physiotherapy evidence and clinical education

I've noticed something interesting within physiotherapy but I'm probably stating the obvious. There's a conflict between those who want to practice according to the best evidence available and those who argue that results and experience are more important. Arguably research evidence and experience go together, but I sometimes get bothered that despite 10 years or more of evidence based practice there 's a large number of British physios who seem too willing to be taken in by the lateast ideas when these new ideas or treatment techneques are promoted by eloquent trainers running weekend courses. Now that evidence based practice is a comfortable term , when you go on any clinical course the course tutor will always throw in how the course content is evidence based and it will do X,Y and Z if you use these techniques. There will usually be a heap of research discussed but what the course tutor will conveniently avoid is presenting sound clinical trails which show the techniques being taught can actually make people's health better in a way which is more effective than the "healing effect" of time or the power of positive thinking. The research "evidence" is evidence by proxy, usually within a related area but never actually about the techniques themselves. Then there's the inevitable using the techniques on one's fellow course participants, and leaving the course ready to be let loose on patients.

I wonder if part of the problem arises from a deep seated desire in many physios to believe in themselves, a need to believe that what they are doing is valuable, effective and skillful and perhaps an inability to deeply question something in which there is a big emotional investment. To allow for the possibility that the majority of patient recover through natural healing processes or through their thought processes is difficult. This would mean that complex "skills" requiring time and money to learn are in reality worth very little, an uncomfortable thought if you have sacrificed financially, something which also creates a feeling of insecurity at work ("if patients get better through natural recovery how can I be worth £25 000 per year?") Yet to question things in this way would be the start of something much better within the profession and for us as individuals. If we had the courage to abandon so many dubious clinical practices we could then put every effeort into those things which really do make a difference. Then we wouldno longer have to go on weekend courses which cost heaps of money to obtain a course certificate which is of dubious value.