Challenges

TheKettleBellPhysioBlog, Business, Exercise, Health, Physiotherapy0 Comments

Of humility, C.S. Lewis said “humility is not thinking less of yourself, but thinking of yourself less.” and Ezra Benson said “pride is concerned with who is right, humility is concerned with what is right.”

I am a Dr of Physiotherapy. I received the Doctor of Physiotherapy Award for Academic Excellence because I graduated top of my class. In addition to my clinical Doctorate, I have two other Degrees and other qualifications coming out of my ears; some of them are mounted on my consulting room wall next to a stethoscope engraved with my name on it from back when I was expected to be doing auscultation with my hospital patients. Physiotherapists primarily train to work in hospitals, not private practice.

The certificates, anatomy charts and stethoscope are only there for ‘show’ because we know that our environment and physical appearance affect clinical outcomes. I don’t refer to my myself as “Dr Neil” (and nor does anyone else) because I’d feel like a bit of a wanker and I’m not a ‘physician’ who practises medicine like my wife, and I don’t hold a PhD (yet).

My life has revolved around exercise since I was 8 (I’m 42 this year) and I’ve been regularly training in gyms for a full quarter-Century! Exercise is what I do; I just do it with a different hat on now.

Yet time and time again, people seeking my advice chose not to listen because they feel they know better or feel more comfortable with someone else’s opinion. Sometimes people clearly don’t believe me, or question my methods. Sometimes I’m left wondering why they came to see me in the first place.

Sometimes people only ever see me in training clothes and forget or don’t realise that I’m even a Physiotherapist at all. In spite of our consultation and treatment rooms, people often speak of PRIDE as a “gym” not a “practice” or “clinic”, and I’m *just* a trainer. We have kettlebells, paralletts, gymnastic rings, a 7m Crossfit-style rig and water rowers, but they never see the elderly frail people using the rings to help them ‘stand up’. Perhaps they assume they’re only used for muscle-ups?

Most people don’t see ‘exercise’ in the absence of pain as part of Physiotherapy. Nobody in group classes knows that I’m watching their every move through a clinical lens. Every lift or swing of a bell is done considering safety, symptoms and pain, anatomy, biomechanics, physiology, psychology, pathology and that individual’s own goals. To the outsider, it looks simple and no different to the trainer that I might appear to be and used to be. I’ve only ever had one client that I’ve been able to discuss (some of) my internal dialogue with, because she had an interest in neuroplasticity. My wife is much smarter than me, but she doesn’t know this stuff either (and she’s not interested). She’s too busy ‘doing medicine’ as a GP and it’s not her role as a practitioner to ‘do exercise’; they refer to someone who does. We have medical practitioners come in to ‘do exercise’ and on the whole they’re not that interested in why I do what I do either. There’s a reason they chose medicine instead of Physiotherapy. I like to think it’s because that was the easier option.

It may look like just a sumo squat, but what people don’t realise is that I’m thinking about the evidence behind classical conditioning and using that loaded squat to uncouple a maladaptive conditioned response and as a tool for addressing expectancy violation. I can’t talk about ‘Physiotherapy’ with clients because a) they generally don’t want to hear it (give a shit) and b) most wouldn’t understand it anyway.

“never use inside lingo on the outside world” my good friend and late colleague Benny Butler used to say, “it’s like masturbation; it makes you feel good, but makes everyone else feel uncomfortable if they ever catch you doing it.”

Last week I wrote a long letter to a local Physiotherapist (who I don’t know) outlining a new client’s health history and examination findings; it was done as a courtesy and took considerable time and effort on my part and wasn’t necessary. The seemingly happy client didn’t return to collect the letter or drop off the outcome measures I had given her to complete – to help me help her. I also hand-delivered flowers to a regular client whose mother had passed away in the 48hrs since I’d seen her last. I go out of my way to do the right thing by people. I have a high ethical, moral and professional bar and refuse to stoop underneath it. I refuse to tell people that their aches and pains are due to bad posture, tight or weak muscles. I won’t “release” anything and we don’t sell orthotics or lengthy programs of care that people simply don’t need.

To steal another quote, this time from Dewey Nielson, “a novice Physio makes decisions through an exercise library. An excellent Physio makes decisions through scientific principles.”

I agree with Sports Therapist Ben Cormack that “when you understand that it’s a little bit more complicated, you can get to some simpler answers because you’re not trying to find this one thing that fixes everything.”

Doing the right thing by our customers, trying to raise the standards of clinical practice and building a new business as a Physiotherapist while swimming against a strong current of out-dated practices and unhelpful client expectations has been far more challenging then I would have ever imagined.

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