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Who's Actually Keeping Physios in Check? · MSKMag OutLoud

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  SPEAKER_00: Who's actually keeping physios in check?
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  SPEAKER_00: Written by Glenn O'Humeral.
• 0:07
  SPEAKER_00: Sponsored by Splose.
• 0:09
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• 0:12
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  SPEAKER_00: If I think about my own appointments with physiotherapists as a patient recently,
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  SPEAKER_00: I've been told I need an MRI, and I've been told I don't.
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  SPEAKER_00: I've been told I need an injection, and the next one said I don't.
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  SPEAKER_00: One says I need eight treatments, one says a couple, and I'll be fine.
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  SPEAKER_00: One says it's my hamstring, the other says it's my glutes, same leg, and still the same old me.
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  SPEAKER_00: And I think any profession,
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  SPEAKER_00: especially one that's supposed to be science-based,
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  SPEAKER_00: should have some level of consistency.
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  SPEAKER_00: As a patient,
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  SPEAKER_00: it's actually quite worrying and certainly not reassuring
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  SPEAKER_00: to be handed polar opposite views by people with the same letters after their name.
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  SPEAKER_00: If I called three plumbers out to the same boiler
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  SPEAKER_00: and got three completely different diagnoses and three completely different bills,
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  SPEAKER_00: I'd assume at least two of them were having me on.
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  SPEAKER_00: I'm not sure why physio should be any different.
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  SPEAKER_00: Nobody's keeping an eye on them.
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  SPEAKER_00: Seems to me as a patient that no one's really keeping physiotherapists in check.
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  SPEAKER_00: Whether that's in the NHS or privately,
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  SPEAKER_00: you need only look around at every other physiotherapy website offering cupping
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  SPEAKER_00: or some new longevity treatment or a new machine that promises to cure everything
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  SPEAKER_00: from back pain to ankle pain.
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  SPEAKER_00: You've got physiotherapists using electromagnetic waves with little or no evidence.
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  SPEAKER_00: You've got Shockwave being offered for pretty much everything.
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  SPEAKER_00: And on that note,
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  SPEAKER_00: it also seems that physios are stepping outside what they're individually competent
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  SPEAKER_00: in and moving into areas they're simply not qualified to move into.
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  SPEAKER_00: Nobody appears to be stopping them.
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  SPEAKER_00: So how am I supposed to choose one?
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  SPEAKER_00: How do I choose a good physio?
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  SPEAKER_00: It's not because they have a degree.
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  SPEAKER_00: It's not because they have an HCPC number or they're a CSP member or a PhysioFirst member.
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  SPEAKER_00: It's not because they own a clinic and it's not because they're a band five or a band six.
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  SPEAKER_00: None of those things told me which of my physios was right about my hamstring.
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  SPEAKER_00: So on what basis can I choose one and how do I know about I'm going to get good treatment?
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  SPEAKER_00: Which brings me to the question of who should be overseeing what physios do and don't do.
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  SPEAKER_00: I had to look through the HCPC's hearings involving physios and there are obviously,
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  SPEAKER_00: and quite rightly,
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  SPEAKER_00: cases to do with sexual impropriety and legalistic issues and some to do
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  SPEAKER_00: with competence.
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  SPEAKER_00: But I couldn't find one about cupping or a laser
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  SPEAKER_00: or telling someone they needed 10 treatments for their back when the physio down
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  SPEAKER_00: the road says it's their hamstring.
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  SPEAKER_00: If a physio says you need cupping to help with your back pain, maybe they're right.
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  SPEAKER_00: But if they're not, who says so?
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  SPEAKER_00: Is there any link between the Advertising Standards Agency and any organisation
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  SPEAKER_00: within the world of Physio?
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  SPEAKER_00: Because the advertising rules already exist and from the websites I've been reading,
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  SPEAKER_00: nobody in Physio seems to be using them.
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  SPEAKER_00: Is ongoing training really taking place and if it is, is it effective?
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  SPEAKER_00: If it's happening, I can't see that it's working.
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  SPEAKER_00: And here's the real problem.
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  SPEAKER_00: The HCPC has failed.
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  SPEAKER_00: The CSP has failed.
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  SPEAKER_00: Physio First has failed.
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  SPEAKER_00: What do I mean by failed?
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  SPEAKER_00: Well, as far as I can see, they are the main bodies in the industry.
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  SPEAKER_00: The ones with the widest reach.
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  SPEAKER_00: The HCPC is the regulator.
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  SPEAKER_00: So I'd expect it to be the one saying no to the vibrating massage balls and the cupping.
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  SPEAKER_00: And it isn't.
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  SPEAKER_00: The CSP is the professional body.
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  SPEAKER_00: So I'd expect it to be the one making sure its members can read
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  SPEAKER_00: a research paper past the abstract.
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  SPEAKER_00: And it isn't.
