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I’m in my living room with a man about the same age as me and he is rubbing my leg and buttock!

The man is one of my best friends, Carl Dunstan. He is also my Physiotherapist (he was my Physiotherapist first).

Carl is one of the best clinicians I have ever met in any discipline or speciality.

He is a rare breed indeed of someone who understands their subject intimately but also has the emotional intelligence and empathy to be able to deliver healthcare in the most caring of ways.

He is here ‘at the drop of a hat’ to help me in my moment of crisis which now comes about twice a year when the symptoms related to my damaged left knee erupts. At this point I think it’s all over and I won’t be able to ride my bike anymore or be able to work, I think I’ll need surgery and life is terrible. He comes and fixes me.

In the dark days when my knee pathology was first diagnosed and I had to mourn for the loss of the person that I thought I was becoming but could never now because part of me was broken, it was Carl who fixed me then but psychologically that time.

Today it’s mostly physical but there is always a psychological element.

It was Carl who taught me the most about placebo and about how it doesn’t matter even if you know it’s a placebo because what matters is that is works.

Today he taught me something else again or at least reminded me of a fundamental basic related to working in healthcare.

Just because we could doesn’t mean we should.

Carl says in his physiotherapy practice at Queens Medical Centre in Nottingham that the conversation has changed out of sight in the last 10 years.

He runs an extraordinary extended physiotherapy service and is currently involved in a pilot scheme whereby if you have a knee injury or a shoulder injury you see him first, not an orthopaedic surgeon. He decides on the treatment that you require.

Only 20% of the patients that Carl sees go to surgery.

The conversation he has with people who have damaged knees like mine goes something like this…

‘10 years ago, the conversation was “can we do something” and much of the time we couldn’t, now the conversation is “should we do something” because most of the time we can.’

There has been a fundamental shift in healthcare where patients expect an intervention for the condition that they have.

2 years ago, I decided not to have surgery and to manage the situation with my knee for as long as humanly possible before anyone put a scalpel into it. That advice was given to me from Carl, his wife Ellie (both physios) and my wife. It was some of the best advice I have ever had.

It’s unlikely that my symptoms would be better now even if surgery had been carried out and in the long term I have the option of surgery should I need it.

Working with Carl’s expertise I can get over these little bumps and symptoms and carry on to still do the things that I would like to do (minus the running which I would never have been able to do with surgery anyway).

But after situations like this and being a patient myself again I reflect back to my own practice.

I am a surgeon (at least that’s what it says on that bit of paper I have) but in the end, we must be physicians first.

We must advice against active treatment when there is still a possibility that patients themselves can adapt to the situation and maintain quality of life without intervention.

It seems we live in a world where everyone thinks they can now buy themselves out of trouble but physiology and mother nature never worked on that basis.

Blog post number: 1640