Chewy and Jim are back and so is the theme tune. Now I am not usually one to call out Chewy’s mum for bias but apparently she is in a grump about the lyrics. Yes maybe we do omit ‘Chewy’s dashing looks’ but there is reference to his ‘gags’ which of course are absolutely dreadful and often unpublishable trash.

Chewy and Jim is best watched in full via the video above (so you can check out Jim’s dashing looks) or you can listen on the usual podcast players.

In this recording, Chewy and Jim cover a lot of ground relating to clinicians identity, conflicts of interest and the perils of social media.

Are We Accidentally Creating a Two-Tier MSK System?

Every few years, MSK seems to rediscover an old argument and insist it’s new. Hands-on versus hands-off. Manual therapy versus exercise. Biomedical versus biopsychosocial. Pick your side, sharpen your acupuncture needles, and head to social media.

But while everyone is busy refighting those wars, a quieter shift appears to be happening under our noses. One that’s less about techniques and more about identity. Not how we treat, but what kind of clinician we are becoming.

Not in the sense of ‘good’ and ‘bad’ clinicians, or evidence-based obsessives versus charlatans. But in the sense of two diverging professional trajectories: the interventionalist and the health-coach generalist.

“I almost saw it as being those that were really trying to hark back to diagnostic specificity [that were getting more into interventions].” - Chewy

Jim asks Chewy this very interesting and insightful question: are we drifting towards a two-tier MSK system?

“I think that there maybe are the crap ends of each of those spectrums.” - Chewy

When we talk about conflicts of interest, we tend to think about obvious commercial ones: paid endorsements, sponsored products, affiliate links.

But many of the most influential conflicts in MSK are reputational rather than obvious receipt of piles of cash.

“Strength and conditioning I see a lot of people doubling down on because it’s grabbing attention.” - Jim

Is Two-Tier MSK Inevitable?

Perhaps some degree of stratification is unavoidable. We do need interventionists. We do need clinicians with advanced technical skills. And we do need generalists who can guide patients through long-term behaviour change.

“The multi-disciplinary clinics are doing very well because they can have some specific components to but also provide a more general service where you can cross refer.” - Jim

Good MSK care exhausts proportionate options before escalation. It recognises uncertainty. It manages expectations. It acknowledges bias. It remains flexible enough to change course without defending an identity.

Of course clinical topics aren’t Jim’s only strengths; he can also make fantastic puns using Chewy’s name. Get involved in the features ‘Would Chew Rather?’ And ‘Who Are Chew?’

Would Chew Rather see lots of complex patients every 30 minutes or just one person for a whole week? And who would Chew like to have dinner with? The answers will likely surprise you… Let us know yours.

If you have any ‘Would Chew Rather?’ or ‘Who Are Chew?’ questions put them in the comments or email them to us [email protected]

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