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  SPEAKER_00: Physio First represents private practice.
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  SPEAKER_00: So I'd expect it to play some role in advising clinics on taking
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  SPEAKER_00: the mystical stuff off their website.
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  SPEAKER_00: It should be a science.
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  SPEAKER_00: I've seen someone describe physiotherapy as an art form as if it's like painting,
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  SPEAKER_00: where two very different things can be good at the same time
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  SPEAKER_00: and three things can all be true.
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  SPEAKER_00: But physiotherapy isn't an art,
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  SPEAKER_00: it's a science,
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  SPEAKER_00: or at least it should be,
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  SPEAKER_00: and I don't think it's a science any longer because science is about evidence,
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  SPEAKER_00: the best evidence we have available at this moment in time,
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  SPEAKER_00: and that's not what I'm seeing.
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  SPEAKER_00: We've got older physiotherapists leaning completely on what they know,
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  SPEAKER_00: what they've seen and anecdotal evidence.
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  SPEAKER_00: During my research,
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  SPEAKER_00: I've seen physios broadly incapable of reading PubMed research beyond a headline and
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  SPEAKER_00: a conclusion.
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  SPEAKER_00: The same older physios are busy saying new graduates simply aren't qualified
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  SPEAKER_00: to be anywhere near patients,
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  SPEAKER_00: and I fear that might apply to quite a number of them too.
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  SPEAKER_00: After all, we can't even get physios to agree on whether manual therapy is a good thing or not.
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  SPEAKER_00: I've heard people say innovation is important,
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  SPEAKER_00: that there's not always science behind innovative ideas,
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  SPEAKER_00: that you have to try new things and have an open mind.
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  SPEAKER_00: As Carl Sagan is supposed to have said,
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  SPEAKER_00: having an open mind is a good thing,
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  SPEAKER_00: but when it's so open that your brain falls out.
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  SPEAKER_00: A new toy every fortnight.
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  SPEAKER_00: One physio I've used seems to get a new piece of equipment every two weeks
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  SPEAKER_00: and sends out an email telling us how wonderful it is.
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  SPEAKER_00: Some measurement device or some healing device,
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  SPEAKER_00: something you jump on,
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  SPEAKER_00: something that rumbles and vibrates,
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  SPEAKER_00: new foam rollers,
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  SPEAKER_00: fancy boots you put on your legs,
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  SPEAKER_00: a handheld vibrator that buzzes you in some way,
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  SPEAKER_00: or a futuristic laser that looks like it belongs in Battlestar Galactica.
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  SPEAKER_00: All curing one ailment or another.
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  SPEAKER_00: Whilst the physio down the road says they don't need any of those things
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  SPEAKER_00: and spends time going through what's actually wrong with me
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  SPEAKER_00: and what progress might look like.
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  SPEAKER_00: When there's such a vastly different advice out there, who do we believe?
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  SPEAKER_00: Is six a magic number?
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  SPEAKER_00: When it comes to private physiotherapy world,
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  SPEAKER_00: from what I can see,
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  SPEAKER_00: the overriding aim now is to make money and not to help patients.
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  SPEAKER_00: Every area is commercialized.
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  SPEAKER_00: I asked Google for the top 10 clinics in my area, got a list and went to their websites.
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  SPEAKER_00: Four out of those 10 sold packages of physiotherapy that I could buy there and then
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  SPEAKER_00: by clicking book now.
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  SPEAKER_00: Unless physiotherapists have somehow developed an incredible level of perception or
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  SPEAKER_00: the ability to read minds,
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  SPEAKER_00: I don't suppose they'd know whether I needed six sessions or 10 without seeing me.
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  SPEAKER_00: So I had a look around at as many clinic websites as I could stand selling packages
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  SPEAKER_00: of 3, 6, 10, and 20 sessions, and the overwhelming majority offer a package of 6.
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  SPEAKER_00: So I wondered, is 6 a magic number?
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  SPEAKER_00: Is there some physiological reason that 6 is the number of sessions you need?
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  SPEAKER_00: Strangely,
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  SPEAKER_00: these clinics,
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  SPEAKER_00: for whom 6 seemed to be the default, all offered different appointment lengths.
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  SPEAKER_00: Some were 30 minutes,
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  SPEAKER_00: some were 45,
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  SPEAKER_00: some 60,
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  SPEAKER_00: one offered 90,
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  SPEAKER_00: which I suppose means 2 of theirs equals 6 of someone else's,
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  SPEAKER_00: or that nobody's measuring anything.
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  SPEAKER_00: It made me wonder why one clinic needed a 60 minute initial assessment
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  SPEAKER_00: to figure out what was wrong with me, another needed 45 and another needed just 30.
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  SPEAKER_00: Are they twice as quick at diagnosing or just half as thorough?
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  SPEAKER_00: Physiotherapy you can trust, apparently.
