physiotherapy blogging is a waste of time?

I'm not sure I've got the point of blogging. I don't have a deep emotional need to see my words on the internet and I have a number of other things I'd rather do that sending words into cyberspace. I achieved the number 1 spot on Google for a few weeks running but I could not be bothered to keep it up. I originally had an illusion of making heaps of money from advertising but lost interest in it. I've increasingly been drawn to researching for a potential non-fiction publication and cant see the point of doing a blog. I don't want to make heaps of vitual online "friends" and the virtual world is not nearly as attractive or interesting as the real world. The only reason I'm writing this today is to ensure that the blog remains active on Google in case I need it in the furture to promote my real world writing. As for blogging about physical therapy, the whole thing seems to be so small and narrow minded that it seems a waste of time.

physiotherapy cartoon #4

I wish the NHS would treat me like a person and not a number...


© 2008

physiotherapy blog goes economic-2008-2009 pay award for physios

I've heard rumblings that the pay award for NHS physiotherapists will be set over 3 years and below 3% for this time. I cannot understand why the health unions are so willing to accept anything that seems to be offerered. I'm bothered by the fact that 3 years seems a long time in financial terms and there's a lot of chance for fuel and housing prices to go up by large amounts when many NHS workers will be in effect on fixed incomes. The proposals I saw (or were they the final agreement?) said that there had been some negotiations about reducing working hours, somewhat ironic since Agenda for Change has only just increased them. I don't know how the negotiators or government expect us all to react at the prospect that in real terms we will be accepting a pay cut as we see our income reduced by above inflation rises in council tax, utility bills and energy costs. We still have to live with the concept that inflationremains less than 5%, something which increasingly seems like an figment of the politicians' imagination. The reality is that those things on which we spend the biggest amount of our incomes go up by amounts much larger than so called inflation. Result? The negotiated impovement in NHS salaries acheved by Agenda for Change will over the coming years be clawed back though setting wage settlements below the rate of inflation.

working for a healthier tomorow

When I wrote Physiotherapy Blog on 17 March referring to the issuing of "fitness notes" by GPs I did not realise that on the same day a report was being published. Working for a Healthier Tomorrow , published 17 March, reviews occupational health within the UK. The principles it tries to address are correct but as with much political discussion about health it fails in the details because of a fundamental limitation in the understanding of the complexities of healthcare and the contradictory priorities which exist. Unless there is a willingness to intiate reform which crosses over multiple government depertments then there is the risk that this report will initiate a knee-jerk reaction in the formulation of new policies which fail to address the issue of long term sickness and return to work. In particular there needs to be a coordinated approach between the health and social security systems in the same way that the report states the need for cooperation between the different agencies in the healthcare system. If my reading of the executive summary is correct then its proposals seem to excessively focus on the "micro management" of long term sickness and return to work without sufficiently looking at the ways that government agencies also are failing to address the problem. A regular annoyance for me is having to fill out Work and Pensions agencies forms for patients. I am annoyed on two counts. Firstly (and the minor complaint) is that I am not allocated time within my workload to do these forms so the whole system is inefficient because they have to wait for theit turn within my order of priorities, so if there is a conflict between doing an urgent letter to a doctor reporting a patient's progress or one of these Work and Pensions agency forms then the former will always get m time. However my biggest dislike of these forms comes from the fact they ask the wrong questions both in terms of what I can answer about the claimant and in terms of trying to address disability. It is without a doubt that physiotherapists have a huge potential role in helping return to work but their input will be limited unless there is a shift within the national culture regarding long term sickness and claiming benefit. In this there needs to be a central govenment lead not only in terms of telling health agencies that they have to work better together but also in putting their own house in order.

To see the report go to:

http://www.workingforhealth.gov.uk/documents/working-for-a-healthier-tomorrow-tagged.pdf

physiotherapy blog offers op art

© 2008

Government crackdown on sickness

Physiotherapy Blog has touched on some of the following issues before. An item on the BBC website says that the UK Government wants to crack down on the growing numbers of people on long tern sickness benefit. There are proposals for the NHS to promote return to work in people who are claiming sickness benefit and the suggestion that GPs give "fit notes" to say what people can and can not do when they are going back to work. Physiotherapists are ideally placed to facilitate return to work and could also support any scheme to assess fitness but there are some huge problems which i have touched on before. Probably the biggest problem is that assessment within a hospital or consulting room is not the same as performance in the workplace. It is impossible to determine the specifics of a work activity within the short period of time in a physiotherapy appointment. The other big issue is the subjective perception of the claimant, especially if it is a pain problem. We probably all know the now old saying "pain is what the patient says it is" but that become a barrier to return to work. Now the NHS exists almost like a machine which tries to move atients through as fast a possible it is no longer well placed to address long term issues such as return to work. The idea that all interventions can be provided as short interventions just does not fit with this model. An approach to physiotherapy based on average episode of care in Britain of 6 physiotherapy sessions breaks down when faced with return to work problems. At present no one is really addressing the contradiction of a Health Service which in the last 10 years has placed waiting time above all other priorities yet isunable to sort out the sickness which is costing the country dear.

The public view of physiotherapy

I read a review in a newspaper today about complementary therapies. To physiotherapists this probably means things like reflexology and the like but this reviewer lumped together acupuncture, Alexander technique, chiropractic and in with these included physiotherapy. What those outside the profession do not understand is the wide diversity of practice within physiotherapy so that now acupuncture is widely practiced by physiotherapists. And this is one of the contrasts between physiotherapy and other "physical" healthcare practitioners, be they regulated like osteopaths or borderline quacks. Physiotherapy has an expanding sphere of practice whereas the "complementary" professions are often build on theories and practices which are in a fossilised state of stagnation. Often these theories are based on clinical experience and nothing else. I've previously writen about the shortcomings within physiotherapy when it comes to evidence based practice. Go into most "alternative" or "complementary" healthcare and you will find there is next to no evidence underpinning practice and in some cases practices continue after there has been evidence of no effect. Usually the "evidence" of results is what is cited as proof that it works a common story being something along the lines "I has a patient with condition X (fill in this blank with a non-acute condition) who had treatment with drug Y (fill in ccommonly used drug) and saw Z (fill in NHS profession) but it made absolutely no difference so Z said they could not do any more for them but I did (A,B,C- fill in with quack treatments) and now they are completely better thanks to MY treatment". (No doubt the complementatry practitioner's bank balance is a lot better as well).

Recipe for complementary practitioner success :
Long appointment time + convinced practitioner + natural recovery process+ psychological influence on condition = patient gets better

What i want to be sure is that the recipe for physiotherapy uses better ingredients.