We are not cars…

I am still amazed at the number of times I hear therapists comparing patients to cars or other machines and themselves as mechanics who can ‘fix‘ them. They also use these explanations to justify how they need to see patients for regular ‘servicing‘ and ‘maintenance‘ treatments. This kind of thinking and talking needs to stop. Patients are not cars, and therapists are not mechanics. However, if you are a therapist who wishes to describe yourself as a mechanic and your patients as cars then I have some thoughts you may want to consider.

cars

First things first, complex, sentient, biological, ecosystems such as human beings and the vessels they call their bodies are NOT inorganic lumps of metal and plastic like cars or any other machine. Bio-mechanics are NOT mechanics. Anatomy is NOT engineering.

To compare the self regulating, self repairing human body to a lifeless, inanimate object such as car is simply ridiculous. The human body has a remarkable capacity and propensity to maintain homeostasis, repair itself and adapt to changes, and like it or not, it has done this, and will continue to do this just fine without any help from you as a therapist poking, fiddling or fannying around it.

Therapists don’t ‘fix’ people

I often have patients tell me they have been told by some other so called ‘mechanic‘ therapist that they have been fixed but they need regular maintenance or risk having more problems and pain in the future. This bull shit really boils my piss. It’s nothing more than fear inducing, scare mongering, crap used to profiteer of the scared and vulnerable.

So if you are one of these therapists scum bags who does like to think you fix people and call or think your patients as cars or any other machine, and use your practice as a garage or car dealership that services things, be aware of this counter analogy I use to rain on your parade and explain to patients why this is not as good as it sounds.

I have a car!

And thankfully it has minimal issues and rarely goes wrong… because I LOOK AFTER IT. I feed my car with good quality fuel and lubricants. I exercise it regularly, and sensibly, ensuring I don’t over rev the engine when cold, or slam on the brakes too often. But I do also give it a blast of full throttle every now and then to clear out its pipes and occasionally mis treat it, and it still works just fine. This I explain is no different to how we should ‘maintain’ our own bodies, exercising regularly, feeding and fueling well, as well as blasting off some steam now and then by going full throttle.

However, admittedly my car does occasionally have the odd problem that I can’t sort out myself no matter how well I look after it, such as the wheel tracking can go out a little, a warning light flicks on the dash board, or a fliter gets a bit clogged. So as I know nothing about cars I do need to take my car to the ‘experts’ to get it sorted out, so I go to a garage and talk to a ‘mechnic’.

But there are often two ways this visit to a garage goes. The first garage with ‘Mechanic A‘ listens to what I say I think the issue is with my car even though I know fuck all about them. He listens to my story rolling his eyes in his head when I say something stupid like I think the ‘over head sprocket thingy is loose‘. He then proceeds to tell me that I’m wrong and using all sorts of technical language proceeds to tell me ALL of the things it COULD be, and how it COULD mean that there are lots of other issues, and how it COULD mean more work is needed. 

He says he will know more when he does some ‘technical stuff’ to my car, and so I leave him to do his diagnostic tests. Later on I get a call telling me he has found the issue with the car and fixed it, but just as he had thought when he was running his tests he found lots of other problems that I was unaware of, and how these could cause potential issues in the future and how I will need to be booked in again to have them fixed. And so we go round and round and round again and again and again back and forth to this garage, and each time I go in, they find another potential issue… anoying isnt it!

However, the second garage I use is different. Mechanic B listens like the other guy but doesnt roll his eyes, he also does his diagnotic tests like the other guy, but he tells me in simple, clear terms that it’s not a major issue and that it can be sorted easily and have me driving around again in no time. He does his stuff, gives me my car back with minimal fuss or problems. Mechanic B also tells me there may be some future issues with some stuff he saw, but, and this is the major difference to Mechanic A, he calmly tells me how long it may be before they may cause any issues, and explains what I can do to minimise them and tells me to just book in if they do cause a problem in the future. Much less annoying hey!

Which mechanic?

So which mechanic do you think I use from now on? Which mechanic do you think I am going to take my wife’s car too if it has an issue? Which mechnaic do you think I am going to tell my friends, and family to take their cars too if they have an issue?

I use this anaology with all my patients who tell me about therapy ‘mechanics’ and ‘fixers’. I explain that if their body was a car, which it’s not, but if it was, which mechanic would you want to use?  Mechanic A where you have to return to week after week having multiple visits, tests, treatments, just in case. Or Mechanic B who sorts the current issue with minimal issue or fuss, gives you advice on how to avoid future problems, but to come back when or if you have any?

In a nut shell for therapists this ALL comes down to promoting self efficacy, and the external v internal locus of control, and in simple business terms the difference between patient retention v patient turnover. Many therapists need to stop comparing human bodies to cars, particularly when it comes to justifying or suggesting regular check ups for people with no pain or issues.

The belief that the human body needs regular movement MOTs or assessments to ‘prevent’ future issues is unfounded. To think therapists can predict or prevent what will happen in the future in terms of pain or injury is nothing short of deluded wishful thinking and clairvoyancy. Finally if you think, that as a therapist you are a healer or a fixer of things, then you are simply a narcissist.