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  SPEAKER_00: Then there are websites.
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  SPEAKER_00: One clinic's homepage tells me it's physiotherapy is evidence-based and I can trust it.
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  SPEAKER_00: A few kicks later,
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  SPEAKER_00: I'm reading about needles rebalancing something or other,
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  SPEAKER_00: the body's natural healing being unlocked and a happy chemical being released
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  SPEAKER_00: that will leave me feeling better in myself.
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  SPEAKER_00: And of course,
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  SPEAKER_00: the old favourite that's been used for centuries,
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  SPEAKER_00: which is great as historical context,
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  SPEAKER_00: but isn't exactly evidence that something works.
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  SPEAKER_00: Many things have been used for centuries.
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  SPEAKER_00: Tobacco smoke enemas, for one.
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  SPEAKER_00: Another site tells me it's shockwave machine regenerates tissue
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  SPEAKER_00: and mends what's damaged and that it works for tendons.
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  SPEAKER_00: And in a phase, phrase doing a lot of heavy lifting, various other muscle problems.
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  SPEAKER_00: And then there's the clinic that's obviously spent some money on a new toy.
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  SPEAKER_00: According to the website,
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  SPEAKER_00: this one speeds up healing, tells you when you're ready to get back to sport.
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  SPEAKER_00: And my favorite, lets you get there without risking another injury along the way.
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  SPEAKER_00: What is this magical product?
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  SPEAKER_00: The measuring.
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  SPEAKER_00: It measures things.
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  SPEAKER_00: I did a little research myself,
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  SPEAKER_00: which you would assume any credible physio would do before spending that sort
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  SPEAKER_00: of money.
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  SPEAKER_00: And for me,
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  SPEAKER_00: there seems to be quite a big leap from measuring something and more accurately
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  SPEAKER_00: to healing faster and never getting hurt.
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  SPEAKER_00: Now, these may just be words and a little bit of marketing spiel,
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  SPEAKER_00: but this is what you're presenting to patients.
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  SPEAKER_00: And some of us read it.
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  SPEAKER_00: I'd rather ask ChatGPT.
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  SPEAKER_00: Both myself and friends have started turning to JackGPD to ask physio-related questions.
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  SPEAKER_00: Not only do we trust it to give us a more sensible answer,
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  SPEAKER_00: we also trust it to give us an answer that isn't made with commercial intent.
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  SPEAKER_00: Whether that's,
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  SPEAKER_00: you need to come and see me more times than you need to because I want
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  SPEAKER_00: to make money out of you,
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  SPEAKER_00: or anti-commercial intent from the NHS, which is, don't ever come and see me again.
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  SPEAKER_00: I'm not saying a chatbot is a better clinician than you.
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  SPEAKER_00: I'm saying that right now it's the most consistent one I've got and it's
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  SPEAKER_00: the only one whose answer doesn't change depending on what it's got in
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  SPEAKER_00: the treatment room.
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  SPEAKER_00: It doesn't need to monetize the equipment it's bought or get a referral fee from
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  SPEAKER_00: an MRI business or a scanning business.
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  SPEAKER_00: It doesn't feel the need to inject every other patient that comes through the door
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  SPEAKER_00: or use a fancy new £20,000 ultrasound machine.
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  SPEAKER_00: That should definitely be worrying for the physiotherapy industry
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  SPEAKER_00: when ordinary people feel they get a straighter answer from ChatGPT than from
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  SPEAKER_00: a physio who simply doesn't have their best interests at heart.
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  SPEAKER_00: Does anybody listen to patients anymore?
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  SPEAKER_00: I've been reading a lot of posts about how physiotherapists can offer real reassurance.
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  SPEAKER_00: But for reassurance to work, you have to trust the physiotherapist.
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  SPEAKER_00: And I trust very few of them to do a good job,
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  SPEAKER_00: or at least the job their title suggests they should do, which is helping people.
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  SPEAKER_00: A few questions for the physios reading this.
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  SPEAKER_00: Who is in charge of making sure physiotherapists do a good job,
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  SPEAKER_00: give the right advice,
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  SPEAKER_00: don't sell things they needn't,
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  SPEAKER_00: don't send people for scans they don't need,
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  SPEAKER_00: and don't use equipment that doesn't work?
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  SPEAKER_00: Who is responsible for continual training and development
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  SPEAKER_00: to make sure physios are actually up to date with the evidence?
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  SPEAKER_00: How can someone become a physiotherapist without the critical thinking skills to see
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  SPEAKER_00: through the cloud of silver bullet marketing and stop them buying a shiny new device
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  SPEAKER_00: that promises for just £50,000 to change people's lives?
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  SPEAKER_00: And how do we bring back trust into the world of physiotherapy?
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  SPEAKER_00: Because right now, from where I'm sitting, on a foam roller I didn't need, it's not there.