Think about it. Every time we begin a new patient assessment, we have got one eye on the patient’s discharge. We love goals and outcome measures so that we can measure when milestones have been reached and end-points achieved.
It seems every opening to a new episode of care comes with an implicit expiration date.
Naturally, funders are eager that packages of care are limited and treatments don’t extend on into days, weeks and months, and we seem to have accepted the inherent logic that care must have term limits.
Time-limited care suits acute illnesses and injuries that are, by definition, self-limiting. And so funding has tended to privilege short termism and emphasise repeated, low cost, ‘curative’ interventions.
The people missing out in this calculation, of course, are those with unremitting, chronic, long-term, incurable, progressive and debilitating illnesses, where living with the consequences of their illness is often a more significant problem than the biological illness or injury itself.
Chronic pain, multiple sclerosis, emphysema, spinal cord injury, diabetes, cystic fibrosis, Parkinson’s disease, chronic renal failure, depression, fibromyalgia, HIV/AIDS, cancer, Alzheimer’s disease, stroke, chronic breathlessness, not to mention the debilitating effects of ageing or congenital illness, all require an unrelenting commitment to care for which there is no end.
Short-term acute packages of care and therapists attempting quick fixes to patient’s bodies might work well for acute illnesses and injuries, but they don’t work well for long term illnesses, where therapists often need to work with rather than on people.
How might physiotherapy be different if we removed our fascination with endings, and concentrated instead on allowing the myriad openings that accompany care to emerge? How might we be better placed to help people with longstanding illness, lifestyle disorders and government health priorities if we dispensed with a model of care more suited to acute illness and injury, and became a profession more concerned with opening doors than closing them?