NEVER see patients as a life long customers or clients, who need regular maintenance. As a therapist ALWAYS strive to make yourself redundant with every patient as soon as possible. Therapists need to start seeing every patient as an advertisement of their quick, simple, clear, helpful, and efficient advice and service, and as that go to therapist who got them going again quickly, with minimal fuss, minimal fannying around and most definitely not by asking them to come back time and time again.

Be mechanic B, not mechanic A, actually dont be a mechanic at all.

As always, thanks for reading

Adam

 

14 thoughts on “We are not cars…

  1. Adam, the important message contained within your post seems to have escaped the attention of the Chartered Society of Physiotherapy. Otherwise, why would this prestigious organisation choose to promote courses in “dry needling” of myofascial “trigger points”, a practice for which there is neither a scientific rationale nor any evidence of benefit to patients so treated?

    • A very good point John, however why the CSP do what the CSP do seems to be totally independent of what most good evidence based physios want to do, and so I see ourselves going down separate paths unless the CSP ups it’s game

      • In Australia, the Australian Physiotherapy Association counsels its members not to call themselves acupuncturists, as to do so would risk them being censured by the health licensing authority. However, physiotherapists are allowed to practice acupuncture upon their patients provided they do not claim to have any expertise in the area. I find this very strange!

  2. Afternoon,

    I think John is spot on. How people are still allowed to sell crap as gold has become a very disappointing state of affairs. The amount of hypocrisy in our profession is staggering. I constantly find people endorsing the approach you describe and the next minute they are doing the opposite and peddling rubbish.
    Personally, I work in private practice. I have never seen people for many sessions in the past but see most people even less now. To be honest I earn less money because of it. However, I have never been happier. I have been on courses where the sole conversation has been how many people are in your filing cabinet. The car analogy goes hand in hand with this. Personally, I find this a disgrace and greed a disgusting characteristic.
    The problem with any establishment is they do not like to answer critique. The ethos of establishment organisations is self-serving ultimately I feel. These people become used to floating around and having smoke blown up their arses. And, did I mention egomania.
    Anyway, I note your comments on twitter recently. Have you had your hands slapped?

    Kind regards,

    Adrian

    • Hi Adrian

      Thanks for the honest and heartfelt comments, and massive kudos to you!

      I have nothing but the utmost respect for anyone who works in private practice and promotes self efficacy and dependancy.

      As I have mentioned before, promoting independence and earning an income are NOT the best business partners, but it can be done, again kudos,

      Cheers

      Adam

  3. Though I agree fundamentally with what you are saying, I wholeheartedly believe in physical therapists serving as primary care practitioners for the movement system. Periodic checkups to make sure all subsystems are in working order is called “prevention” – or as the adage says “an ounce of prevention is worth a pound of cure.” The revolution in the business model is not only #getpt1st, but also, do you have a PT on your health care team?

    • The idea that we know when a ‘sub system’ what ever that is, is working or not is based only our assumptions and guess work

      For sure people need to move more and often, stay strong and healthy but they don’t need physio checks ups to do this, it needs to be driven by society and all healthcare professionals

  4. Please bring your course to Australia sometime soon (preferably tropical Cairns in Queensland!).
    Love your work.
    Ryan

  5. well said. With your permission I will use this analogy in my practice.
    This is the philosophy I follow and it drives me crazy when I hear other physios telling patients they need t’o “book in” 2x week for the next few weeks.

  6. People are not cars, but they are like cars in some ways. The car analogy can be useful in explaining the benefits of exercise and activity. Comparing the need for exercise and activity to keeping a car lubricated or needing to take it out on the highway every now and then often resonates with people. Horrific though it might be, some people’s knowledge of their car is far superior to their knowledge of their own body.

    Your main complaint (which I agree with) seems to be the use of the car analogy to justify promoting regular check-ups. I think this is infrequently the way the mechanic/car analogy is used, at least in my experience.

    I believe we can be objective and evidence-based and promoting self-efficacy and all that juicy good stuff while also using metaphor and analogy to help us communicate with our patients. We can use the knowledge they have to support new knowledge. Ie “Here is how your body is like a car, but it differs in this way…”

    Now I am not supporting calling our knowledge or management strategies “tools”, or that when we learn or adopt new ones we are adding to our “toolbox”. Clearly that would be madness. 🙂

  7. So you’re saying don’t use the metaphor because you don’t like comparing people to machines, but you use the metaphor to explain things to your patients? Also, you should maintain your body, just as you would maintain a car, but DON’T you DARE compare people to cars… I am not really sure I get your point of this article. I also have no idea why I am taking the time to write this comment, because I have already wasted enough time reading this page.

    • Ezekiel

      I’m not sure why you bothered to comment either and likewise in not sure why I’m bothering to respond but here goes…

      You missed the key point of this piece is that I ONLY use this metaphor to undo all the bull shit that comes with it when other therapists compare humans to machines.

      Again as I said to compare the self regulating, sentient human being to a dumb (or even smart) machine is ridiculous.

      When people do, I use this counter argument/metaphor

      That is all

      I’ve wasted enough of my time explaining something I already explained quite clearly and simple to someone who has difficulty understanding a short simple blog

      Good day

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