How to be an expert in physiotherapy today

There was an interesting collaborative blogpost by Jarod Hall a few days ago.  Titled ‘Knowledge Bombs for a Successful Clinical Career’ it summarised a great collective effort by a number of experienced clinicians looking to summarise some of the key tenets of current clinical practice (link).

Some of the summary points were that good clinicians build therapeutic alliances and actively (‘truly’) listen to their clients; that clinicians are experts at the basics and should not take the blame for patients not getting better; and that education and exercise are key.

There are many things to like about this blogpost, not least the collaboration between colleagues and the earnest attempt to offer suggestions for how practitioners might improve.

I particularly liked how the piece provided an inverse, and perhaps unintended, critique of physiotherapy.  If physiotherapists were already masters of ‘truly listening to their clients’, for example, then surely this would not have even been mentioned by the participants.  So perhaps the list of recommendations could also be read as a list of critical comments on the profession at the moment?  (It needs stating that we need to truly listen, because we aren’t currently doing it enough).

As well as this inversion, I had a number of more substantive issues with the post.  The first was that the advice offered was rather non-specific and really could refer to any practitioner.  Indeed, much of what was suggested here has been written about in the work on the sociology of professions for more than half a century now.  Take the work of Elliot Friedson on medicine (and the subsequent development of narrative medicine and psychology that let to so much illness biography work since the 1990s), or Patricia Benner et al on nursing. And we should not forget the stellar contribution of people like Joy Higgs, who pioneered much of the work on the craft/tacit knowledge implicit in physiotherapy expertise.

Secondly, as far as I can see, only physical therapists were approached to offer comments.  It would have been nice to have seen some of the views of professional colleagues and clients who, I am sure, would have reinforced many of the comments here.

In many ways, the findings of this mini-survey were a simple form of qualitative research, so finally it would have been good to get a sense of the Jarod’s own positioning in presenting his findings.  Why were these quotes chosen and not others?  How did he arrive at the broad themes that emerged?  What is his own view?

From a meta critical perspective, it seems clear now that we are moving to a new era in physiotherapy, and texts like this provide an insight into some of the challenges ahead.  The once dominant manual, sports and musculoskeletal physiotherapies are rapidly being supplanted by therapies focused on more three-dimensional, embodied and complex practices that are well suited to clinical problems like chronic pain, which has become the syndrome of choice for a lot of therapists wanting to exercise their expertise.  How we talk about our work and our relationship with clients and other funders, then, will do much to define our practice in 2017 and beyond.