I was stuck in a rut. Only four years out from college and I was somewhat questioning what I was doing. I wasn’t enjoying my days work. I didn’t feel like I was helping people in the way I had previously hoped. A mere four years and I had already lost my flare. Did I need to change direction in my career? Had I lost my passion? Was I ever cut out to be a physiotherapist in the first place?
I began to blame myself for not being able to fix my clients.
“Why aren’t they getting better?”
“What am I missing here?”
“Why can I not fix them?”
“Will I ever be a good enough physio”.
“Why is this helping sometimes but not always?”
“Maybe your not doing the mobilisation correctly- but should it matter?”
“Do they need to be referred on, or am I just inadequate?”
I began to doubt myself with everything I was doing?
I was an over acheiver in school. Always wanted to be at the top of the class. Did pretty well in my exams. And so when I enterered the big bad world of physiotherapy, I was confused. I wasn’t getting consistent results. It was difficult for me to accept. I wanted to be the best of the best. But I wasn’t. I wanted to help people do what they love doing. But I wasn’t. As I blamed myself, I also blamed clients.
“Non-compliant to home exercise program”.
“Continued to run despite physiotherapists instructions”.
And so by shifting the blame, I didnt feel as much guilt. But inherently, I knew I was wrong. I knew that neither I nor them were to blame for a lack of progress. I no longer believe in blame. Blaming people. Blaming structures. I don’t think it is helpful, nor is it conducive to successful recovery.
In University we learned about the Biopsychosocial model. The Postural Structural Biomechanical Model was slated… by some at least. Our lecturers and academics were very pro BPS, our clinical tutors, maybe not as much. And so my ability to implement a lot of what I had learned was inadequate. I was stuck between two models and confident in implementing neither. Jack of all trades but master of none comes to mind but I lacked confidence in both.
I was comfortable in neither approach and found I didn’t have enough depth in my knowledge. Theoretical knowledge of the BPS model was good, but practical elements poor. And as for the PSB, I felt my practical skills might have been slightly better, but still not something to be desired. Maybe this highlights my persistent strive for perfection. Always wanting to be right. But when I came out of college I felt I was failing. I felt I was resorting back to a biomechanical model because it was easier. Easier for me to explain, and easier for my clients to grasp even though inherently it wasnt what I believed.
I had no experience explaining the intricacies of pain and while I knew how much pain was impacted by psychosocial factors, I was lost as to how to incorporate them into a management plan. And so I found myself putting everything down to a weakness or a flaw in the body, though deep down I knew this was wrong. I knew deep down, that focusing on these “flaws” or “weaknesses” wasn’t maximising my potential to maximise that of my clients. Blaming a structure was not necessarily helpful. Blaming posture certainly wasn’t. And yet here I found myself; laying blame.
I strongly believe our bodies are the most amazing and fascinating things on the planet. The millions of functions within this one human-being working siultaneously to create this beautiful individual. Millions of cells symbiotically functioning in numerous different organs and muscles and systems. Complimenting and competing with each other to get that balance on the tightrope of homeostasis.
Each and every one of these collection of systems unique. Everyone different in their own way. No replicas; similarities, but no copies. And instead of embracing these differences in bodies, I found myself blaming them.
Two weeks ago, I left work on a Thursday evening and began to reflect on my day. I turn off the radio, and allow myself 15 minutes on my commute to just be with my thoughts. Sit with them, acknowledge them, and just let them be. After a heavy day in work it is important to shed the load, as a colleague and friend, Teresa Waser would say, “Care without Carrying”. When I walk in my front door at home, my thoughts have been and gone, and I am home. No more time to dwell and carry the load of the day.
But this particular Thursday, as I sat in my car and reflected on my day- a total of seven clients; two women’s health and five musculoskeletal, I found the corners of my lips being gently tugged up towards my eyes. A smile slowly creeping in. A day that I cared, without carrying without needing to try. A day I that felt like I had made a difference. Not to just one or two clients, I felt like, after a long time of slogging through, going through the motions of doubting and questioning myself, I had finally made a consistent difference.
These differences may not have been completely life changing, but I felt like I was helping. Rome wasn’t built in a day. I felt that I was on a different journey with each my clients as opposed to leading the way. Decisions were made together, goals were set together, improvement was acheived together. I finally was able to jump down from that fixer pedestal and join the crowd.
But what changed?
It was me. I changed. I changed my attitudes, my ways of implementing interventions, I opened my ears and listened. Instead of being stuck between two models, and wondering which one I was following that little bit more, I allowed myself to follow my client.
Over the last few months I have participated in the Physio Detectives “Online Peak Simplicity Masterclass” and it has changed me in so many ways. The masterclass has encouraged me to voice my concerns, ask questions, look for answers but also to accept if that definitive answer does not exist. To accept not having the answers for the questions being asked, and not feeling guilt for saying “I don’t know”. To be confident and comfortable in uncertainty. And with that, I was freed.
The freedom I have gotten over the last three months of resetting has been nothing but positive. At times there was discomfort, but progress isn’t made in the comfort zone. The freedom to enjoy uncertainty is exhilarating. I learn more, about conditions, about people, about their lives and even it seems, about myself as a physiotherapist.
The freedom to stop and take time. To ignore the pleas from the plinth behind me. To ask questions. To understand. To spend whole sessions on subjective examination and delving deep into the problems, goals and concerns faced by the client if that is what is required. To question more. Dig deeper, to understand. To allow the client to lead me.
I feel free from the burden to diagnose, and free from the guilt of not fixing because I have reframed my role. I am no longer a fixer. I am here to help and facilitate my clients to get their groove back, just like I have recently found mine.
As physiotherapists, there is a lot expected of us. We are to care for, assist, guide, help others all while taking on the load of their needs. It is no easy feat to do this without experiencing an element of burn out. Is what I have experienced over the last few years burnout? Maybe not? But change needed to happen.
Self care in a healthcare profession is paramount to success. How can we expect to care for others if we cannot care for ourselves?
How can we expect to help others if we’re carrying the burden of their success on our shoulders? Since reframing my role as a physiotherapist, since I have looked upon myself as a facilitator rather than a fixer, I have given myself the freedom to not always get it right. But with that freedom, I find I am succeeding all the more.
Since allowing the client to guide and to lead, empowering them to make choices for their own bodies, we have made progress in leaps and bounds, together. As Antony Lo would say, progress in minutes, not days.
Listening to the client, asking where they are, where they want to be and finding out what’s stopping them. That is the most important and crucial part to ensuring we succeed. And so it is the client that will lead. Maybe they have the answer already, maybe not. But listen. Hear what they have to say and take it from there.
I have stopped jumping to the plinth for an assessment after cutting them short in their story. I have stopped feeding the need to get an objective assessment complete on session one. I have sat and listened, if that is what they need. I have educated and discussed concerns and goals.
The client may not always want a rub down, they may not want a home exercise program. Their session is about them. It is about what they want to get out of it. And so since allowing them to guide me, I have began to enjoy what I do all the more. Reaching for the stars on a clear night. Targeted to each specific star. Not a stab in the dark, not pushing through thick grey fog.
Directed treatment in line with the needs, wants and goals of my client. Allowing me to help, in the way is most appropriate. Allowing us to achieve goals together. Allowing me to make a difference. But mostly, pushing us both to getting our groove back.Leave a reply