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Hello from an Australian Physio

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  • Hello from an Australian Physio

    Hi everyone.

    I'm Max, an Australian PT in my first year of practice. I introduced myself as a student here a couple of years ago, and have lurked occasionally since, but now I feel I will be more regular on the forum.

    A little bit more about me, if you're interested. I hope it's okay to read, and if you take offence to what I've written, I'd love to discuss.

    Throughout my degree, partly as a result of reading this website, I became quite sceptical of aspects of the profession. This influenced my university experience. Some of my close friends were also very sceptical, and several of us are quite unsure if there is a place for us in the profession. In fact, someone close to me left the profession for another career. Unfortunately, I feel my first year of work is a 'trial', to see if I am suited to physio.

    I'm currently working in a rural area, in a varied private role. A large proportion of the work is MSK. Outside work I listen to physio podcasts, look at what is happening on social media, and so on. At the moment, I find the work frustrating. I feel I am just starting out, at a time when much of what was done in the profession is essentially set to be discarded. I find the 'woo' that is embedded in the medical industry, allied health, and patients' beliefs, very draining. I have a strong desire to be help others in my career, and I'm uncertain if I am doing that in physio.

    If anyone has advice for me, I would appreciate it.

  • #2
    Welcome Max!

    As another rural PT in Oz, it's good to see you here and posting. I'm a little further along the career timeline than yourself, but not by much.

    I can honestly say I have been where you are. I came quite close to leaving the profession (and still end up there from time to time).I found the disillusionment I felt was the first step to looking broader and finding places like SS, which have helped both to highlight my lack of knowledge, but also give hope for finding a solid base from where I can formulate my own reasoning and understanding. I've worked in a number of settings here and overseas, some experiences good and bad, but they all help to shape how I view things.

    Finding your place can be hard, particularly when you see thing all around you which make you question it. We tend to be quite self-reflective in our profession, which I think is good for the ongoing improvement of what we do, but it can also be draining, as you've said. Part of me feels the rural setting, can lend itself to a bit more flexibility to formulate your practices, but every setting it a bit different. I have a lot of autonomy where I work, so that helps.

    Feel free to send me a message whenever you'd like, and if I can be of help or support, I will. Otherwise be as involved as you can on here, I sometimes find the questioning of everything we do can be confronting at times, but necessary to evolve.
    Ben

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    • #3
      Thanks Benno, what an interesting response. I will send you a message.

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      • #4
        Hi Max, You're welcome.
        Simplicity is the ultimate sophistication. L VINCI
        We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

        Everything should be made as simple as possible, but not a bit simpler.
        If you can't explain it simply, you don't understand it well enough. Albert Einstein
        bernard

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        • #5
          Welcome aboard, Max.

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          • #6
            Originally posted by Max View Post
            1-- I feel I am just starting out, at a time when much of what was done in the profession is essentially set to be discarded.
            2-- I find the 'woo' that is embedded in the medical industry, allied health, and patients' beliefs, very draining.
            3-- I have a strong desire to be help others in my career, and I'm uncertain if I am doing that in physio.
            1-- It won't necessarily be discarded. It's just that universities have created a 4 year degree course when it could easily be taught as a 1-2 year apprenticeship, with no deterioration in outcomes or safety. Think about the situation of your own aches and pains, if you've ever had any. It feels nice to be in the presence of someone with a good warm vibe who moves you around. That won't ever go out of fashion. But be prepared for an Uber-style disruption. Anyone can do it.

            2-- When you say woo, you mean psychology, right? Get used to it. The brain is by far the most important player in pain.

            3-- A strong desire to help is likely to be detrimental for both yourself and the patient. It's a long post to explain why this is the case. Can explain if you really want.

            What about getting into banking or law? Better money.

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            • #7
              Hi EG.

              If you would like to explain how a desire to help people will be detrimental to myself and the patient, I would be interested.

              With 'woo' I'm referring to misleading or misinformed information or influences, etcetera.

              I'm unsure if you are being straight forward about banking or law.

              cheers

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              • #8
                Originally posted by Max View Post
                Hi EG.

                If you would like to explain how a desire to help people will be detrimental to myself and the patient, I would be interested.

