“These idiots who do things differently to me don’t have a clue!” said Chad Headstrong, a self-described passionate and vocal Northern Beaches Physiotherapist. Mr Headstrong contacted The Good Health Tribune after reading one of our recently published articles to offer his input and expert opinion on the subject matter our reporter had addressed.

“Yeah yeah, I’m sure you guys were all having a good laugh among yourselves over how clever you were sending up a scenario where a Physio gets in trouble with the cops for providing manual therapy. But this is serious. Have you not heard of low value care? That’s what this is all about. You see, low value care is defined as;”

…use of an intervention where evidence suggests it confers no or very little benefit on patients, or risk of harm exceeds likely benefit, or, more broadly, the added costs of the intervention do not provide proportional added benefits

“We shouldn’t be making a joke of this. We should all pull together, put an end to this pointless division and start practicing the same way as me and my mates do, you know- the right way”.

Our reporter put it to Mr Headstrong that the definition of low value care appears somewhat vague and confoundingly layered, and that it therefore might be difficult to prevent subjectivity from affecting how it is used as a basis for determining the value of a given intervention.

“I disagree. It’s not complicated. If there’s strong evidence for the intervention- it’s high value. If not, it’s low value. If the risk of harm outweighs the benefit, it’s low value. If it costs a lot of cash, and doesn’t add benefit above cheaper alternatives, it’s low value”.

Leaving aside the lack of clarity over the threshold at which evidence is defined as strong or weak, or the uncertainty over whether ‘high value’ refers to that which benefits the patient at hand, the healthcare system, the society writ large or the clinician’s ego, our reporter wondered aloud to Mr Headstrong about the potential for disagreement to arise where there is an absence of evidence to guide an assessment of the risk of harm vs benefits.

“Ok, hold on a minute, I know what you’re getting at and I’m not falling for it. Look, the “risk” of harm isn’t necessarily about physical harm from treatment. Far from it actually. We’re talking behavioural and societal harm. We have a responsibility to minimise the risk of patients developing a dependency on future treatment. It’s our responsibility to build patient self-efficacy any chance we get. That my friend, is truly high value care.

There’s no denying it. Think about it… if patients can sort themselves out at no risk or cost to anybody, the benefit is infinite, you know x/0 =infinity. I’m sure you’ll agree there’s no value greater than infinity. So it stands to reason that any clinician who fails to be hyper-focused on patient self-efficacy as the top treatment priority is a provider of low value care. They need to shape up or ship out” explained Mr Headstrong. Our reporter drew a breath to pose an additional question but was cut off mid sentence.

“It just makes me sick thinking of all those half-wit clinicians out there peddling treatments that help patients recover from injuries and pain problems faster than they would if left to their own devices. Think of the immeasurable damage they’re doing to societal health literacy. How do they sleep at night? What good is relying on someone else for a quicker, more comfortable recovery from injury when you could just as easily do it yourself in as little as twice the time and at no cost to anybody?

And another thing. I don’t want to hear you asking for evidence linking low value interventions to increased dependency… or whinging about how there’s no reason why active treatments could be just as harmful to self-efficacy as passive ones. You don’t need an RCT to know that expenditure on chronic pain problems continues to rise without a concomitant reduction in its prevalence. And you don’t have to be a rocket surgeon to realise that this is all caused by irresponsible clinicians taking steps to help patients feel better when we all know they’d be better off if we told them to harden up and stop being so pissweak so we can get on with building a society that isn’t as soft as a tub of devondale butter”.