David Bolton is a regular contributor on NOIjam, he’s written more than a few cracking posts, never fears stepping on a few toes, or carving up sacred cows. But as we were reading through a recent draft that he sent us, we had a fascinating response here at NOI HQ, split quite neatly along generational lines. David wrote a piece raising the issue of ‘professionals vs technicians’, but the millennials* in our office didn’t agree with everything he had to say. We thought that this would be a nice opportunity for a bit of back and forth with the hope of stimulating further discussion. David’s words have been left in their original form, but the millennials’ responses have been combined into a single voice. We’d love to hear where you stand in the comments.
David Bolton, a Baby Boomer
The debate here (in the UK) over the Black Cab verses Uber is hot. I only know that when I get into a black cab I know that the driver is a professional. Drivers have worked and studied hard to acquire “The knowledge” as it’s called. They have learnt the streets of London by heart and don’t need a satnav to find my destination. Road works, traffic jams, blocked streets don’t faze them. If I would be in a wheelchair, pushing a pram or have a dog I would still be welcome. I know the driver is insured and that the vehicle is tested and approved. The fare structure is set out clearly and the driving professional. The driver is, indeed not a technician but a qualified, reasoning professional.
Safe, easy and efficient – Uber is the way of the future. Why fight it? I know exactly who is going to pick me up before they arrive, I know their number plate, and have an idea of how well others have rated them. This crowdsourced information means that I’m super well informed about the driver before I step foot in their car. Getting into a cab is a complete unknown for me and more than one friend has had a dodgy experience with a cabbie they can’t track. And what’s wrong with a satnav, or Google Maps? I have great respect for the ‘cabbies of the past’ who have memorised the highly complex ‘Knowledge’ (and developed impressive hippocampi) but these days, why waste your time when technology can do this for you? No fuss with money (safer again not to carry cash), instead my journey finishes with an electronic bank transfer (no chance for those sneaky young boys to do a runner) emailed straight to me. We’re moving forward with the pain revolution – time to move forward with the transport revolution too!
My ophthalmologist has spent many years qualifying medically to be able to make the right diagnostic decisions for the health and safety of my sight. Her diagnostic skills and clinical reasoning are backed up with various tests. Certain high street chains have technicians with similar diagnostic equipment as hers, but apparently, no in-depth professional academic medical knowledge. Yet still they prescribe solutions based on technical findings and not clinical reasoning. I don’t think that a second pair of sunglasses for free is worth the risk!
I don’t wear glasses (yet) so I can’t comment directly on ophthalmology. If I did have a real problem with my eyes, I would certainly want to go to a medical specialist to get things tested and diagnosed correctly – I’m with you there. But if all I needed was an update to a prescription or new glasses, give me a technician with the right equipment any day – more convenient, faster and cheaper! And while we’re at it, can we get the pharmacist to update my pill prescription without me having to make an appointment with a GP four times a year!
My Podiatrist has taken a minimum of four years to acquire his medical knowledge and skills to be able to care for my feet and postural wellbeing. Certain high street shops have similar equipment, found in the Podiatrist’s surgery to measure my gait etc. Apparently, without any apparent in depth medical knowledge they are prepared to prescribe the type of footwear I should use based on their technical findings – they even guarantee a cure for my backache…
Again, my feet are holding me up OK for now. But nearly everyone I know that has been to a podiatrist for anything more than a corn or a wart seems to be told that they need very expensive orthotics. Some of my young millennial podiatrist-friends tell me on the sly that I should try a $20 off the shelf orthotic before I go to them for the $400+ pair anyway, but they’re unlikely to tell me that in the clinic. Whether it’s foot, knee, hip or back pain, there appears to be more than a few fully qualified podiatrists offering near-miracle cures too. Of course this problem isn’t just isolated to podiatrists – physiotherapists, chiropractors, massage therapists all come in good and not-so-good varieties.
