An open letter to the therapy industry, by Mike Grice - The Endurance Physio
What a rollercoaster the last few months have been not only for the world, but for all of us within the Therapy world.
We have all experienced and endured our own unique circumstances and will have no doubt reflected on it based on these individual situations.
One thing that I have been very aware of is time. How the speed of life has allowed me to have more time in some areas of my life, much less in others. and how it has allowed me to think deeply about the bigger picture of the therapy landscape, beyond that of the day to day life of being a therapist.
It’s taken me this long to really organise those thoughts, but I hope that this piece can resonate with you and hopefully stimulate further debate or conversation within the industry.
The Therapy world has long been a fantastic advocate for building resilience in our patients and clients and boy have we had to show our own resilience!
I think it’s really important to take stock and congratulate ourselves and each other on how we have in general, rolled our sleeves up and adapted to these circumstances in a proactive and dynamic manner.
The therapy world is also certainly used to handling situations where change is both encouraged, welcomed, and also resisted.
Recent years have seen us battle, challenge, and reform our thinking, when it comes to some of the traditional ways we treat.
The patho-anatomical and passive model of care that potentially creates dependency, a model that saw us as fixers of ailments and healers of injury has certainly been challenged.
The concept of us being mythical beasts that could source, identify, and manipulate everything that we could possibly think of in order to restore health and well-being is constantly questioned from within and from those we treat.
Our recent journey, although still fraught with division and animosity, has seen us evolve somewhat.
We have developed a way in which many techniques and treatments are now aligned within a modern thought process, one that prioritises patient engagement, self-management, empowerment, education, and reassurance.
This when coupled with an element of "hands on" or the traditional perception of care, but delivered within a narrative that fits comfortably into modern thinking, alongside ongoing improvements in exercise prescription and self-management rehab seems to be the most powerful approach to modern therapeutic care.
Now, we certainly weren’t at the end of this journey, and we certainly weren’t perfect, but no matter how slowly the therapy steam ship was turning and changing its course, we were starting to make a change and were setting sail in the right direction.
Then the pandemic came….
So, what has this done for us?
Well for many it will have confirmed some of the thoughts and thinking they already had when challenging the traditional concepts of care.
It’s been reassuring for some to be able to stand back and treat at a distance using education, reassurance, empathy, active listening, attentiveness, exercise, therapeutic alliance and be able to facilitate and guide patients towards self-care.
For others, this approach has proved remarkably difficult and testing. Of course, there are no right or wrong answers on this.
"Telehealth" or digital care has been adopted or expanded from its previous involvement across the therapy world to varying degrees, again receiving mixed feedback from therapist and patient alike.
For some, it has been a tremendously difficult time. A fundamental struggle to engage patients from a distance. A time where they may feel isolated, segregated, handcuffed and unable to perform or deliver care in the way they want or feel they can.
And of course, many of us have struggled to source and identify avenues of financial support and help and this has left the majority of us worrying about simply keeping our businesses alive.
I guess that each therapist and patients’ experiences fall somewhere along a spectrum based on their beliefs, values, training, current practises, and previous experiences.
What recent weeks have enabled me to do is to take a 10,000-foot view and spend some time considering what the long-term impact of COVID-19 may be on the therapy world.
What will happen as the clouds lift and we continue to return to practise?.
Will the therapists who have struggled with online clinics etc double down on getting people through the doors to “fix” them?.
Will they seek to apply passive care and resurrect their identity and confidence at all costs?.
Will they seek to build their credibility even higher that they are indeed the fixers that the patient cannot improve without?.
Will the now touted “outdated narrative” of fixers and healers rather than facilitators be exaggerated even further?.
Will Therapists need to scratch the itch that may have become even more irritating during lock down as people message seeking care and they have felt unable to deliver remotely?.
Will the need to pay bills and help the business survive affect the way we run our business?.
Will the public react differently to therapy?.
Will they seek to be fixed, to be cared for, to be reliant on a therapist?.
Will the flood gates open and will we regress the recent progress?.
Will there be a desperate urgency to be healed?.
