What makes a 'Good Physio'?

Perhaps it's a function of my personal and professional maturation (which can be hard to see sometimes) or perhaps it's due to my romantic passion for seeing this profession realize its full potential, but I've become quite interested in capturing different peoples' views on this topic of 'what is a good physio?'.  In fact, in collaboration with another colleague at Western we've recently kicked off the 'good physio project', which is expected to be a 2 to 3 year series of related research studies that is currently in the information collection stage.  To be clear, we're not the first ones to be interested in this area; for example Margaret Potter and colleagues published their findings on the qualities of a 'good' physiotherapist back in 2003, finding that good communication was the top ranked quality of a good physio.  However it's fairly safe to say that this is an area that has received relatively little attention in comparison to the qualities of good practitioners in other fields such as nursing and psychotherapy.  It's an area that holds relevance to me not only as a passionate advocate of physical therapy, but also as an educator who works to develop physios of tomorrow, and as a father/husband/son/brother/friend/consumer who has personal reasons for wanting to drive the value of quality physiotherapy forward.

This past Saturday I had the very good fortune to be one of the presenters of a 1-hour interactive session on Valuing the Softer Side held during the Ontario Physiotherapy Association's annual congress in Toronto Ontario.  We had a great turnout, standing room only in fact, for this session that was quite clearly focused on an area that not only has received little attention, but is also seen as a sort of 'fluff', that being soft interpersonal skills that can't be easily quantified.  It was heartening to see the turnout and also to realize that we were not the only session that included a component of soft skills in their talk.  I was particularly impressed with the session offered by McMaster University PhD student Folarin Babtunde who presented his comprehensive exam work on therapeutic alliance in physiotherapy.

I decided to start the session by asking the 150 or so attendees to consider the following question: Think about a physiotherapist who you consider to be particularly 'good', this may be yourself or someone you look up to as a model or mentor.  Or if you can't think of a single person, think about the qualities that you think of when you think of a good physio.  I then somewhat dangerously provided my cell phone number and asked the participants to text me their answers.  Within 2 minutes or so I received 96 texts, to the point I had to take my phone out of my pocket due to the buzzing.  In the days since I've conducted a thematic analysis of the responses I received, and from those 96 texts extracted 186 qualities that the audience thought of when they thought of a good physio.  Below is the summarized pie chart showing the relative representation of the different meta-themes I identified within their responses.

UPDATE: I've done this several more times since then, we're now at over 400 texts describing qualities of a good physio.  The image below is the most up to date.

While this was not an ethically-approved study and did not conform to best practices for descriptive thematic analysis (read: I didn't have a second person independently conduct the same analysis then compare results), I've personally conducted this type of analysis several times in the past and like to think I observe above-average academic rigor when doing so.  One thing to make note of here is that, while the responses were overwhelmingly in favor of interpersonal skills, there was still representation for clinical or instrumental skills.  So it's not all about the therapeutic alliance but clinical skills do matter.  However, evidence indicates that the effect of many treatments may be a 50/50 split of the skill or technique of the clinician and the quality of the therapeutic alliance.  This is in contrast to the overwhelming preponderance of pre- and post-licensure professional development opportunities available to physiotherapists that skew strongly towards perfecting instrumental or clinical skills with a conspicuous absence of opportunities to develop these critical interpersonal skills despite what appear to be, at least from the group of PTs attending our session on Saturday, important qualities of a good physiotherapist.

If you're interested in an upcoming opportunity to develop these skills in yourself, I encourage you to actively seek professional development opportunities in this areas as they do exist.  I am running one with my colleagues Jim Millard PT and Jas Dhir PT in Mississauga this coming weekend and it's not too late to register.  Click on the courses link above to find out more.