The situation can be ridiculous.
Too often, patients are stuck with a web-search to find their therapist. Who is nearby? Who is convenient? Sometimes, in the event that their complaint is acute and non-complex, the most convenient and closest therapist will do just fine. Often, if the patient is lucky, their needs are fulfilled in the short-term, and that is all they were looking for. They run a quick search, look at a few pictures, sometimes read a brief bio, swipe left, swipe right…go to their physio for a quickie: a brief 20-minute eval, a bit of manual therapy and a paper with some exercises on it. “See Joanne at the desk before you leave, she will schedule you next week [at the same time as 2 other patients] for a follow-up visit.”
Meanwhile, all too often, therapists are holding themselves to a ridiculous (and false) ideal. Rest assured, no one is getting all their patients better in a week, and if most of their patients are not coming back for the 3rd or 4th visit, it is because they are dissatisfied, not because the therapist is a miracle worker. Still physios focus on (and remember) their successes. Their web page shows the best and brightest pictures of themselves and their clinic. They write a little bio including where they went to school, what their professional interests are, and a few personal notes (e.g. their hobbies or favorite sports teams) to seem relatable. They mention their many success stories and offer testimonials. They try every way they know how to entice the next potential patient/client to swipe right.
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On a rare occasion, I may say or do something really stupid – it doesn’t necessarily put my relationship with my wife in an endangered state, but these occasions sometimes lead me to take pause and wonder what it would be like to be “out there” as a 40-something among all the other singles looking for what might make them (and me) happy. The premise seems less-than-promising.
I am not at all good at small talk. I don’t give a shit about the weather or what someone else’s kids are doing. Seriously, there is a whole bunch of stuff that my own kids do that I don’t care about – I don’t have the resources to feign interest in the mundane mindless bullshit of social convention. Say something interesting or don’t say anything at all. Can’t you just imagine how much fun it might be to hang with me at the local watering-hole?
Speed dating sounds good if for no other reason than neither party has to fabricate an artificial and polite way of ending an otherwise tedious conversation after I tell an unlikely suitor that my interests include philosophy, neuroscience, photography, professional cycling, and progressive rock music.
Of course, there is online dating as well. I could take my pick of virtual matchmakers – or I could just fly by the seat of my pants, cross my fingers, and log onto Tinder. What could possibly go wrong?
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Yesterday afternoon, my wife and I arranged for some “us time” later the same evening. My (very romantic) proposition went something like this: “Any interest in a quickie now, or (perhaps) something a bit more substantive later?” That’s right, I am Don-Fucking-Juan – be very jealous (or weep for her…whichever feels most appropriate).
So, she leaves in the early evening to go to a friend’s house to hang out with a bunch of girlfriends, drink wine, and color (you know, the adult coloring books that are inexplicably popular at the moment). I have no clue as to how this sounds like an appealing night to her, but she is more social than I and has far more friends than I do, so maybe the problem (in this instance) is mine, not hers. Anyway, I get the house tidy and the kids bathed/put to bed right on schedule at 8:30. Her friend – who wasn’t planning on staying long – drove her, so I was expecting her back at around 9:00.
Of course, 9:00 rolled around and she hadn’t returned home. 9:30 came and went…still…she wasn’t home. At 10:00, I found myself thinking, “At least there are some good basketball games on.” Then, at 10:32, the dog started barking and the garage door opened a few seconds later.
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This morning, I woke up considering the importance of context.
Sometimes it is best to go fast; other times it is better to go slow. Sometimes it is a good idea to talk; other times to shut the hell up. Sometimes a tender touch is needed; other times something more firm. The environment is incredibly important: the same act can be performed in a bed, on the living room couch, in the shower, over a kitchen counter, or on a park bench – each has the potential for a different result. The time and stress of the day has an impact. Did your favorite Pandora R&B Grooves channel just get loudly interrupted by an advert for a local used-car dealership? Sometimes these factors matter; other times they aren’t factors at all. The resulting confluence of all these variables will, inevitably be unpredictable.
This is what I tell myself…
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“The world would be a better place if people would just accept that there’s nothing new under the sun, and everything you can do with a person has probably been done long before you got there.” – Hooper
The PT blogosphere is full of folks who are willing to share their thoughts on the best way to do our job as physios. There are a countless number of blogs and courses that hope to teach us a variety of techniques, featuring gurus who demonstrate enticing (short-term) results; they want to teach us how we can do the same. We too can learn their overly complicated system of assessment and interventions and begin to implement what we learned on our first day back to work!
Of course, this is similar to looking to the tabloids at the grocery counter for sex advice, or comparing oneself to a porn-star to see if you are doing it right. NEWS FLASH: Cosmopolitan magazine hasn’t discovered “21 mind-blowing sex moves you’ve never tried before”, a guy need not have an 8-inch penis to satisfy his lover, a woman need not pleasure her freshly-waxed-self with (painfully) long-manicured nails to turn a guy on, and a small-town PT in Wichita didn’t just miraculously construct a new science-based system of care from his/her unique experiences and views of the human body, which (by the way) has already been studied with ridiculous detail for thousands of years prior.
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Our patients deserve better than what much of the physiotherapy profession has to offer. They deserve someone who is willing to listen to them, establish a relationship, and provide authentic, personalized, one-on-one care. They deserve to receive that care in an environment where therapists appreciate that context matters, the environment feels safe and encourages novelty, the music is carefully selected, and the therapist doesn’t do the same trick every time. That is how therapy, or any other relationship, thrives.
I wouldn’t consider looking for an understanding partner by swiping right or left on a screen after reading a <500 word bio and looking at 6 pictures, nor should a patient consider finding their therapist in a similar manner. Patients need the therapist to understand when a progression may be too fast, when listening is more important than education, when manual therapy is too firm, and when the context just isn’t right. They need a therapist that appreciates when the day has been long, or when the stress has been overwhelming.
Patients (and therapists alike) need an opportunity to develop a relationship based on mutual trust with shared goals; only then can either be afforded another chance to do better next time.