Is PT for everyone?

Is physio suitable for everyone?

When the Curtin Clinic is not so busy, the students double up on patient visits. I ‘sat in’ on another student the other day, and went through a painful experience. It was obvious the patient did not believe physio was of any benefit and she has not been compliant with her HEP despite claims to the contrary. She was there because the surgeon had wanted her to go through a clinical trial of physio before he would consent to surgical intervention. (Surgeons have been successfully sued in the United States for not offering alternative therapies as a part of seeking informed consent.) The patient was nice enough but her disinterest was clear from the beginning. The treating physio student used soft tissue massage as a part of the management, but it was the first time applied on this patient in the last two months of coming to the clinic. The complaint was longstanding and she had tried extended periods of physio in the past, with limited success.

Physios assume that just because we teach patients what is good for them, they will go ahead and follow our instructions. I feel this is a poor and erroneous assumption. It is equivalent to assuming people will quit smoking because it causes cancer, and or eat less because weight gain is associated with diabetes and heart disease. Physios assume that every person is well motivated to take care of themselves. Sadly, this is not the case. We live in a pill-popping society where everyone is looking for a quick fix. If given a choice of how to get better from a condition, patients would always prefer a one-time passive treatment over an extended regimen of active exercise management. The vast majority of patients are interested getting rid of their pain, not doing exercises.

It pains me to have heard time and time again, people saying “physios haven’t done a thing for me”. Do we simply brush these people off, blaming them for a lack of motivation or refusal to take responsibility for their own health? Or perhaps, our management plans have not taken into consideration patient motivation. Maybe there is something more we could do. I feel we should examine how we can increase patient compliance. Perhaps, we can strike a better balance between passive and active care, or make better exploitation of the placebo effect. I am not certain. Your input would be much appreciated.