Time for a change.

I am leaving physiotherapy. 
I don’t know for how long, I don’t know when or even if I will ever come back.
It’s not a decision I took lightly, in fact for weeks I tried to convince myself otherwise, tried to convince myself I was making the wrong choice (who knows, maybe I will realise that later). 
It’s weird really, for as long as I’ve known, I’ve had a burning passion to be a physio. The variability of work, the interactions, the chance to help people and of course the day to day challenges are all things which drew me to this profession.

I overcame a lot of personal obstacles to get where I want to be today as a qualified physio, my road to qualifying was far from straight forward or easy, at times it definitely would have been easier to quit but here I am today. Most people in physiotherapy are caring, empathetic, determined & committed individuals (give ourselves a pat on all our backs) and not too many people leave the profession, especially after only being in it for 3–4 years…. but again, here I am today.

For me, physiotherapy has slowly lost it’s appeal and the day to day challenges that drew me to the job have become more of a mundane cascade of losing battles, firefighting and constant career blocks. I have not lost my empathy, I have not lost my appetite to develop as a physio or search for evidence or push myself to better my practice, nor have a I lost that spark to see people get better and change their lives — that is still as important to me as it ever was and it is what I will find most difficult to leave. It is things largely out of my control which have pushed me away from the profession, things I largely cannot influence which I think needs addressing as they’re universal problems within the profession. This isn’t intended to be a rant as such but I think certain things need to let out into the open, for all the positives of being a physio, there are a growing number of negatives.

