Overservicing – my thoughts.
So Physio originated a bit over 100 years ago as a service to help people with polio get moving again. I wasn’t there but I presume the treatment was intensive, over a reasonably long period of time, and got much better results than the status quo at the time of treating polio with lower limb callipers and immobilisation.
As Physio evolved the main role of Physiotherapists was to assist with people’s rehabilitation in hospitals in a variety of settings – cardiothoracic, neuro rehab, post orthopaedic rehab, and eventually musculoskeletal outpatients.
What is the common theme amongst all of these settings?
The end goal is patient discharge.
When I started my Physio degree in 2000 there was a heavy hospital focus on our training – lots of neuro, cardiothoracics, and musculo was geared towards a hospital outpatient setting.
I would like to challenge the conventional hospital thinking around the concept of early discharge vs lifetime care.
Let’s fast forward to private practice physio in 2017.
The bulk of our clients consult with us to get rid of their pain. If you have been in business long enough you will observe that someone you may see for treatment in one year can come back the nest year, or the year after that, or the year after that, or alternatively you may never see or hear from them again.
I am going to open up to you and tell you the situations clinically that have made me feel the highest level of guilt.
99% of these situations come from when I was a young practitioner with not enough tools in my belt. I couldn’t give the patients with the most complex conditions the help they needed, based on my initially poor diagnostic skills. I specifically remember a guy I treated in my first year of physio who had what I thought was discogenic pain. I lay him on his tummy (it almost hurts me to tell this story), mobed the hell his lower back, and he almost couldn’t get off the bed or out of my clinic quick enough, and he never came back. I didn’t know how to salvage this situation.
Guys there is no worse feeling than treating someone and not getting them the result that is possible with physiotherapy. The second part is the kicker – they come back in 5 years later and say “you know that problem you treated me for – it never really came right (or) I went to the chiro for 6 months and he fixed it for me”.
What is the benefit of discharging someone before they are better? the ONLY reason I have ever seen this occur is the Physio (you or someone who works for you) being concerned about the finances of the patient and thinking ” I don’t believe they can afford to keep coming until they are better”. Guess what? That is YOUR shitty limiting belief. Why are you projecting it onto your patient, who desperately wants your help and wants to get better.
Who accuses Physios of overservicing the most? You guessed it, other physios. Why are we ripping down our fellow practitioners (within reason of course – I remember being told about a clinic that did 9 sessions of therapeutic ultrasound for every client who came through the door – shocking) when the vast majority of us are doing our level best to get our patients better.
Even after being a physio for 14 years and doing more than 70 000 consultations I still don’t have the ability to predict how every patient will end up, and I can’t accurately predict how many sessions and over what period of time a patient will need to get better. If I can’t do it over that long a time then how can we expect young physios to do it?
How have I got around this? I give my patients plan A and plan B. “Let’s do treatment and exercises XYZ, based on improvement we do this, based on lack of improvement we do that?” My patients love this approach as I cover all bases, and from my own end I derisk all outcomes.
Lets get back to overservicing. The people who are most conscious of this is us, the physios. Not our patients (consider before coming to you they have probably been offered a 6 month, 3x a week pay upfront chiropractic plan) so your 10 sessions to help them with chronic and debilitating low back pain is just a drop in the ocean.
I notice a strong trend in physio. The best and most experienced physios see their patients for the highest number of visits. I intend to gather evidence to prove this over the coming 2-3 years as part of further study I am going to do, and I may need your help.
Why is this the case?
Experienced physios get people closer to full recovery, and build great relationships to unearth more problems they can help their patient with. They get great outcomes.
Physios who discharge their patients too early lose the opportunity to build trust with their patients. The patient feels lost, and they still want and need answers to their pain/condition. The patient then goes on the search, to find someone else who can help them.
The worst part of this is that this patient now goes around telling all of the people they know “physio couldn’t help me”. They don’t say “practitioner x didn’t help me” – they refer to our whole profession!
When you discharge your patients without giving them the best solution you create people in society who go around telling their friends that physio couldn’t help them.
So physios – don’t discharge patients after 2-3 visits when you can’t help them – refer them to a GP, senior physio, help them find out what is wrong, try pilates, gym based strengthening, a pain specialist/rheumatologist (based on blood findings of course), and ask them to keep you posted as to their progress and results.
After all pain and injury is a journey, not a quick fix.
