The practice of letting go
It is interesting to look at the influences that have changed physiotherapy practice over the course of time. While over the years there are some aspects that have remained unchanged, there are others that are almost unrecognisable. It would be nice to think that the primary drivers for those changes in practice are evidence based.
New ideas abound in physiotherapy practice, But do we stop doing things in a timely manner? To quote creativity expert Roger von Oech: ‘It's easy to come up with new ideas; the hard part is letting go of what worked for you in the past, but will soon be out of date.’
It’s a basic human instinct to continue to do things that have been successful, or things we are comfortable with. The challenge is to incorporate new ideas without throwing the baby out with the bathwater. This involves being anchored to a clinical reasoning process or a clinical framework in which new ideas can be safely tested, outcomes monitored and effectiveness determined.
However, I think it is common in physiotherapy (as well as many medical and non-medical disciplines) for this not to be the focus of our efforts when we reflect on our practice. Instead, we can become anchored to the intervention or the technique, rather than the underlying reasoning process.
As a younger physiotherapist, I was guilty of a common trait among rookie clinicians. I would often find myself ‘flip flopping’ between techniques or approaches, on the basis of which recent courses I had attended or which clinical experts I’d been speaking to. This resulted in some internal turmoil about how I could take my skills forward and progress in this profession which I love.
The cure for this in my case came from a stimulus outside the profession. It came from spending time with some experts in innovation, who unintentionally helped me find a better anchor. By making me reflect on my practice in a different way, they managed to help me take the focus off the ‘what you do’ and the ‘how you do it’, and concentrate instead on the ‘why’.
This focus on the clinical reasoning process anchor allowed me to integrate new ideas into practice and to consider new research in different ways. It also helped me to target what I needed to stop doing. Therefore I think the profession is better served if we support young physiotherapists to strengthen and develop their reasoning skills during their early years of practice. This will occur organically through experience, but it can also be facilitated.
Over the last couple of months, the physiotherapy profession has mourned the passing of two of its great innovators: Bob Elvey and Robin McKenzie. Both, in their own ways, heavily influenced the modern practice of physiotherapy. These great thinkers developed new techniques and reasoning processes, but more importantly, new paradigms relevant to the management of musculoskeletal conditions. In my view, one of the best ways to honour the memory of these great clinicians, mentors and leaders is to continue to challenge ourselves and our practice every day, to strive for excellence, nurture innovation—and to practice letting go.
MARCUS DRIPPS, APAM
APA National President
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