• Alex Phillipos

Answers are Not Solutions

If you sell a man a fish, you feed him for a day. If you teach a man to fish, you feed him for a lifetime. Allied Health is unique because a primary resource with which people can improve their health is their own body. Broadly, it's possible to experience marked improvements with respect to pain, discomfort, dysfunction or altered ability by making minor adjustments to habits or behaviours, or by doing light exercises that don't need much in the way of equipment or resources. Granted, there are times when people need outside resources; crutches to offload injured limbs; slings to support joints after operations; medication to minimise the effects of infection and disease; but the lion's share of the work done in physiotherapy makes use of the human body and its properties. These properties, including human anatomy, human physiology, human pathology and human developmental biology, have remained largely unchanged for the majority of our history as a species and have been documented with increasing degrees of accuracy. Thanks to advances in science, improvements in the resolution of microsocopy, and epistemological developments in the experimental method, we live in a time when intimate knowledge about ourselves and our bodies is at our fingertips. Not only do we have the resources at our disposal, but theoretically, we have all the knowledge we need to make use of those resources too. So why do people still need to see Allied Health clinicians? People can still be injured, people can still get sick. People still need surgery to re-bore worn out joints, fix broken bones, and manage disease. Even so, those kinds of medically involved patients constitute a small proportion of presentations. More than 85% of patients who presented to clinic over a six-month period at our practice presented with illnesses of living; conditions whose severity was associated with chronicity and habits. Why is this? Even if people don't have the time to exercise proactively, they can at least type their symptoms into a search engine and be given a rough diagnostic guide, find themselves a program, and monitor their progress, right? Of course they can. So why do they come into clinic? Is it the fact that clinicians can offer an expert opinion? Of course, there's that. Is it the fact that Google can't write a sick certificate? Maybe. But maybe there's more.

Google can give an answer. A clinician can give a solution. Let me explain. When I was younger, mathematics was my poorest subject. It wasn't because I got my answers wrong, and it wasn't because I wasn't passionate. It's because I didn't show my working. I didn't show my solution to the problem even though I posted up an answer. My teachers didn't know how I arrived at that otherwise correct answer and so couldn't award me marks, because the point of a mathematics assessment isn't just about getting the right answer but showing the teacher that you understand the nuts and bolts of how to get from a bunch of numbers and letters to, hopefully, a figure with only one or two decimal places and as few Greek letters as you can manage. A clinician's job is to draw on empirical knowledge of the human body, engage with the patient with respect to their injury, evaluate that against the patient's life and demands of living, and then evaluate the sum of that against the current evidence for the problem. A clinician takes all the variables and composes them into a clinical equation, performing mental and practical work to move things around until the answer comes out as close as it can be to where we want it. A clinician's job is to solve the patient's problem, not to just provide answers. I emphasise this: answering someone's problem is as simple as declaring a diagnosis, giving a general exercise program and advice, and undergoing monitoring. Solving someone's problem is peeling back the interrelated layers of the person, their life, and their contributing factors before showing them how you did the work. I as the clinician need to explain why I weight some evidence more thoroughly than other evidence. I as the clinician need to explain why I use one operation over another. I as the clinician weigh up the pros and cons and then write down the solution. The first important distinction here is that if I get a Year 12 math problem wrong, I'm the only one disadvantaged by that. If I as the clinician solve the patient's problem incorrectly, they don't get better. I still get paid, but they don't get better. The second and more important distinction is that when I solve a problem and show the working, I give the other person a chance to see how I moved the levers and knobs to arrive at a solution. It's not reasonable to expect a patient to understand how to push those levers or fiddle with those knobs, but people generally appreciate being walked through their course of care in a manner that orients and empowers them. At the very least, they know where they stand in the context of their course of care, they know where they've been, they know where they're going, they know what to expect, and they know how far they've come. At best, I can open their eyes to their own ability with respect to their health, and they start acting proactively. The problem with this, at least from a private health perspective, is that the space between the question and the answer comprises the margin of business for a healthcare clinic. The less the patient can solve their own problems and the fewer tools they have to generate their own solutions, the more associated they become with their clinician. And remember, it's not that the clinician hasn't addressed the problem: I can either answer the problem simply or provide a comprehensive and empowering solution. In either case, the patient's presenting complaint has been mitigated. But in only one of these cases is the patient better armed to deal with their problems in the future. God forbid that should happen because if people could solve their own problems then most of the service industry would vanish overnight. People need Allied Health clinicians because despite the availability of information and the availability of knowledge and context, they need that contextual competence that ties all of that together in such a way as to make it comprehensible. People need Allied Health clinicians because good clinicians answer peoples' problems. Great clinicians solve peoples' problems within the context of their lives, sometimes definitively. Does that mean that all problems can be solved? No. But showing the working is better than just writing a number on the page and calling that it. But Private Health doesn't work this way. If you sell a man a fish, he knows where to go for fish and fish accessories. If you teach a man to fish, you've lost a customer. So what have we learned? As a clinician, the minimal responsibility is to answer the patient's presenting complaint and address this. As a client, you need to find a clinician who doesn't just answer your questions, but who will solve your problem and show their working. This goes beyond just having your clinician do exercises alongside you, but being able to drill-down to the fundamental ideas behind those exercises. You may get a bunch of information that seems irrelevant at the time, but your clinician has the first responsibility of informing you for the purpose of consent, and to educate you, because that's their job. Find someone who will explain your problem in the same way that a year 10 physics textbook explains how wavelength equations work. Because when you do that, not only will you get an answer, you'll see how they arrived at that conclusion. You'll get a set of tools that you can return to in the future, and you'll know how to make some use of them.





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