By David Bevan @DJBMSKPT
We are truly living in extraordinary times. The coronavirus is currently tightening its grip on global economies and in doing so placing immense pressure on our healthcare system. This has and will like cause untold suffering throughout our society.
In the coming months many may tragically suffer personal loss, and many will struggle with the financial impact of this global pandemic. In this blog, from the perspective of a physio, I reflect on the changes to my profession and tell you how I see hope hiding in amidst the chaos.
Minimising “non-essential contact” has led to physiotherapy practices converting to online video consultations (VC). For some, this has been an overnight change in service provision and represents a completely new way of working (for at least the foreseeable future). For many, this redefines what it is to be a physiotherapist. Most clinics have faced the heart-rendering financial reality of splitting their workforce into two distinct groups: government-backed “furloughers”- those who are granted a leave of absence, and those who now need to work incredibly hard with short timelines to seamlessly transform their work from face-to-face sessions to Facetime-savvy VC practitioners.
Embracing life as a furloughed Physio: what I am doing with my new-found “spare-time”
For me, despite having to enter the “furlougher” community, I do see the potential for hope in what would otherwise be a worrying time for me and my family’s finances. The first and most pressing opportunity is to offer my help to the National Health Service (NHS). For most of us here in the UK, the NHS has not just been pivotal in our own career development, it has also paid our university fees. It has been there for my family and friends in their hours of need. So, this “spare-time” does provide us the opportunity to give something back to the health service and continue to provide care to the general public by offering to work for local hospitals on the wards or in their outpatient departments, or to provide support in domiciliary care. It could even be helping indirectly within a call centre setting (such as the UK’s 111 service).
This time will also give me the opportunity to re-evaluate; who I am as a practitioner? What is my mission statement? What are my strengths? What are the areas in need of development? Can I do more i.e., write blogs like this, that can help my fellow practitioners? Yes, this time will be hard for potentially life changing reasons, but it may just give me the space to be a more rounded practitioner- someone that will be better equipped to make a noticeable difference to those suffering in the future.
Life in front and behind the camera: the benefits of video consultations
Where does potentially weeks or even months of VC leave private practice now and in the future? We really don’t know, but it will likely change dramatically. The use of VC has now been commonplace in our “resource strapped” NHS services for many years. Often with great successes and improved efficiency- words that private health providers (PHP) like to hear. There are some practitioners out there that have foreseen the advent of ZOOM et al and in some parts of their practice embraced this form of consultation already. However, the majority of private clinics have not move beyond the PHP driven status quo and still operate a face-to-face service. The “tech-savyy” pioneer practitioners may be ahead of the game, and could play an important role in supporting wider service change in these fast-moving times. The rest of us will have to listen, learn and adapt.
VC could benefit patient groups (e.g. persistent pain conditions). These cohorts historically struggle to engage and fail to show long-term improvement following “conventional” face to face therapy. Remote VC provides a non-threatening environment and could result in a truly client led experience. Likely a result of meeting in their own “safe” environment. No matter what colour we are told to paint our waiting room walls our clients will always find their homes or offices less threatening. This makes more socially difficult but important “red flag” questions much easier to ask and discuss openly (a tick for clinical safety!). In addition to this, VC can also give you as a practitioner a unique chance to understand the environment the client is living in and ultimately “hurting” in (e.g. homes, sports clubs or offices could be assessed).
Hands-off physiotherapy gives light to our other strengths
I guess the elephant in the “ZOOM room” is its inability to facilitate touch. I don’t intend to stoke the flames of an echo-chamber-driven-debate on that glorified school playground known as Twitter. But, ultimately our most effective therapeutic tools are arguably listening, looking, educating, reassuring and gaining trust (O’Keeffe et al). All of which video can facilitate nicely. That is not to underestimate the “power” of therapeutic touch, however, in its forced absence we might appreciate the importance of non-hands-on skills a bit more, and our clients may recognise their importance too.
Conventional assessment is going to be tricky. But our ongoing dependency on not so “special-tests” forces our patients into diagnostic pigeonholes that fail to acknowledge the wider picture (Hegedus et.al). VC may finally turn the tide on this reductive approach to clinical reasoning. I do concede that undertaking important objective tests such as neurological examinations will also be hard but will require our problem-solving skills to find the answer.
Measurement of joint range and muscular strength directly is a potential challenge for us as clinicians. But refreshingly (in my opinion) this may make us consider functional impairment (e.g. the ability to control or attenuate load) which could be viewed via video.
The Coronavirus is likely to have a devastating impact on many lives. With this in mind, the impact on our own profession pales into insignificance. The reality is that suffering is an individual experience and many of us will also go through hardships professionally. To quote the US suffragette Helen Keller when speaking of her own disabilities: “this world maybe full of suffering but it is also full of overcoming it!”. We, as physios, must seek hope in the chaos and and embrace the changes to our profession, and this way we can play our part to help our country get back onto its feet again.
David Bevan @DJBMSKPT is a lower limb physiotherapist who has worked in multiple sectors and settings of musculoskeletal physiotherapy in the UK. He currently works for The Abbey Clinic which specialises in sports injuries and MSK disorders located at Bisham Abbey (National Sport Centre), Marlow UK.