Why isn’t my therapy working?

Where two opposites should attract!

I write to you as an often seen persona non grata in the rehabilitation world. I bring you today the (already known) inconvenient truth of the Healthcare Industry.

There are two main drivers in a rehabilitation process, the client (active, or ideally active) and the Healthcare industry (passive, or ideally passive). Blaming one or another is not correct as both roles are being played in a very wrong way.

On one side, we have the Healthcare Industry that wants and needs to profit from the higher end pressure on the board, charging more to the patient and expecting not giving much in return.

To find health should be the goal of the doctor, thus everyone can find disease — Andrew Taylor Still, MD

On the other side, the client/patient usually has their priorities twisted and expects the Healthcare System to fix him with no cost and/or self-responsibility.

Before you heal someone, ask him if he’s willing to give up the things that made him sick — Hippocrates

Even with two sides of the coin, this happens more often than it should. We all know someone that has been through some hard times during recovery, making it look like a never-ending nightmare. It’s my job to prevent that from happening, and after wondering why I decided to write about it taking into account both, the Healthcare and Patient’s side of the story.

It’s very common to hear people complaining about the way they were approached when they sought an opinion of healthcare professional opinion. Here are some of the reasons why I believe it happens:

• The Healthcare System still treats symptoms and not the person. Assuming the problem is always on the site of pain/symptom leads to an incorrect diagnosis.
• The treatment is about being profitable. A system where you go back for a therapy session every 2/3 days with no plan of rehabilitation, has everything to go wrong.
• The treatment is focused on the disease and the person’s overall health. The solution of the problem is, most of the times, on what you can do, rather on what you can’t do.
• The treatment doesn’t empower the patient, it scares him. Someone goes to the doctor with back pain and comes out with extra 3 muscle imbalances, “poor posture”, weakness and an “inactivity” prescription that most probably won’t help them.

If the doctor himself is afraid of pain and movement, how do we expect him/her to help a client to overcome his common fears?

It’s easy to blame others, but “it takes two to tango” and most of the times the patient is actually the main driver for that failure, and why?

• The patient relies on the therapist to “fix” him. There’s the expectation that the therapist should be the one responsible for the rehab’s success.
• The patient is not willing to change what made him sick in the first place. It’s always expected a quick fix will work, as opposed to changing the behaviors that were responsible for the appearance of the “disease” in first place.
• The patient believes (and is taught) that there’s no solution to his problem. The community and their circle of influence often show plenty of negative outcomes that make him believe that they are lost cause.
• The patient is not motivated. One of the main factors is that the therapist can’t do the patient’s work for them.

There are four main drivers to succeed in a action: What we think (mental), what we feel (emotional), our beliefs (social/spiritual) and what we do (physical).

In a Utopic world, we would be able to fit all of these factors and adapt them to a better and proper service. It’s a problem that can be solved by changing both parties priorities and how we educate them. It will take a long time before we can integrate Health and Wellbeing into our educational system, as as well adapting our Healthcare System and it’s education style.
Before long, people will have to want that change. Until then, I’ll keep doing my part.

With the Healthiest Regards,

Joao Luciano,

Physiotherapist — Health and Performance