Tom Walker is one of the oft-discussed-seldom-heard breed of Physio known in #TheBigRs circles as ‘The-Full-Time-Job-In-Band-6’. He’s also one of the most insightful and determined Physios we know. He kindly reflected on two conversations he had at #TheBigRs 2.0 in Birmingham. Cause for concern… but simmers of hope are a’flickerin…
When Jack asked for feedback and thoughts on the second Big R’s event, I confess I went blank for a moment. Where to start? I had sat and listened to many impressive people, who talked compelling and convincingly on the need to consider the direction in which our profession is travelling, and how we may perhaps open a wider dialogue on how we might serve our patients and (dare I say it) society best, but also how we can demonstrate our worth as profession.
I think other blogs and formats have covered those speakers better than I can, but more than that, I was also drawn back most strongly to two conversations that I had during the day. These were the conversations which I found myself discussing first when colleges asked me afterwards what the event was like and about.
The first of these was with Adrian. If you haven’t heard his story, I suggest you check out the Physio Matters podcast here. By chance, I sat down at the same table as Adrian at lunch, and when I asked him what he did, I was expecting the usual stock answer of physio/researcher/blah blah blah. When he said he was here as a patient, I paused for a moment. Then, (and I apologize to Adrian and to the other folk sat at the table for this) I got a bit over-excited and started to fire questions at him as it occurred to me what an amazing opportunity it was. And, the more I think about it, the more it makes me realize how absent the patient voice is. I have never had the chance to sit down on an equal footing with a patient and discuss their experiences, their thoughts, their beliefs. And that’s not right. Sure, on a daily basis in clinic I ask questions that I hope might give an inkling into these processes, but often I feel that the situation, social niceties and the power imbalance of the situation all have an impact on the responses. Hence, I never truly know what the patient is thinking. I can’t see how we can possibly work towards what I hope is a shared goal of improved patient understanding and empowerment without that voice. So, a massive thanks to Adrian for attending and for a brief bit of his time, to Jack for inviting him and here’s to an ever-greater voice for the patient, the centre of the what we’re about. I believe Adrian (and Joletta Belton) are speaking at the conference in October – go listen to them.
The second conversation happened with someone who I won’t name, for reasons that will become obvious. We talked about some of their recent studies, and we got on to the topic of models of back pain (as you do in the pub #tragic). Like myself (10 years ago) they had been taught a model of flexion being a mechanism for causing disc prolapse and extension as a possible mechanism of relocation. Only, they had been taught it pretty recently. Now, the subject of spinal flexion is well beyond what I want to discuss here (I suggest you have a look at Greg Lehman’s blog here) but suffice to say I’m broadly in the ‘flex away, although I’d probably observe traditional form if lifting heavy weights’ camp. Now, I think there’s a real issue with telling folk that bending has prolapsed their disc, ‘cause it turns out spinal flexion is actually really useful. I can use it to put on pants, look at interesting growth-s on my feet, curl up in the foetal position whilst my four-year old son attacks me with cardboard tubes (don’t ask), you name it. I flex my spine many, many times a day, and I reckon you probably do to. So, I’m pretty concerned about a model that tells you not to do that, unless there’s very strong evidence not to. And I’m even more concerned that this is what the bright young physios of the future are getting taught.
I spoke to a patient today, who had twenty minutes of ‘heat lamp’ as part of their treatment for what is a complex persistent shoulder pain. She told me how angry that made her, and what a waste of time it was. That’s not part of physio as I see it- it’s the epitome of low-value. Part of this journey of change (you might think that the profession is fine as it is, and whilst I disagree, I certainly respect your right to your view- this is all about a dialogue) has to start with those enthusiastic young souls who are entering the profession- and their training has to reflect the current evidence. Clearly, some universities are doing a fantastic job of this, but clearly some- not so much.
I think the Big R’s recognizes that the challenges our profession faces are wide and varied, and I’ve discussed but two of them- but I reckon they’re pretty important ones all the same. And if the whole Big R’s thing seems like some sort of self-appointed back-slapathon, fair enough- get your voice heard- it’s what it’s about. Tickets for October’s conference are available here