"Seated physios giving advice on exercise to patients over the phone" - a follow-up

I posted a tweet about a small bit of news from the Chartered Society of Physiotherapy (CSP) that had caught my eye yesterday.  It was about 'A telephone assessment service in Cambridgeshire [that] is helping more than half of its physiotherapy patients to self-manage their conditions' (link to the full press release here). It featured an image that I thought was interesting and just a little ironic.  Here is the image.

My comment on Twitter was that this was 'a thing of postmodern beauty', and both the picture and the full report raised the ire of some in the Twitter community.

There were a number of things going on in this report that I think said some important things about the present state of the physiotherapy profession.

Firstly, there was the 'delicious irony' as Glenn Ruscoe (@GlennRuscoe) called it, of seated physiotherapists telling people to do more exercise, but there was also the sight of a profession, that was once synonymous with physical work, delivering advice down the phone.  Randal Glaser (@randalglaser) suggested that we had 'discovered how to turn our active job into a desk job!' and @7Calypso asked 'whatever happened to hands on treatment?'  Rebecca Nygren (@BeccaNPhysio) expressed her 'despair', a sentiment shared by Tim Budd (@TimBudd) who thought that it was a case of 'more patients "seen", more money "saved"'.  Roger Kerry (@RogerKerry1) summed up the feeling of many when he wrote 'Seriously? Come on #Physiotherapy profession, you're better than this'.  Matt Webb (@mattcwebb42) advised us to 'Forget the phones. Doesn't work and never will', and David Evans (@drdavidevans) echoed Roger's comment, saying 'I have serious concerns that continuing along this path, the #physiotherapy profession is in danger of obsoleting itself'.  Nicholas Clark (@DrNickCC) concluded that 'This type of service evolved as waiting list crisis Mx strategy; its not "moving" & shouldn't b where we aim as a profession'.

Others, however, spoke against these negative portrayals.  Todd Davenport (@sunsopeningband) was 'Confused. Sitting down is impermissible for physical therapists? Putting them on a treadmill would be better?'  And @TherapyGirl5 said 'Hold up... Forget the image. Before judging... the real issue, more people are being reached vs high wait times' and that this was evidence of a 'Great process happening. People getting care and advice sooner. Nice touch point happening. May reduce chronic problems too'.  David Hart (@hartphysio) argued that '"it's better to keep moving". = valuable contact time saved. The profession is moving with demands #Physiotherapy'.  Martin Docherty (@MartinDocherty2) agreed, arguing that it was 'Just one of many ways profession are interacting with pt's to identify those who will benefit from self-mgmt.

This is only a summary of the responses, and there were other side conversations going on, where people disputed the inevitable polarities in the argument.  But what they suggested for me was actually a growing sense of maturity in the way that we are now debating healthcare reform.

It is clearly impossible to say that initiatives like this are either simply good or bad.  All we can really say is that they are problematic and worthy of debate and discussion.  It clearly shows, for instance, a profession confronting the rapidly changing economy of healthcare in innovative ways.  It challenges our presuppositions about physiotherapy as a 'physical' occupation, and suggests that physiotherapy can also be something delivered down a phone line or wifi connection.  But it also suggests a double standard, where young, fit, able-bodied professionals use technologies of affluence to 'offer advice' - with all the emotional and psychological overlay that comes with that -  to people who are probably less fortunate than they are.  It also plays into modern paranoia about sedentary behaviour in some deeply ironic and humorous ways.  It also suggested that although this was a telephone service, the practitioners hadn't forgotten the importance of good posture and wearing a proper uniform!

Stories like this then are gold, because they say important things about where the profession is going and, perhaps without really thinking about it, hold a mirror up to ourselves and reveal how our face is changing.