The idea that people should take more personal responsibility for their health is nothing new. For more than 40 years now, we have been promoting the belief that self-care is obviously good and necessary, and that people should be less passive and less dependent. This view has been particularly prevalent in physiotherapy, where the shift away from so called 'passive' modalities has been accompanied by an equally powerful set of discourses pushing behaviour change and an activity-is-best agenda. We've written about some of the dangers of this approach elsewhere (Nicholls et al, 2018), but a recent paper published in the journal Sociology of Health and Illness adds weight to the belief … [Read more...] about A more complex view of patient self-management
I’ve just returned from the biennial NZSP conference held over the last two days in Auckland, and I find myself, once again, disheartened by some of the ideas my colleagues are promoting. Years ago, when I was a junior practitioners and an even more novice qualitative researcher, I would go to physiotherapy conferences hoping to hear the brightest and the best, speaking about cutting edge practice. But rarely did I hear anything about people as people, social theories, politics, disability rights, gender issues, etc. There was never even the slightest mention of anything qualitative to break up the dry diet of quantitative facts and figures. (Those were the days when physiotherapy was … [Read more...] about Exercising our demons
One of the biggest growth areas for physiotherapists in the coming years years will be the management of chronic illness. The numbers of people now living with conditions that were once relatively rare is quite staggering, and they are becoming more complex. A report released last week by the Australian Health Policy Collaboration (link) has once again highlighted the need for us to take a society-wide approach to managing the threats posed by conditions like heart disease, diabetes, cancer and respiratory illnesses, through a concerted effort to tackle the 'upstream' causes: alcohol consumption, sedentary behaviour, high salt intake, smoking, etc. Obesity, diabetes, hypertension and … [Read more...] about Do you need a four-year degree to tell someone to stop smoking and do more exercise?
One of the ways that physiotherapists have recently looked to secure greater influence in the health care system has been to take on role previously done by others. Extended scopes now include limited prescribing rights and some invasive procedures like injecting, cannulation and bronchoscopy. We now also have new consultancy, advisory and leadership roles that are changing the nature of our practice. And one of the most popular extensions that can be taken up by the whole profession has involved the drift towards public health medicine. Physiotherapists and others are looking at the possibility of offering 'wrap-around' care where once they were specialists in discrete areas of … [Read more...] about New: Encroachment
If you were to design a health care system from scratch, and began with the people you wanted to form key alliances with, who would you choose? Doctors, nurses, occupational therapists, podiatrists...? In the past, the choice might have been easy. Health care was strictly hierarchical and doctors were at the top of the pyramid. No health professional could become established without the patronage of the medical profession. But is that still true today? Health care consumers now have much greater choice when it comes to health providers and they are exercising their choice in innovative and interesting ways. Over-the-counter remedies, alternative and complementary therapies, … [Read more...] about New: Alliances
I start a week of teaching on the social determinants of health on Monday with our 1st year physiotherapy students. It's part of a course/module we run at AUT called 'Physiotherapy and Health Priorities' and it looks at applying public health principles to our practice. Social determinants aren't something that physios have spent a lot of time studying in the past, and it's a bit alarming to see how little research is out there that points to a role for the profession. We're not even driving the ambulance at the bottom of the cliff on this issue: we're the people who pick up the patients who have left the ambulance after its already crashed. Clearly this is not a wise or enviable … [Read more...] about Social determinants of health and physiotherapy