Although it’s going to be hard to accept, particularly by those people currently striving to make a difference in the profession, but it probably won’t be this generation of physiotherapists that bring about the radical change necessary to prepare the profession for the new world of 21st century health care.
There are any number of reasons for this:
- Physiotherapists are, by and large, a relatively conservative bunch, who don’t instigate radical change
- Physiotherapy is highly respected and well patronised, so there are few indicators that we need to change much
- Most people in positions of authority have received a traditional training, and tend to like things the way that they are, thank you
- And besides, there are few physiotherapists with the skills and knowledge of things ‘outside’ of the traditional biomedical disciplines to be the agents of change
So unless there is a sudden unexpected surge towards the study of subjects like philosophy and sociology, our existing profession leaders are unlikely to make the transformational change necessary to shift the profession very far from its existing base of support.
No, if change is going to happen, it will happen from beneath; from people who may be too young, or too occupied with other careers right now, to know that they want to become physiotherapists.
Change will come with the next generation of physiotherapists.
But how will they be know how to change if their tutors continue to promulgate the ‘old’ model?
The answer lies in new curricula that express the things that physiotherapists know to be important , but struggle to articulate. The humanities for instance.
The humanities have become a major feature of medical education in recent years (see, for example, the Journal of Medical Humanities, The BMJ’s Medical Humanities and the Journal of the History of Medicine and Medical Humanities. There is also the excellent BMH Medical Humanities blog, which you can find here).
There have been some really excellent books produced about the interface between the humanities and healthcare. (A broad set of disciplines incorporating communication and cultural studies; critical studies, including areas like disability and gender studies; (bio)ethics, health care politics; history of health, medicine and professionalisation; journalism, literature and creative writing (including new social media); philosophy and sociology of health and healthcare). (Note: You cannot read the medical humanities without first going through the work of Alan Bleakley – a fantastically clear, concise and readable writer on the subject – see reference below).
The (medical) humanities are the studies of people in health care: people as patients, people as professionals, people working together, people struggling with illness, and so on. And this is clearly a huge area of new interest in physiotherapy.
But it is such a big topic, and our curricula are already stuffed full of clinical content. So how will our physiotherapy schools adapt?
What we need perhaps, is a new humanities curriculum that picks up on all of the material that needs to be understood by students if they are going to become the new faces of physiotherapy.
The curriculum would be scaleable to different programmes, but would address many of the shortcomings of existing, overly technical, skills-based training programmes.
National bodies would by necessity have to take the lead, but it would be us, as the existing torch-bearers for the profession, that would need to make it happen.
At least now there is a path that we can follow.
References
Bleakley, A. (2015). Medical Humanities and Medical Education: How the medical humanities can shape better doctors. Abingdon, Oxon: Routledge.
Agree on all counts, especially this: “And besides, there are few physiotherapists with the skills and knowledge of things ‘outside’ of the traditional biomedical disciplines to be the agents of change.”
While initially enamored with the idea of moving from the biomechanical/biomedical to a biopsychosocial (BPS) approach to care, I am beginning to loathe the term BPS. Yes, BPS-teaching takes folks trained like myself and can open our eyes to what they we failing to address as clinicians, but remains reductionistic and explicitly breaks the patient into more parts, still. Now, as I wish to move ahead further with developing a way to work in a manner that is truly non-reductionistic, I realize that there are few foundations to anchor to in the literature. As you have mentioned in the past in your own writings, the profession jumped onto the biomedical so early in our history, (for the most part) all writings of relevance to humanism are in other fields (e.g. social work, psychology, medicine, nursing).
Maybe I am just looking in the wrong places, but my favorite search engine tells me there is a paucity of information related to physiotherapy and a humanistic approach to care; therapists should be motivated to be agents of change, moving the profession away from a fragmented view of the person seeking care. It would help to have the research, views and history to inform that change.
Thank you for these insights. Please add medical anthropology, which is a part of social/cultural anthropology, to this list.
Working in the specialty of palliative care has moved me to explore medical humanities, as traditional models of Physio so limited in this field. Maybe the changes happening in clinical practice will precede the changes needed in Physio education.
Hi David
Thanks for the great post, and also for pointing me to Bleakley’s book.
@KeithP: I agree with everything you’ve said, except the bit that says “therapists should be motivated to be agents of change”. Or rather, I don’t disagree with you only think that what you’re suggesting is enormously complex and difficult to do. Our professional education and practices in the clinical space do anything but encourage a culture of developing change agents. I think that physiotherapy is one of the most conservative allied health professions and least likely to play an active role in facilitating thinking that challenges the status quo. When you say that therapists should be agents of change, I worry that you’re asking those who are most invested in the current system (and therefore least likely to change) to lead the charge. How do go about developing these agents of change is perhaps one of the most difficult things we could ask physiotherapists to do, embedded as they are in a system of thinking about the world that actively discourages any kind of critical self-reflection.
@Jo Bayly: I think that what is more likely is that we will see a concomitant shift in the clinical practice and education spaces, where like-minded educators and clinicians are both engaged in this process. If it’s only the educators, the clinicians will take much pleasure in informing new graduates that “that isn’t how things work in the real world”. And for why I think it’s highly unlikely to be led by clinicians, see my previous point in the comment. I don’t see the integration of humanities into professional practice working unless it is led by both clinicians and academics.