I spent the last two weeks in Norway and Denmark, meeting clinicians, lecturers, researchers and students, and generally talking about The End of the Physiotherapy.
I spent quite a bit of time talking about the ways physiotherapy might transform itself to adapt to the future, and one of the ideas we kept coming back to was the importance of ‘leaving’ the profession. I wrote a little about this idea in a blog post just before I set out for Scandinavia, and the subject kept recurring during my visit.
The biggest issue for many people seemed to be not so much the need to change, as much as how to change: how to find new ways of thinking and practicing physiotherapy that kept the best of the old and new, given that our toolbox for change contains very few saws and only one very old hammer.
At a study day with educators and clinicians at the beautiful University College Absalon in Roskilde, I talked about the idea that we cannot be innovative as a profession if we only use the concepts and ideas that are already part of physiotherapy, and that our best chance is to firstly recognise what these are, then deliberately subvert them.
So this means actively and deliberately not thinking biomedically; resisting the urge to think about diagnosis, objective assessment and treatment plans; not normalising or pathologizing; putting aside the body-as-machine and reductive ways of thinking about posture, movement, function and rehab; etc.
Then the task would be to find new ways of thinking.
In society, the people who generally come up with innovative new ways of thinking and doing are creative types like designers, architects, artists and musicians. So perhaps one way to think transformatively about future physiotherapy might be to try to learn to think the way they think?
I gave an example from the brilliant book Art as Therapy by Alain de Botton and John Armstrong, where they’ve taken some very common human emotions and explained how art, rather than psychology or medicine, can help.
In the section on sadness they show an image of a piece of sculpture by Richard Sierra titled Fernando Pessoa, about the life of the Portuguese writer and philosopher.
The sculpture is of a 9m x 3m wall of weathered steel that sits in the middle of the gallery space. If you stand really close to it, it feels overwhelming. You can’t see its edges, it blocks out the light, and it feels as if you’re completely enveloped by it. Stand further back, though, and you see that it’s not insurmountable at all, but with a bit of effort, you could make your way over or around it. It looks black on the image, but in reality its a kaleidoscope of textures and colours. Stand at the end and it looks like the letter ‘I’.
A sculptor will tackle a subject like sadness with metaphors and allusions, using carefully chosen materials and spaces to make us think differently.
Interestingly, when we talked about this image in Roskilde, the physios came alive and lots of people had ideas about what the sculpture meant for them and how it related to sadness. Big and oppressive though it was, they said, the fact you could get around the big dark wall suggested that the sculptor was offering hope and encouragement to us. The size and sheer heft of the sculpture also reflected what for many was the physical embodiment of deep sadness.
Learning to think in these new ways won’t, in itself, be the ‘answer’ to the questions posed by The End of Physiotherapy, but the idea discussed last week was that thinking in ways that were familiar to us would almost certainly result in poor outcomes in the future. So what choice did we really have?
Sometimes it can feel like the barriers we face in our day-to-day work are like a heavy dark wall. Perhaps stepping out of our familiar ways of thinking offers ways to change the narrative and open space for radical new ways for the profession to grow?