Will people who quite rightly benefited from government and social support for prolonged periods in so many ways now suffer from a sense of dependency on others in the long term?.
Will the population identify with all the things modern care is trying to promote?.
Will their recognition of the power of self-management be enhanced?.
Will this mean they seek to be autonomous keepers of their own health and wellbeing more than ever before?, and will we see a new boom in health and fitness that may present a different spectrum of injuries and ailments for us to help?.
Will we see an uptake in the understanding that we are there to help, but from an arm’s length predominantly?.
Will they see us as a pastoral type carer who can be utilised as needed at different times in different ways throughout their lives?.
Will it be a case that if the right person finds the right therapist then all will be ok? and if not, we could have the perfect storm? But isn’t this what happens now anyway?.
How will the public and private sector react?.
Will health insurers further embrace and fund telehealth or will they want to incentivise people coming through the door more than ever?.
How much will the NHS maintain or expand online services and which areas of MSK or healthcare at large, be funded or prioritised for this?.
It must of course be noted that this is not an attempt to raise the hands-on v hands off debate in another guise. There are many in the industry who have built reputations on trying to be divisive and that certainly not something I’m interested in doing.
Many modern therapists provide first class care predominantly through the medium of hands on treatment, such as our Sports Massage and Soft Tissue colleagues.
There is an absolutely appropriate place for this in modern MSK care that we should embrace.
But we need to consider whether or not we see a backward step in the narrative that supports it, the delivery of it and the potential to provide over necessary care in all facets of the industry whether due to patient demand or our need to re-establish our identity and business standing.
COVID has seen unprecedented and much applauded improvements in the communications and inter profession alliances between professional associations that have held long, divisive relationships.
Associations that in truth, were a million miles apart pre-COVID.
Maybe most importantly, will this united approach seen by a number of professional associations during this period continue? and will this lead to a long-term unification of the fractured industry? - I truly hope so.
The list of questions goes on.... I guess we simply don’t know at this stage, people will need to do what they feel is right for them, their families, and their business.
They will need to manage their reputations in whatever way they feel appropriate, rightly, or wrongly in the short term and only when the dust settles will the long-term impact be revealed.
Will it make no difference at all and we have simply paused for 6-9 months or longer?.
I guess it will fundamentally change some people and their practise, others will have some aspect of change and some, none.
What has been exceptional to witness is the innovation and passion shown by so many of us to diversify and adapt.
Learning and continued professional development has been a great way to illustrate this. Virtual conferences, webinars, live Q and A’s and the many other ways we have communicated and adapted have shown us there are many ways that aren’t the traditional ways for us to develop ourselves, our businesses, careers and skills.
Many have used the opportunity to change things that they may have long wanted to but were nervous of, or unable to due to busy work commitments.
Electronic solutions, going paperless via automated emails, online booking, and payments, or just giving the clinic a coat of paint may have revolutionised the way some of us work.
For now, I urge people to simply think of the future, be mindful of a potential impact on our futures, accept all opinions and viewpoints and potentially we should start to think about gathering collective thoughts as we move forward, hopefully as a unified industry.
These are just the thoughts of a therapist, a therapist who is fortunate enough to have a job that allows him to interact daily with many many therapists across all the professions and to spend time contemplating.
A philosophical old therapist that has listened to many stories of life as a therapist during COVID-19.
Please do continue to treat and work as you see fit during these tough times, none of us know each other’s individual unique circumstances, and it is unfair to judge those who shoes we have not walked in.
Once again, congratulations on your / our ability to put the patient first always, and being able to pivot and shift to find a way to do what it is we love to do the most - simply help the person in front of us.
It’s with a heavy heart we read that Therapy Expo isn’t going to be the experience and opportunity that we all love and enjoy so much in 2020.
It’s certainly one of the highlights of my calendar each year and I’ll miss it, and the opportunity to meet so many of my colleagues old and new in person.
Please do stay safe, stay well, and look out for those you hold dearly.
See you on the other side, thanks for taking the time to read, and hopefully we can all catch up again in 2021.
Yours in therapy.