Last month, local Tradesman, Barry Gidley 44, sought treatment for a complaint of lower back pain from a Northside Physiotherapy clinic, only to be discharged from care following a single appointment. Mr Gidley reached out to The Good health Tribune to complain about the manner in which he was dealt with by the clinic. Mr Gidley joins a growing number of Physiotherapy patients who have reported dissatisfaction with the treatment they have received within the archetypal private practice setting.

“The Physio didn’t do anything! He just talked at me for 30min and told me I needed a healthier lifestyle if I wanted to get rid of my back problem. I told him that I wasn’t worried about the long term. I told him that my overall health is my own business and that I just need a bit of help whenever my back arcs up. He said he wouldn’t do anything to help because it would just create a future dependency on more treatment. The guy was a joke. He didn’t do anything to help. I basically paid $100 for nothing” said Mr Gidley.

Our reporter asked Mr Gidley how his experience differed from previous Physiotherapy treatments. “Well you see, we’ve only just moved to the area so I’ve been on the look out for a new Physio. I used to see a guy back west who helped me a lot. My back’s always played up, maybe 2-3 times per year and he always helped me to get through it. He was good. He’d often talk about options we could chase up to get on top of things more long term- you know- get my back to a state where it didn’t flare up so often. But it was gonna mean that I’d have to change a bunch of things- you know- exercise more, join the gym, cut back on the piss, give up the darts, get to bed earlier… all that kind of stuff. And I just used to say to him “Yeah, i get it… but I don’t have time for all that- or the motivation if I’m being really fucken honest… I love my smokes too much haha”. My back’s never great but I can mostly put up with it day to day… all the lads on the worksite are in the same boat. I just need someone to help me get through those flare ups when they happen so I can get back to work quicker, and that’s what my old Physio was able to do for me”.

Our reporter managed to track down Mr Gidley’s former Physiotherapist for a comment. “Yes I remember Barry well. He’d come and see me for 3-4 sessions a few times per year. Always the same problem. And he’d always bounce back with some hands on work and a review of a few simple home exercises. Barry was happy to manage things that way. We talked about what it would take to really get on top of his back problem in a more sustainable way. But in my view, he didn’t seem to have room in his life for big lifestyle changes. His view of himself was that he was functional enough to not worry about the next episode until it occurred. He was happy managing things that way. My view was that I could help him best by helping him out when needed, and by continuing to gently nudge him on other strategies for future management.

I have a few patients like that. Not all patients are ready for big lifestyle changes. Their symptoms just aren’t a big enough deal to warrant the effort or expense. Some might take 5-6 recurrent episodes over a few years before they decide to make changes. Others, like Barry might not ever get to that point where they think the benefit is worth the cost”.

Mr Gidley’s former Physiotherapist went onto say that Barry’s story is emblematic of a growing trend among a vocal minority within the Physiotherapy profession. “There is a push toward a treatment approach that prioritises the promotion of behavioural changes that are associated with better long term health outcomes. I think it’s great that our profession is developing skills in these areas as it is undoubtedly going to help swathes of patients who have been medicalised or otherwise poorly managed. There is definitely a whole bunch of patients who need to unlearn unhelpful ideas about their pain and disability, and who will greatly benefit from the acquisition of self-management skills and strategies.

However, I think we need to understand that behaviour change in a patient population is a tricky thing. As I already mentioned, not everyone is ready for change, and we still need to be able to help those who aren’t ready. We need to be able to meet patients at their level of understanding and readiness for change.

Furthermore, I think it’s important to recognise that a decent proportion of patients do not “need” us to prioritise the promotion of self-efficacy in every instance. Physiotherapists should be comfortable with the idea that patients, to varying degrees are dependent on us. There’s nothing fundamentally wrong with patients depending on us, particularly over the short term. And on the flip side, we should be comfortable with the idea that Physiotherapists depend on patients. In the private practice setting, it’s a fundamentally transactional, codependent relationship. We need to be at peace with that truth.

Somewhere along the way, it’s become unpopular to provide treatments that expedite the natural history of common injuries and pain problems… or at least make that process more comfortable and less painful. Equally, it’s become unpopular to incorporate such treatments for patients with more longstanding problems and symptoms. But the thing is, we can be good at doing that and we shouldn’t shy away from it. These are valuable services to our communities and given a sensible explanatory narrative, they can be offered without fear of damaging patient self-efficacy or worsening societal health literacy.

The challenge we have is to get better at deciding who needs what. Who needs the wholesale lifestyle change? And how urgent are those needs? Who has been saddled with unhelpful beliefs that must be wound back? And how urgently should we pursue that for a given patient? Who has low self-efficacy and how do we best help these patients? Who has high self-efficacy and how do we best look after them?

These aren’t easy judgment calls to make on the run but to me it’s the best part of the job… trying to find a way to understand where the patient is coming from, where they want to go, what their expectations are, what their broader health needs are, what narrative they want to hear, what narrative they need to hear… and then building a personalised plan that ticks all the boxes and leaves the patient feeling motivated to participate.

When we discharge patients like Barry after one appointment, we’re really just robbing ourselves of the opportunity to contribute to the health of our communities”.