This post will discuss 4 different styles of physio and the conflict that exists between them. This tension sits within our profession as a whole, within our local clinics, between practitioners and quite honestly, I’ve felt it within myself for several years.
At it’s core, the distinction sits between philosophy and ideology.
Philosophy involves understanding the why behind an idea and looking at it from a pragmatic perspective.
Ideology on the other hand is about spreading beliefs and often indoctrination.
In the current social media driven world, there is far more ideology than philosophy. A great test is this: When challenged, fundamentally, are you willing to change your position?
Those that are able to change and adapt are likely the philosophers. Those that dig their heels in and stick to what they know, far more likely the ideologues.
Two sides to every coin: for every highly clinically driven evidence-based practice physio out there, there exists their exact opposite. Below we will delve into the ideologies of the Superhero and the Salesman.
I’m a big fan of the movie inception. The concept is fairly simple, deep, deep down in your brain, an idea or a thought may exist that very much defines your world view. This is a core belief.
The False Dichotomy
One fundamental idea that I think we collectively have great difficulty getting our proverbial heads around is that between a good clinician and a good commercial therapist. It seems that social media in particular has created a false dichotomy. This is what happens when ideas are stripped down to right vs wrong; good vs evil.
The ideology dictates that to be a good physio, one must always practice evidence based care to the highest ethical standards. Those who do are flying the flag for the profession and ensuring it’s longevity. Those that don’t do this are considered charlatans. Unfortunately, the downside is that some clients may not want this style of care, and this approach can potentially be unhelpful for these individuals.
On the opposite end, many business owners are faced with their own existential crisis. Ensuring financial viability of their clinics and the ability to pay their staff. They are often accused of being ‘too salesy’ or money driven. Usually an owner has gotten to their position by having great commercial therapy skills, often alongside clinical skills, but perhaps at times, out of balance.
Having worn both hats I have very much felt both of these challenges myself. I remember back in 2016 deciding that I wanted to see clients less frequently and aim for faster outcomes. Luckily, I had already established a large base of referring specialists and returning clients and this experiment really didn’t have a negative impact on my caseload. Conversely, in 2020 when clients dried up during the various lockdowns, I remember the fear of thinking my clinic would go under. Suddenly my drive was to ensure the remaining clients did in fact provide enough bread to go around.
The 4 Faces of Physios
On the below graph, I’ve created a matrix where these two ideologues sit in opposite quadrants. The clinically driven practitioner I have labelled as “the Superhero” and their alter ego, “the Salesman”. It is important to note that these are caricatures. The intention is to portray an idea, not to offend.
In the parallel quadrants we have “the Lost Soul” – struggling to find their purpose in the fiery world of good vs evil. And lastly, “the Gun”. For clarity, this definitely is not me or some lame attempt at self affirmation. I am no better than anyone reading this blog quite honestly and I’m sure my results are identical to yours.
However, I feel that this concept, “The Gun”, is the physio that we all strive to be. Walking the line between best practice and taking the best care of the person in front of us.
The Lost Soul
This is likely where the majority of physiotherapists new to private practice begin. We all start from zero when we graduate from university, and there are certain aspects of clinical practice that we may simply not be prepared for. How do you decide when to follow up a client, when you have never seen their injury before?
The internal conflict usually sits between what our expectations were coming in, vs the reality we face. Put another way, there is a big difference between what our university lecturers are teaching us, and what our local clinic owner wants us to do. Do I represent and do right by the profession, or do I succumb to my mentors requests.
Common behaviours:
- Block booking some clients eg. workcover BUT then sporadically reviewing others
- Doing a lot of talking and a lot of massaging
- An overall lack of cohesion between their management plans and their actual consults
- The caseload killing phrase “see how you go”
The lost soul is governed by a lack of consistency between clients. They have a fear of asking private clients to return as they may worry about the value they are delivering. As Paul Wright would say it’s like they have decided to be both the clients physiotherapist and their financial advisor.
The Superhero Physio
This is likely going to offend people, but as I’ve said already, this is a caricature and not based on anyone I actually know. If it’s you, I’m sorry. But there is a reality that needs to be faced here, that being a pure clinical physio, driven entirely by empirical evidence does not make you exceptional. In fact, it may mean that most of your clients get great treatment but perhaps, a number of them walk out the door disappointed and may very well go and see the chiro down the road that same afternoon.
Behaviours
- Giving too much in their consults
- Long periods between follow up appointments
- A predominant driver towards exercise based medicine
- An excellent grounding in evidence based practice
The Salesman
The salesman is the superhero’s archnemesis. They have confidence, swagger and the gift of the gab. They are often seen by others as being too money focussed and/or sleazy with their style.
Behaviours
- Giving too little in their consults
- Very short periods between follow up appointments
- A predominant driver towards manual therapy
- Exceptional sales and communication skills
The Gun Physio
Otherwise known as the Unicorn. This is the pinnacle of practice. A winner on all fronts, they are loved by their clients and by their boss. Other therapists aspire to be them and new clients are drawn to them like magnets. “The Gun” easily builds new working relationships, gets all their recalls done and has a full diary.
Behaviours
- They give enough in their consults, but still leave people wanting more
- Appropriately spaced consults based on individualised treatment approaches
- A balance between manual therapy and exercise
- Both communication, sales and marketing skills as well as a good handle on evidence informed practice.
This final caricature is really an aspiration. Once again, I wouldn’t suggest for a minute that it was me, or anyone I know to be quite frank. Every physiotherapist has their strengths and weaknesses, we are all unique in our own styles and personalities. The Gun Physio to me represents an infinite goal.
If I want to be the best physiotherapist I can be, it starts by becoming more than just another physio. It involves years of commitment, both financial investment and a wealth of hours of learning and practice. And the goalposts continue to move. As new research comes out one needs to learn and adapt.
It is truly the infinite game and one that I would encourage everyone to play.
