Can you teach physiotherapists to be empathic?

There has been a lot of talk in recent years about the capabilities that health professionals will need in the future.

This is partly because the sheer economics of future healthcare will mean that other ways of delivering routine tasks – those that once required extensive training and expensively employed specialists to deliver them – will be given managed by smart machines, wearables, robotics and AI.

A friend of mine was saying the other day that she recently sat with her elderly mother in hospital for two weeks during a bout of illness, and during that time only two of the nurses actually took time to build a relationship with them.  The others just came in to do things to her: take her obs., give her meds, take her to the toilet, etc.  My friend – an experienced nurse of many years – bemoaned the lack of real nursing and saw very clearly how a machine could do many of the tasks the nurses now busied themselves with.

And it will happen, because you don’t need to train for 3 years to do routine tasks that someone – or some thing – far easier to train and employ can do.

But what persists in the literature is the sense that the main advantage we have over machines are the very things we already know we want most from our clinicians.  We want them to be caring and thoughtful, compassionate and accepting, to be able to listen and convey hope and confidence.

Some recent work done with colleagues in physiotherapy practice and management shows that words like resilience, cultural competence, initiative, collaboration, and empathy come up much more often than anatomical or physiological knowledge, technical skill or knowledge of research evidence.

Yuval Noah Harari – the author of Sapiens and latterly, 21 Lessons for the 21st Century – said recently that we have placed far too much emphasis on technical skills and should spend much more time developing critical thinking, communication, collaboration and creativity (link).

But one of the problems I have encountered consistently over the years as a physiotherapy educator, is that physiotherapists generally don’t believe these things can be taught and, perhaps because of that, have no skills themselves in teaching and stair-casing these things.

The argument goes that things like compassion are somehow absorbed by the person through experience – in the way that you lay down cortical bone under stress perhaps – and that teaching these things is impossible because they are subjective and can only be understood by the person experiencing them.

And so our curricula are filled with content that is more objective, measurable, more easily compartmentalized and reduced for easy testing.

But if these reductive skills are the ones most at risk from technological reformation, and our clients and colleagues are saying that the humanistic and relational skills are more important in practice than the technical competencies, are we not failing the profession if we don’t look for a solution?

I’ve recently seen a physiotherapy curriculum that tried for a decade to bring the humanities to the foreground.  But it has now reverted back to what it was before – with its siloed single subjects and technical rationalism.  This is mainly because the educators charged with collaboratively, critically and creatively couldn’t work out how to integrate the subjective and objective; the nature and the culture; and the body-as-machine into the world we live in.

This is a real shame, not least because it will leave a generation of future practitioners unprepared for the real world of work.

But more than that, it will give governments, health officials and funders more justification to replace us with machines and healthcare assistants.

It is no good for physiotherapists to claim that their work is relational, humanistic, person-centred, collaborative, critical, or creative if practitioners have to learn these things despite their curriculum rather than because of it.

As educators, we have to find a way to make biology work in service of culture, the anatomical body as secondary to the person, and the individual as servant of the community.  Because if we don’t, someone else will.

Here’s a nice brief example of designing learning resources with empathy.