Amy Hiller has been a member of the CPN from its inception and she recently presented at the Critical Physiotherapy Forum at the Australian Physiotherapy Association conference. She is a musculoskeletal physiotherapist, a qualitative researcher and an educator. Amy is currently a PhD candidate at the University of Melbourne where she investigates communication in physiotherapy. I interviewed her about her PhD work.
What got you interested in exploring patient-physiotherapist interactions to start with?
I have always enjoyed listening to people’s stories and trying to understand each individual and their unique circumstances through my clinical work. It was, however, after my year studying masters of musculoskeletal physiotherapy that I first became particularly interested in understanding communication and interactions with patients. At this point I felt disappointed that although my traditional clinical skills, manual handling and clinical reasoning had improved, I was not experiencing noticeably better patient outcomes, nor was I sensing that patients were any more satisfied with my level of care. I became frustrated with trying to be objective and specific because I felt that this compromised my engagement with each patient as a person.
I subsequently became fascinated by the idea that I could impact upon patient outcomes and satisfaction more through my communication than any other skill.
I reflected on the lack of communication training that I had experienced through my physiotherapy education and decided to start reading about it. I was surprised how little knowledge seemed to exist specifically about communication in physiotherapy and had a nagging desire to learn more.
You say in your paper “Exploring healthcare communication models in private physiotherapy practice” that despite physiotherapy literature strongly promoting patient-centred care, evidence points to practitioner-centred communication. Why do you think this is?
In many instances, I sense that the biomedical paradigm is still a key focus of physiotherapy. The emphasis during undergraduate physiotherapy training, particularly in clinical education, is often on objective measures and evidence based practice (which is still often wrongly perceived as being the best evidence based on randomised control trials). This positivist and biomedical focus aligns with a practitioner-centred model and limits the achievement of patient-centred care.
In addition, there is a lack of knowledge about what patient-centred care entails in physiotherapy. This makes it very difficult to teach or adopt a patient-centred approach. A couple of weeks ago a student in my lecture about approaches to physiotherapy practice said “I feel like we are told over and over that we need to be patient-centred but no-one is explaining or teaching us how to do this”. Her comment reflected my perspective and concerns about patient-centred care — it seems appropriate, but the current theory doesn’t really explain how to achieve patient-centredness in physiotherapy practice.
Whose work has influenced your understanding of physiotherapy communication? Whose work would you recommend to others interested in learning more about this area?
For me, Eline Thornquist has written the most interesting and detailed descriptions of patient-physiotherapist interactions. Her writing emphasises communication as an integral component of practice and details the non-verbal bodily components of communication in physiotherapy. Ruth Parry has also made significant contributions to the area of communication in physiotherapy. In particular, her manuscripts provide insights regarding teaching communication in physiotherapy. I have also developed a friendship with, and respect for Veronika Schoeb who has a particular interest in goal setting, but is as passionate as I am about the need for knowledge in this area. I would certainly recommend reading any of their manuscripts for insights into the practice of physiotherapy interaction.
In your study you say that touch was used as communication, could you give more detail on how touch might be used in physiotherapy in this way?
When undertaking the observational component of my research exploring interaction in private practice, I sensed that touch was a powerful mode of communication between physiotherapist and patient. It became a significant focus of the research. I propose two main ways that touch is used as a communicative tool. The ‘clinical’ touch of assessment and treatment conveys physiotherapist competence. In the interviews undertaken as part of the research, patients highlighted the confidence they gained from the physiotherapist touching their painful, stiff or otherwise unhappy body part. The second type of touch conveys empathy, care and understanding. Physiotherapists innately use this type of touch in ways that provide reassurance and support to their patients. The ‘rub on the arm’ or ‘pat on the back’ are classic examples of this. Used with sincerity and meaning, this ‘caring’ type of touch is a powerful communicative medium.
What advice would you give to physiotherapists researching in this field?
My main advice and suggestion would be to use observation of one-on-one clinical interactions as a method. Interviews and focus groups are useful but are limited in that they only convey the patient or physiotherapist perspective of what occurs and why, rather than providing an understanding of what actually occurs in practice. I perceive that there is a distinct lack of empirical observational research about communication and interaction in physiotherapy so I encourage anyone interested to go for it!
What support do you think clinicians and students would benefit from when considering their communication with patients?
As with almost any aspect of practice, support in the form of education is the most obvious answer to this question. Support to achieve a reflective approach to practice and an ability to adjust one’s own communication with patients is also an important component.
For education, I think as a profession we first need more knowledge and theory about communication in physiotherapy to assist with our teaching. Second, we need appropriate forms of communication skills training embedded in physiotherapy curricula and added to professional development programs. In some countries, simulation training has been used successfully to practice communication skills in physiotherapy. Video recording and subsequent reflection about communication with patients is another common teaching tool for communication. It is my long-term dream to understand and acknowledge the importance of communication with our patients in physiotherapy practice.
Amy can be contacted at: firstname.lastname@example.org
For more of Amy’s work see her researchgate profile