                With 'woo' I'm referring to misleading or misinformed information or influences, etcetera.

                I'm unsure if you are being straight forward about banking or law.

                cheers
                It's impossible have a desire for anything without a simultaneous negative judgment of its opposite. If I desire warm weather, I will judge cold weather as bad. People don't like to have their pain judged as 'bad' or 'unwanted' or 'problematic'. If you do that (through your desire to improve things), you can inadvertently create an aversive attitude in the room... and an aversive or goal-oriented attitude can lead to pain becoming 'sticky'. So the pain doesn't leave the body as it would otherwise naturally. The idea is to view pain as good/natural/healthy/important, and relinquish the desire to fix it. You help by giving up the desire to help - quite paradoxical. I'm referring to the attitude more so than what you do physically, but the attitude will also come across in your physical handling. A common error is to use forceful spinal mobilizations on a stiff spine.

                Academics can be very out of step with what it means to be a clinician. I guess they do their best but as a new grad you can already see how you wasted fair bit of time and effort getting a degree, when a lot of the material and skills are questionable.

                The law/banking comment was just to see if you maybe wanted a job which was more in line with the attitude of achievement. An achieving attitude won't work in a chronic pain clinic, because the moment you run up against resistance, you'll start blaming yourself or the patient. However I have seen an achieving attitude work in a sports physio clinics. Maybe that would suit?






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                • #9
                  Hi EG.

                  Interesting point about helping the patient, and judging pain. I understand exactly what you mean, and I have thought around that before. I think what you say there is a bit of a generalisation- I find patients vary a lot in how much they themsleves have judged their pain, and how much they want it judged by me. Some become confrontational or withdrawn when I attempt to de-catastrophise (in a way not judging, accepting) their pain. When I work with rugby, as a volunteer, a lot of players dont want me to judge, just like you say-'she'll be right' and I just stay out of the way as they smash through their injury and back to play. Sometimes with a work cover patient, they seek validation and condemnation of their pain state, as they feel ignored by the employer. And so on.

                  With regard to 'helping people', I meant in more broad terms, a desire to be altruistic in general, not specific to physiotherapy or pain.

                  The attitude of achievement is probably a factor for me, as most people, but more important (I hope) is doing good for others. I don't find I blame myself or the patient really. I'm uncertain if sports is for me, because in that case I would work with quite a well, population, in a well supplied, desirable role. I do find sport, and being around sport, enjoyable. I also believe that some health work done around sport is really great and because it filters down to help people more generally.


                  Last edited by Max; 07-08-2017, 01:29 PM.

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                  • #10
                    Welcome Max.
                    Yes, universities do well in teaching the sciences of the body, but are woefully short on teaching communication skills, wide neurosciences, or specific pain curriculi , yet overdose you on "treatment techniques" with little to no solid support.
                    The "woo" is strong in many profesions, and ours is no different.

                    Your assessment skills for red and yellow flags, some manual treatment skills and exercises, and your attention to biomechanics are not wasted; they can still offer you a lot in this profession, but their explanation and their role has to be re-assessed and adapted. By you.

                    All the best!
                    We don't see things as they are, we see things as WE are - Anais Nin

                    I suppose it's easier to believe something than it is to understand it.
                    Cmdr. Chris Hadfield on rise of poor / pseudo science

                    Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

                    We don't need a body to feel a body. Ronald Melzack

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                    • #11
                      Welcome,Max. I didn't have doubts about my profession when I started (at Uni of Queensland) but that was along time ago and I did not feel happy choosing physio but was not really interested in anything else so I thought it could be interesting.
                      I graduated but after 10 months I abdicated and became a research technician at Uni of Q. I then left the profession and enjoyed my time there.
                      When I decided after 2 years that the profession becoming more scientific in its teaching, I returned and became interested in Neuroscience; and spent many years enjoying the challenge of TBIs and strokes.
                      So hang in there and listen to what your brain is telling you. It could be paediatrics, outpatients, Rehab dept, Cancer wards. Acute work.
                      Give yourself a bit of time to ponder possibilities. I agree with Bas; and his principles. Listen to your patient's story and go with your instincts. what you are really interested in - go with that.

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                      • #12
                        Thanks everyone.

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