think; fewer people presenting at A&E? I’m a more experience therapist, so perhaps it’s simply a natural progression? More numbers coming in meaning more chance of seeing something out of the ordinary (purely %)?
Or is more being missed?
So, something else I would also pass on to any therapist, regardless of their job title, or level of training;
Know your Red Flags.
No, I’m going to go further; obsess about Red Flags
Know what isn’t right. And if it doesn’t look right, or feel right, don’t try to be a hero – refer on.
I am fortunate that I am able to access scanning technology where necessary, and I know not all therapists can – but most of the people I have mentioned already had previously been having weekly treatments elsewhere for months before presenting in my clinic, and I knew within 10 minutes that I was not going to be able to ‘cure’ their pain. I didn’t even touch some of them. The role at that point is to get them in a room with someone who can help. This is not a sign of weakness, or a failing. It is the most important part of the job – safety first.
If you, as a therapist, see someone with back pain do you think CES, or MSCC? If you see a hip injury, do you consider Infection as a potential cause? If you see a runner with calf pain, do you think DVT, or PAD? Do you know how a Pancoast tumor would present? If you do not know what these are, you have a couple of options; learn about them or become more confident at refusing treatment and referring on. It really is that important. Start with this book. Print a list off and stick in front of you if needs be.
Of course, with this increase in pathologies/conditions of the more sinister nature presenting, there does inevitably come more stress. I have more sleepless nights now than I ever have. I find myself working more unsociable hours now than I ever have. Recently I received an out of hours message from a Consultant Radiologist to expedite a referral for immediate hospital treatment, which – of course – you can’t sit on.
I spend more time now questioning whether I am doing a good job then I ever have before.
For every sinister pathology I see now, I wonder about the ones I must have missed as a less experienced therapist…for all the good that useless thought process does.
And I question the very, very strange emotions you feel when you are “right”, knowing full well that what you got correct has potentially negatively changed someone’s life forever.
Do you/should you feel pride? Guilt? Guilty for feeling proud?
It’s all very odd and hard to balance, and they stay with you for a long time.
And what of the ones whose referral is ignored or overruled by ‘higher powers’, and have the worst possible outcome? How do we come to terms with those, knowing that you made the right call, but it fell on deaf ears and now can’t be undone? It can be a brutally heartbreaking role, sometimes.
I am extremely lucky to work in a multidisciplinary clinic with an open-door policy (when not with a client, of course!) where I can offload, compare notes (GDPR first, of course!), or have an ear to simply listen to me. I value them greatly and I genuinely think it would become too much without them.
Please note that this is not in any way self-congratulatory, so please take anything which sounds that way with a pinch of salt.
Nor is it a complaint, or whinge, or rant.
I still love this job and take huge pride in it; I am merely highlighting the role, or place in the system, that this job now fills, which I believe is very different to the one it used to be and could maybe do with some more support – as many won’t be as fortunate as I am to have colleagues around them.
I’m not 100% sure if there is any message for this blog (or if there needs to be – it’s my blog and I’ll cry if I want to – maybe I’m just tired), other than reinforcing to any therapists who may be reading, once again, to really, really focus on the red flags, and be confident enough to not treat someone – it may help them in the most important way.
And yes, I still rub legs 🙂