In the 5th of this series on the key principles of the biomedical model we look at reductionism, or the idea of dividing the body and health into systems and structures. So far we have covered specific aetiology, germ theory, Cartesian Dualism, objectivity and experimentation, and there are two more pieces in the biomedical jigsaw after this week’s look at one of the most important structural elements of healthcare practice. Early on in the history of medicine it was realised that the body and health were so complex that they would be better understood by being broken down into component parts. Ancient and pre-modern notions of health and the body had concentrated on broadly holistic … [Read more...] about What is the biomedical model #5
A couple of weeks ago, I posted the first of a series of short critical summaries of the biomedical model. The biomedical model is perhaps one of the most important theories underpinning physiotherapy, and yet it is rarely taught overtly in the physiotherapy curriculum. Clinicians don’t see it hiding behind their assessments and diagnoses. They don’t see it underpinning most of the treatments. And they don’t recognise it as a key driver of the kind of knowledge we accept to be true and false. So having a better understanding of how the biomedical model works would seem like a good idea. In the first post of the series, I briefly wrote about specific aetiology and the idea that one of … [Read more...] about What is the biomedical model #2
There has been a flurry of interest in the value of exercise as a therapeutic remedy in some sections of physiotherapy social media in recent months. Some of this, at least, appears to be a reaction to what have been called 'passive' treatments, and a neoliberally-inspired desire to see people take more responsibility for their future health and well-being. Exercise is clearly a very valid and appropriate intervention for some people. It has been for as long as human civilisation has walked erect, and it almost certainly will continue to be useful into the future. But a recent special edition of the journal Qualitative Research in Sport, Exercise and Health has cast doubt on some of … [Read more...] about Exercise is medicine
Last week, the National Institute for Health and Care Excellence (NICE) updated its advice on the use of autologous chondrocyte implantation for treating symptomatic articular cartilage defects of the knee (link). Perhaps amid all of the other newsworthy events of last week, this announcement passed you by? In reporting on the announcement, however, the CSP's statement said something interesting. It said; The treatment ... is used to help patients with an articular cartilage defect – or early arthritis in the knee – which tends to affect people in their 20s and 30s, often as result of a sporting injury. But the NICE guidance stresses that surgery should only be considered once … [Read more...] about Physiotherapy as process, not event
Not so long ago, physiotherapists had a very close, perhaps paternalistic, relationship with the medical profession. But it seems now that our quest for professional autonomy is pushing us further away from physicians and surgeons. There are few in the profession, I think, that would dispute the obvious benefits of greater independence for physiotherapists, but this is a critical ideas blog, so I'm going to do just that. Physiotherapy has, for much of its history, been wedded to medicine. Indeed, the modern physiotherapy profession only survived and later prospered because its founders made subservience to medicine a condition of entry. Memberhip of the Society of Trained Masseuses … [Read more...] about Doctor knows best
In this post, physical therapist Keith Waldron Jeffrey Bishop's article Rejecting Medical Humanism. In this article, published in 2007, Dr. Bishop writes eloquently of the metaphysics of medicine, referencing the works of Nietzsche, Foucault, Heidegger, and Deleuze, and how they relate to today’s biopsychosociologisms. He puts forth a compelling argument against the use of the humanities and narrative medicine as an add-on, or a compensation for the mechanisation of medicine. He writes of a continued dualism that no longer distinguishes the body from the mind, but instead focuses on the dichotomy between meanings and mechanisms. Dr. Bishop reflects on the ever-increasing emphasis … [Read more...] about Keith Waldron – Rejecting Medical Humanism – 30DoS #29
In a recent article by titled Listening-touch, Affect and the Crafting of Medical Bodies through Percussion, Anna Harris discusses the effect that technology has had on the loss of doctors' physical assessment and treatment skills. The article focuses on the technique of percussion - the 'listening touch' as she calls it, that comes from percussing the chest to perceive the density of underlying tissues. Here's the abstract for the paper, and here's a link to the paper itself: Abstract The growing abundance of medical technologies has led to laments over doctors’ sensory de-skilling, technologies viewed as replacing diagnosis based on sensory acumen. The technique of percussion has … [Read more...] about What skills are you losing?