The fitness studio down the road offers pilates, yoga, pump and spin to name but a few. If you mention you have pain, often without a scrap of medical knowledge and diagnostic reasoning skills, their fitness class is just what you need for a cure. A “six pack” is all you need.
Hmmmm. If I recall rightly, it was highly qualified physical therapy professionals (quite a few of them here in Australia) that kicked off the whole ‘core-stability’ thing. Yes, fitness people have picked up the fad and taken it too far in many cases, but they can’t be the only ones we blame. But even more, if a fitness professional inspires someone to get out of the house, get moving and get exercising, is this such a bad thing in our increasingly sedentary world? Some banging tunes and a group of my friends in a spin class is a great way to spend an hour – I would encourage more to give it a try.
The guru next door, having done a weekend course is now a “practitioner” of Cognitive Behavioural Therapy. God forbid that you have a psychotic breakdown in one of his sessions!
OK, I can see you point here in a way, but on the other hand, if I want to get really controversial, what’s the real risk here? We ask probing questions all the time as part of a physiotherapy consult, any one of which may trigger a significant response. The weekend warrior might just have a few better tools to get through it safely than a lot of allied health professionals, and doctors for that matter.
Many patients end up in my care because of inappropriate advice and even injury resulting from technically directed applications, given by people who cannot produce any evidence that they have some form of medical knowledge and diagnostic reasoning to their credit.
Sure, this isn’t good. But in my training and work, I’ve heard plenty of horror stories from very experienced, highly qualified health professionals of things going wrong (no deaths thankfully, but lots of people being made accidentally worse), despite the best of intentions and carefully reasoned approaches. I think anyone who is in the business of ‘treating’ another human being has to take on the responsibility of knowing what they can do, and more importantly what they can’t do. This goes for allied health professionals as well as fitness instructors, technicians or any kind of therapist. This is a key personal responsibility and I don’t think we can just trust a professional body or more years of training to ensure this.
The list goes on and my point is, where are we going with all this. Is the age of professionals so outdated?
Maybe it is! But maybe our profession is demanding it – its no longer OK to just be a manual therapist, or just know one exercise prescription base. To keep up with what clients demand and what they need; to treat in a biopsychosocial way, we’re expected to have some understanding of psychology, philosophy, technology, research, and a whole array of movement bases. If we are going to be truly biopsychosocial then we need to up-skill so that we can effectively integrate the psycho, and the social. And maybe stepping outside our profession is a great way to do this. Besides, I don’t want to do just one thing in my life. I don’t want to be only physiotherapist – if there is something good that I can use from pilates, yoga, tai chi or anything to get people moving and living in more comfortable ways then I want to use it or send them to try it out. I’ll always give them some advice about what might be appropriate and what might be going too far, but I also trust people to be in charge of their bodies and not just blindly do what they have been told.
Do we really feel safe in the hands of amateurs? Are we prepared to risk our health and wellbeing in the hands of Technicians?
I think the line between amateur and professional is not what it used to be. I’ve met many ‘professionals’ that bank on their university qualification and don’t keep up to date, or have done masters and further studies but use it to keep justifying their outdated techniques. There are many dinosaurs out there! But with a phone and an internet connection I can now access nearly any piece of knowledge from anywhere in the world. I can ‘sit in’ on lectures from the top professors at nearly any university, or listen to the sharpest minds debate both sides hot topics via a podcast on the bus. Now, I’m not saying that I’d want to have heart surgery from someone whose only training was via YouTube, but I do think that the age of knowledge being hoarded by professions and professionals has passed.
I only know that if I have the choice between an amateur and a professional, I’m prepared to pay the price for the safety and comfort it brings. I put my trust in their academic background and reasoning skills. I take comfort in knowing that if things don’t go to plan, they probably will have the reasoning skill to find solutions, or will know someone who does.
– David Bolton and the NOI millennials
*Millennial – the generation following Generation X. Born in the years ranging from the 1980’s to around 2000.
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