Given the unrelenting pressures to reform, cut costs, and redesign practice, it’s hard to know whether to push the profession’s stability, history and established culture, or to promote a radical new professional image.
And faced with healthcare innovations that seem to be dissolving old certainties, it’s hard to know whether we like it or not.
Imagine, for instance, that robots were shown to be more reliable manipulators than physios, or that a low-cost assistant could do the work of post-op respiratory physiotherapy just as well as an expensively trained clinician. Would we promote it?
In some instances, like this recent trial by a ‘short-stay rehab unit based at a Nottingham care home’ that ‘managed to cut 90-day hospital readmission rates to just five per cent’, it would seem a relatively easy choice. Of course its good that patients spend less time in hospital! But maybe the decision is made easier by the fact that it promotes the idea that more physiotherapy is a good thing. It argues that physiotherapy is a worthy and necessary thing to have and that service improvements came because of the specific physiotherapy intervention, not despite it.
We have a much harder time supporting interventions that replace physiotherapy, however. Even when they do things better. In this respect physiotherapy is just as ‘political’ as any other vested interest, and it is far from objective. Most people who have invested time and passion into becoming a physiotherapist will work hard to perpetuate what they’ve established. But is this necessarily in the interests of our patients, or the health service at large?
Evidence-based practice has been a powerful way for physiotherapists to try and demonstrate that what they do matters, but ironically, there is little evidence that EBP itself is making any difference to the perceptions of our patients, our peers or our funders.
Perhaps the answer is to see the difference between the objectivity needed to make the right clinical decisions, and the totally biased, passionately subjective, deeply invested conviction that what physiotherapists do matters and is worth fighting for?
The fundamental question seems to me to be this: if it were in the best interests of patients or the healthcare system as a whole, for us to disestablish physiotherapists, would we do it?
This, as much as anything else in current debates surrounding the profession, seems to me to be the biggest dilemma facing the physiotherapy profession today.