I qualified as a physiotherapist in 1998 and worked for 10 years as a clinician (UK NHS and private sector) before moving in to academia. My interest in research began very early in my training and while working full-time as a clinician I undertook an MSc in Health Services Research between 2003 and 2005. During this period I reached out to other active researchers asking if I could join them and also began writing for publication. This eventually led to a full-time position at a University and a PhD.
But, as I write this blog I have been away from clinical practice for over 10 years. My wife has been saying for a long time, ‘you can’t call yourself a physiotherapist because you don’t treat patients!’ I used to defend that point, but now I am happy to concede that she is right. I am an academic…
Let me explain my transition, my crisis of confidence and now my acceptance. As an academic, my day-to-day job includes identifying useful research questions, collaborating with patients, clinicians, and other academics for this purpose, writing grant applications, securing ethical approval, setting up and monitoring large-scale research studies, preparing reports and publications, presenting at conferences, managing a diverse group of people, and herding cats. There’s a lot more that my day-to-day job involves, including supervising, mentoring, reviewing, assessing, teaching but the reason for me stating these things is to highlight how different my role is now to that of a senior physiotherapist 10 years ago.
I often hear criticism of academics for not understanding the ‘real’ clinical world. I understand the basis for this criticism, but I think one problem is that some of this criticism is based on a lack of understanding of the academic role (yes, yes, I recognise it’s far more complicated than that but this is a blog trying to deal with one aspect of a complex issue).
Let me give you an example. The SPeEDy study (surgery versus physiotherapist-led exercise for traumatic tears of the rotator cuff) was an idea conceived over two years ago. Many clinical physiotherapists would ask me; ‘what about traumatic rotator cuff tears, what should we do with them?’ Then, a patient approached me; ‘I’ve got this problem, here’s my history; what should I do?’ So, as an academic, I looked in to the research literature. I could see that clinical views were strong but there was a real case for uncertainty and a case for further research. I reached out to clinicians (surgeons and physiotherapist), patients, and other academics to develop an application for research funding. Last year this application was funded. We will work with expert clinicians (surgeons and physiotherapists) across eight hospitals in the UK. They will be integral to the development of this study. I also reached out to physiotherapists, asking them for their input on the physiotherapist-led exercise intervention, rather than relying on my individual views. We are now in the process of setting this study up, developing study processes, seeking ethical approval etc etc. This is now my day-to-day role.
So, what is my intention for writing this blog? Principally to highlight the different skill sets; it’s not an ‘us’ versus ‘them’ type scenario, but rather a recognition of different skill sets. I recently stopped delivering my ‘rotator-cuff’ courses for a number of reasons, but a part of this was me recognising my role as an academic and naturally my case for uncertainty, which is not always a good outcome from a clinical course. I am far more comfortable now with uncertainty, not knowing, but wanting to find out the ‘right’ answer. As a young clinician I valued my training in McKenzie’s method of Mechanical Diagnosis & Therapy (MDT) tremendously. I spent a lot of time and money on this training and it helped my confidence so much. But then I began the diploma in MDT and realised that many of the claims were not substantiated. Overnight I went from a confident clinician to a blubbering idiot! This was difficult because much of my clinical efficiency and reputation had developed in relation to this approach. Essentially. I had become conflicted without knowing.
Of course, I still have conflicts, often unconscious. But I have the luxury of not having that clinical pressure when designing and delivering research. This links to the concept of equipoise which is an important concept underpinning research. Essentially if you’re an advocate of an approach then legitimately the clinical and research communities can ask whether you are the best person to be leading that research.
Working together is the answer, recognising the different skill sets.
Thanks for making it this far.