By Nicholas Gambin
In keeping with the spirit of RAW, Nicky set off to learn about the practitioner-client relationship through the perspective of a health profession that people might not know much about – physiotherapy.
There are multiple practices and professions that fall under the health services field, but most of them involve one important common factor; interaction between people. One area where this can be clearly seen is physiotherapy, which is an “approach with multiple forms of treatment, where the idea is to improve a person’s function and mobility, and to get them back to the life they want to be leading.” This is the definition that Edward de Gabriele gave me. Ed is currently a second-year physiotherapy student at the University of Malta, and the current president of Malta Health Students’ Association (MHSA).
When I asked Ed about how the actual process of physiotherapy begins, he mentioned two distinct ways; through the patient themselves or through a referral. When people identify a particular area of pain, they either go straight to a physiotherapy or to their general practitioner. In the latter care, a GP might be able to make the diagnosis themselves, but will then give the patient a referral letter for a physiotherapist if they see that they aren’t the right person to treat the injury. Physiotherapists also speak to people before and after operations about factors such as dealing with their wounds and mobility.
One of the most important aspects of physiotherapy that Ed really highlighted is that “you don’t just treat an injury – you treat a person”. He mentioned the biopsychosocial model, which looks at health problems as a complex interaction between biological factors (ex. genetics), psychological factors (ex. personality), and social factors (ex. culture). This concept tries to instil the idea that a patient is not just another number or body. “Every person is going to handle their injury differently, and if you just treat them as an injury, the chances are that they will be less likely to cooperate and put 110% into their rehabilitation.”
From the start of the journey, it is very important for a physiotherapist to ensure that a patient will commit to their rehabilitation. No matter how long the recovery process is estimated to be, a physiotherapist will want to maximise the chance that a patient will stay motivated and not give up. In fact, Ed argued that “at the end of the day, you can be the best physiotherapist in the world in terms of your treatment methods or techniques, but if your patient isn’t motivated and they don’t care, all that will go out the window and will be for nothing.”
Of course, making sure that a patient is motivated is easier said than done. A very important technique is goal-setting. Ed elaborated that it’s not just a matter of setting goals at the start and end points of the process, but goals should be set from one session to the next. In this way, a physiotherapist will be able to check the progress of the patient’s recovery, and adapt the goals to suit their rehabilitation. In addition to this, it’s important to show the patient concrete evidence, like data. “If they see that there is improvement, that will keep them motivated. If you don’t do that and just tell them that they are improving but you have nothing to show for it, there’s going to be a much bigger chance that they will become demotivated.”
A physiotherapist also needs to establish a level of trust with their patient. How easy it is to create this trust ultimately depends on the patient’s faith in the profession. When dealing with sceptics, Ed emphasised once again the importance of having goals and evidence to back up any observations. Furthermore, to get a patient to trust their physiotherapist, they need to show them that they are on their side and want the patient to recover.
When you’re treating a person and seeing them regularly for a specific period of time, a physiotherapist does end up forming a relationship with the patient. A session will be more difficult if the two people involved just sit in silence for the whole time, which is why a good relationship and good rapport is important. Ultimately, one of the best things a physiotherapist can do is simple – just get to know the patient in front of them. “We’re treating the person, but you cannot treat a person that you don’t understand. If you understand the person, they’re going to feel like it’s less of a burden to go to a physiotherapist.”
This idea that “the patient and the physiotherapist have the same goal – to do what’s best for the patient,” is what Ed emphasised to be the key to understanding what physiotherapy is all about. “Seeing someone walk in, maybe worried or scared that their life is going to change, and seeing them improve and be really excited about that improvement,” is what he describes as one of the gifts of the profession.