Conversations with my Physio: Part Two

Another interesting conversation with my Physio today. (Dear Physio, should you, by some freak of the internet, stumble across this blog, I do hope you don’t mind our interactions being scrutinised. It’s not personal, I promise).

She mentioned that she is thinking of doing a course in accupuncture for Physios. I expressed surprise at accupuncture being available on the NHS, especially within a hospital clinic, since hospitals are traditionally particularly the domain of bio-medical types of healthcare (for an introduction to this, you could go further and do a lot worse than Unit 2 of K101. Alas, this isn’t available on Open Learn, but the fuller but older version of this material from K100 is). We ended up having a conversation about the evidence-bases of conventional and alternative therapies.

(picture nicked, appropriately enough, from the NHS choices website introduction to accupunture)

Perhaps because of her previous framing of anatomy as the central knowledge of physiotherapy, I had been thinking of the discipline as quite bio-medically oriented and positivist. But she characterised it as the soft, holistic end of medicine because they don’t prescribe drugs and do things like physical manipulations. She talked about the way she feels things in her hands when she is treating someone and how hard that is to write up in her notes.

We talked about the legendary finding (i.e. neither she nor I knew the source, but we’d both heard of this piece of reserach. A quick look at Cochrane just now doesn’t find it either) that treating scar tissue with high doses of ultrasound works equally well whether the ultrasound machine is plugged in or not. Her point was that it’s impossible to properly test this sort of thing because she would never prescribe ultrasound on its own, she would always accompany it with physical manipulations, exercises etc. I recognise this as the argument that evidence-based healthcare is incompatible with the ethics of offering patients the best care. (I’m not sure that she’s correct that it couldn’t be done ethically, but I’m interested that that’s her perception of how evidence-based healthcare doesn’t work in practice).

One day, I really ought to write something proper about evidence-based care. I keep returning to it as an overarching issue, but I get daunted by how quickly it gets into epistemology and ontology.  In the meantime, here are links to the two most accessible articles on some of the problems of evidence-based care that I have found (and at a much more introductory level, there’s my material in K101, Unit 19, section 3. This was new for K101, so unfortunately there’s nothing similar in the K100 material on Open Learn). Note to self – at least do something with the swathes that were cut from earlier drafts because it was (correctly) judged to be too difficult for Level 1.

A chapter by Miles Little in a book, available on Googlebooks

An article in the BMJ, (I think that’s open access). It also features in abbreviated form as a chapter in the K101 Reader (because I chose it)