A recent short paper in the journal Sociology of Health & Illnesshas offered some important insights into overdiagnosis and overtreatment (Armstrong, 2021). For some years now, health service managers have argued that there is ‘too much medicine’ in healthcare, and have used the language of cost containment and ‘Choosing wisely’ to increase professional accountability. But health professionals have themselves been concerned with too much reliance on expert advice, and have criticised other competing professions for encouraging patients’ dependence on the therapist for the cure (Traeger et al., 2017; Baldwin et al., 2015; Copnell, 2018). What’s really interesting about the … [Read more...] about Doing too much
What’s the point?
Last Saturday, I saw one of the most anarchic, joyful, and truly pointless things I think I’ve ever seen, and it made me think a lot about how we fixate on doing meaningful things in practice. One of my doctoral students is a child psychotherapist. A guy in his early 50s, he grew up listening to bands like Crass in the era of political, hard core punk in the UK (this kind of thing, for instance). He’s been a drummer for years, but isn't formally trained. He has this belief that anyone can play music, or at least make a pretty unruly noise, and you shouldn’t have to be trained musician to be able to express yourself through sound. His latest project is a collaboration with two other … [Read more...] about What’s the point?
Borderland practices*
Borders and boundaries seem to have taken on extra importance over the last few months, especially since COVID appears to be entirely indifferent to national borders, and its existence relies on its ability to move freely between us. We’ve spent the summer in New Zealand thanking our lucky stars that we live a long way away in the bottom corner of the South Pacific, and the ability to close our borders has meant life has relatively normal. People can hug and move freely, gather in groups, and care for loved ones. Because of our accident of geography, we’ve been incredibly lucky to have so far dodged the COVID bullet. But even here there are people who object to the government … [Read more...] about Borderland practices*
Is all movement ‘good’ movement?
How do you judge if one movement is good and another bad? Many claim that movement is the core of physiotherapy 1, 2, 3. But how far is the profession prepared to go to justify its claim to be experts in movement? Presumably, no-one would dispute that the improved diffusion of oxygen through the pulmonary interstitial space of a COVID-19 sufferer is good. And we can celebrate those that made that possible. But what about the movement of air in a black man’s throat, or the movement of the knee of the police officer that killed him? What about the lack of movement of the people who stood around and watched him die? Is the movement of a thousand protesters good movement, even … [Read more...] about Is all movement ‘good’ movement?
Is COVID showing us the future for physiotherapy?
There are two ways you can read the latest promotional campaign from the Canadian Physiotherapy Association, that states that physiotherapists’ work takes them ‘from treating patients to moving people’. The first is that physiotherapy spans hospital and home. The other is that the very nature of physiotherapy is changing. COVID-19 is undoubtedgly reshaping the contours of physiotherapy like other cataclysmic events before. But there are some important differences that we should be aware of. World War I and the polio epidemics that ran until the 1960s produced enormous numbers of casualties needing physical rehabilitation, but there had been wars and epidemics before. What was different … [Read more...] about Is COVID showing us the future for physiotherapy?
Looking back on the biopsychosocial model
In the 2nd in this series of occasional posts looking back on the last six years of CPN blogposts we return to the thorny issue of the biopsychosocial model. Thorny because the BPS remains a touchstone for physiotherapists who claim to offer a more holistic therapy. All of these posts take a different view. Hopefully you'll still find returning to these arguments challenging and inspiring. The first post comes from October 2016 and asked whether the biopsychosocial model was all it was cracked up to be. The post focused on the claims of the BPS model to be holistic and pondered ' how the model has saturated people's thinking at the exclusion of other ways of being 'holistic'.This post … [Read more...] about Looking back on the biopsychosocial model
Physiotherapy in a time of pandemic – an addendum
Earlier this week I wrote a post on the history of physiotherapy in times of pandemic for the history.physio site (link here). I've been thinking a lot about this recently and wanted to add a couple of more philosophical reflections that I hoped might be therapeutic for readers. The first thought ties in nicely with the history piece, and it is that we should remember that for almost the entire span of human history, humans have lived with the threat of illness and death, and it is only in the last half-century that some have enjoyed stable economies and secure employment, access to immediate, low-cost, advanced healthcare, good food and safe living conditions. I say 'some' because, … [Read more...] about Physiotherapy in a time of pandemic – an addendum