Welcome back to Chewy and Jim!

The lads are joined in this recording by Rob Beaven who, amongst other things (like a chiro but we don’t hold that against him), is Partnerships Manager for Physio Matters. Jim and Rob didn’t want to involve Chewy but his name being in the theme tune kind of forced their hand.

Chewy, Jim and Beav discuss clinical competency amongst MSK Therapists, using social media to ask for help, and the problems associated with just ‘having a go’ at treating stuff.

So strap in, this is definitely best enjoyed in audio but here is a summary of the discussion if you don’t have any earphones in because not everyone wants to hear the theme tune for some reason…

“If you see somebody with a stress fracture and you misdiagnose that as something else, you’re going to prolong their issues there. Or if you miss cancer, which everybody can, nobody is perfect… that’s the obvious safety component [concern].”

Self-judged clinical competence is a tricky balance to strike, of course if you think you are incompetent at everything you will never see any patients and if you think you are amazing at everything you will equally cause some problems. This lends itself to some obvious safety concerns when missing red flag diagnoses.

No one is perfect and diagnoses get missed or provided incorrectly; this happens and it’s part of the landscape of being ‘autonomous’. The real skill lies in knowing which scenarios are pushing YOUR limits or have a layer of complexity that require assistance from elsewhere.

“Just imagine the perils of a new graduate physio in this climate. They’ve set up a neuro triage service or they fancy neuro rehab…the dangers of that if you’re the first contact professional for that person, who’s like, ‘oh, he’s got a bit wobbly on his feet, or should his face look like that?’ That is so dangerous.”

Physios particularly are in demand, there are growing waiting lists and vacancies meaning patients are fighting at the door to be seen. Therapists are making their way into open posts sooner than they should and without appropriate support. Making all these dangers more likely.

I don’t care what people say, patient mileage (how many different cases you have seen) is an experience that has to be earned through graft and your gut feelings need honing through the random weird s**t that comes through your door unexpectedly. Entering private practice without support or an FCP post where you are seeing unfiltered referrals a couple of years out of uni is a recipe for dumpster fire. No one here is saying clinicians who have been practicing longer are always better but boy-oh-boy it helps to have seen more presentations and individuals to understand the complex nuance of clinical practice.

“I see enough social media posts that are like, ‘I have this patient coming in with this diagnosis that I’ve not treated before. What do people suggest?’ I just don’t think that’s an appropriate support mechanism.”

The conversation discusses some logistical practicalities of individuals’ scope: worrying examples of this can be seen across social media regularly and are what prompted this discussion. It is clearly more challenging as a clinician who works on their own or is isolated to access support or mentoring for complex cases and there is a clear financial implication in the private sector of turning away patients. From a cynical point of view though, this can potentially increase the risk of ‘having a go’ - when seeing paying patients means keeping the lights on at home.

Social media is not a good place to seek unfiltered advice because any weird, fringe or incompetent person could reply. We need robust support mechanisms in place that we trust BEFORE we need to seek their assistance.

“Unfortunately we have a number of people that are [at] irritatingly far ends of a spectrum - self-flagellators who are over-reflective to the point of anxiety, and peacocks who are cavalier and just have a go. As an industry, we are not regulating that well amongst ourselves.”

Chewy harks back to one of his editorials [1] where he posited that clinicians fit into two groups: those who are overly critical of their skills and those who are under critical, causing a double edged sword in this particular scenario, especially when consulting social media. Those who ask for help (self-flagellators) are likely to be helped by the peacocks which is probably not a desirable outcome. The peacocks don’t ask for help and barrel on treating anything and everything. Without proper regulation, we have no way of managing either side of the coin so the practices shall continue.

Reference

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