  1. We live in an ever devolving society. People care less and less and less about looking after themselves because hey, ‘medicine will fix me’. We are overweight, under-exercised, lacking awareness of our health and if I’m being totally honest I think as a society we’re becoming quite lazy in general in all aspects of life. I am tired of seeing out of shape people turning up to clinic making continuously poor lifestyle choices but then expecting to be ‘fixed’ by physio or orthopaedic surgeons. The blatant lack of desire by many (not all) to actively take control of their health and make positive lifestyle changes has reached the point to me that most patients I see are genuinely beyond hope or help. They don’t want to be told they should stop smoking, lose some weight, commit 150 mins a week to moderate exercise to ease their MSK related problems and even when you tell them, most don’t/won’t do it. Maybe this is due to personal or financial pressures, time pressures or other variables but in general we are exercise phobic (in the UK) and this has been passed down now for a couple of generations. This has probably been a problem for as long as physio has existed but it’s one that I unfortunately do not see improving any time soon because I feel in the UK we don’t place enough time, effort or emphasis on exercise, there are campaigns that try but ultimately we’re failing, miserably. It makes the job amazingly difficult to complete when the vast majority of patients you see, are less interested in helping themselves than you are.
  2. That may sound like empathy fatigue but it is not, I still empathise and feel for my patients and truly want what is best for them but I feel I cannot provide that anymore either. Even for those patients who are not willing to change, physios learn and develop motivational skills and even in some instances develop skills in eliciting/discussing behavioural change — but when you can only see a patient once every 3–4 weeks for 20 mins, how far are you going to get realistically? The pressures on the NHS and the resources it is afforded are the biggest barrier to completing the job as effectively as we could and it is very disheartening to know you could help these people with the right time and effort but you simply do not have that time. NHS staff are overworked, particularly physios working within MSK sectors — 12 patients? 15? 20 a day? It’s sounds like nothing compared to the 30–40 nurses/doctors may see in a day on the wards but when you’re ultimately solely responsible for that person’s treatment, dissecting their lifestyle & habits, formulating rehab ideas and realise you only have access to 4 dumbbells in a department (sometimes satellite clinics have nothing) and 20 mins to show them what to do, how to do & why to do it, it makes a difficult task, even more so. Cries for better equipment are universal but how can physios be expected to truly do their jobs as exercise therapists when NHS gyms typically consist of a treadmill, a few dumbbells, some steps and a wobble board? Coming up with fun and creative exercise ideas was something I always enjoyed but not being able to physically push patients in a gym as you need is very frustrating. It isn’t the NHS’s fault, it’s being chronically underfunded by that snivelling Tw*t Jeremy Hunt, they’re/our hands are tied in many ways sadly.
  3. I feel most MSK related pain is iatrogenic. I’ve said it and I don’t regret it. Many don’t agree but we have instilled a sense of fragility over the years through GPs, surgeons and physios alike. Probably because we didn’t know better, but years of ‘take it easy, don’t push it’ ‘don’t lift too heavy, you’ll do a disc’ ‘oh yeah if you have a cartilage tear it’ll need sorting’ have led to a population who have no idea how to manage their symptoms and generally, worry there is no hope for them. I get so many patients who have seen GPs, surgeons or other physios in the past with attitudes like ‘It’s arthritis, there’s nothing I can do about it I have to live with it’ and I wish these were isolated incidents but they aren’t. We are fuelling our own fires as physios, showing patients poor management strategies, sometimes putting profit over quality care and often failing to empower patients like we should be and all without consequence. Short of harming somebody, poor quality care has no backlashes for the therapists providing it, there is nothing out there to truly monitor physio practice and influence positively (just take a look at the CSP frontline magazine, the leading body for the profession continuously spouting poor treatment modalities and outdated courses) — something discussed at length at the recent ‘Big Rs meeting’ hosted by Chews Health & Connect Healthcare → https://twitter.com/jenna_bardsley/status/987324159381397504
    We don’t help ourselves by perpetuating the theory that the human body is fragile and it is making the job more and more and more difficult. Not least because our management of MSK related issues is sometimes so far from what research tells us it is frightening, just last week I saw a therapist using Megapulse for a chronic lower back problem…. what the fuck, it’s 2018. Which ties in with my next point…
  4. Aiming to be a profound evidence based clinician is often met with giggles or snorts of derision as if aiming to let the best, most modern research guide your treatment is somehow a bad thing. I’ve been blatantly told by clinicians (who mean no harm or malice in any way shape or form) that I should have tried X, Y & Z even though the evidence overwhelmingly doesn’t support it because ‘You can’t learn everything from research’ — which is partly true but what are we saying about ourselves as a profession when we are ignoring the very source of most of our knowledge & expertise? I largely work with brilliant clinicians, incredibly up to date with recent evidence, trying to incorporate this into their treatment that I am immensely thankful for but I still see people recommending ultrasound for lateral ankle sprains or acupuncture for chronic neck pain…. usually getting paid a lot more than me as well, where is the incentive? As a young physio I am intrigued by research, the process, the outcomes, the problems, how it influences practice and that is where I want to be. But there is no support to do this, recent proposals to my own trust for small pieces of retrospective research or qualitative research where shot down quicker than I could get my reply in, the support offered was literally non-existent, even when I offered to do it all myself just with some guidance around ethical approval etc. our research team offered me nothing instead letting me know as I was completing a masters, I should just do it there instead.
  5. Finally and maybe my biggest bug bear is that physios are woefully underappreciated. The losing battles I refer to come in the form of lack of compliance, behavioural change etc. but mainly because the population I deal with seem to not value a physios opinion. Now this could be due to the low socio-economic status of the area adding additional challenges but it’s infuriating. Often stemming from some past shitty low value treatment they received 15 years ago (see point 4) but sometimes stemming from our own healthcare colleagues — I once heard a GP proclaim to a patient to not bother with physio because it was a waste of time and I often see surgeons sending patients straight for procedures, usually no better than placebo, because physio ‘won’t change anything’ — and it makes me angry (until I see somebody frictioning a fucking MCL sprain).
    But the public often see us as just physios. Just somebody who will rub you down and tape you up. Patients fighting for scans, injections, surgery despite your best attempts to educate and re-assure these aren’t necessary. To have your clinical & professional knowledge questioned so aggressively on a daily basis is difficult at best & utterly exhausting at worst and I feel the support is not universal sometimes, as a second opinion with another therapist usually yields the final result of the patient going for said scan or injection *SMH*. I appreciate patients aren’t experts and just want what they think is best for themselves and their loved ones, but even when presented with the best advice, often your opinion isn’t valued because you’re just a physio. 
    A piece that Nick Hannah of Instagram has made beautifully here → https://www.instagram.com/p/BhnNR9MFMKl/?hl=en&taken-by=hannahmoves
    People don’t seem to appreciate or even know the level of training, study and sacrifice physios make to qualify. Nor do they appreciate the ability to critically think, analyse & diagnose a wide variety of MSK symptoms as well as screen and evaluate for non-MSK/sinister symptoms for further management. They don’t realise the scrutiny and level of responsibility physios have to detect serious pathology and the consequences, if a simple error is made before treatment and this reflects in the pay physios receive in the NHS where a senior Band 7 clinical specialist can receive as little as £31,696 a year. There is no opportunity to be fast tracked through the pay scales for outstanding performance, nor is there even recognition a lot of the time for good performance either. I know we work in healthcare and our job is to deliver outstanding treatment regardless but as a junior(ish) clinician with a 150+ patient caseload, putting your heart and soul into a position and getting no reward for it is demoralising — it would be easier to just do a shit job……. Undervalued, overworked & underappreciated sums it all up (although the same could be said of all healthcare professionals in fairness).

So I’ve had my bit. I love the positive impact good quality physio can have. I was excited about the potential opportunities the profession could take but right now I don’t see it happening and I don’t feel I am making a difference anymore which is a real shame; ultimately that’s why I went into the job. Maybe some of it is my own fault, maybe some of it is due to the region I work within and the pressures on the NHS, maybe it’s a societal thing and I should just suck it up… I imagine it’s a combination of them all. Maybe I just need a break, a change to recharge my batteries?
I will continue to routinely keep updated with physio, read the evidence base, keep on top of the progress in treatment and the development of ideas and obviously continue engaging online in discussion (hopefully start some private work at some stage for myself if I can) but for now I am stepping down from front line healthcare in pursuit of another healthcare related challenge. 
I hope physio & healthcare in general buck their ideas up sooner rather than later because I think they risk losing a lot more people if they don’t.

**Did not realise how many views this blog would get, I should clarify that despite my many frustrations, I have been very lucky to work in teams with fantastic clinicians full of support & willing to put in hours of their time to help me develop as much as I could. Most of these issues are universal to every public sector physio — my frustrations are largely based at the wider profession as a whole.**