It is hard to change behaviour
Previously I was thinking about all the things that end people's lives in western and other industrial or post-industrial societies. All the main causes of death are due to our behaviours, for example smoking, overeating, eating unsuitable foods, taking no exercise and driving too fast. Quite a catalogue.
Shouldn't it be easy to change our ways and prevent the problems we really don't want? If you want to stop smoking, don't put cigarettes into your mouth. If you want to lose weight, don't eat. What could be easier? Didn't Mark Twain say something like "Giving up smoking was the easiest thing I ever did, I must have done it a thousand times."? Dieting and giving up smoking are very simple things to do, so straightforward, so clear to understand that it's a wonder why they are so difficult to do.
I don't think there is anything harder to change that our or someone else's behaviour. Our behaviours are so important to our coping in the world that we are very attached to them and find them difficult to break once they are set. We often stick with behaviours which are counterproductive or personally damaging, so difficult do we find it to give them up.
So it would be a good idea, if we want to change, to make it easy for ourselves when we try to stick to a new line. The process of change is complex and interesting, and I will return to this process again.
A buyers market for physiotherapists
The large NHS hospitals were the automatic choice of many newly qualified physiotherapists when they were considering their first job. It seemed the obvious choice with the variety of experience, supervision systems, peer support and on-site expertise.
A small town hospital in East Devon (South West England, UK) recently advertised for a junior physiotherapist. Nobody goes there without a good reason, it's just not on anyone's travel plan. The breadth of experience is restricted, the opportunities relatively few. Did they have any applicants?
You bet! They had over two hundred!
Now some of those can be explained by the fact that India has a surplus of physiotherapists at the moment, with an M.Sc. necessary for them to progress. Many apply to the UK and are now finding they have little chance of success with the large numbers of unemployed UK applicants.
Out-of-work physiotherapists have had to make many hard decisions to go forward somehow. Some work in non-health jobs, others have taken volunteer posts or posts which are usually taken by unqualified people.
One upshot of this is that physiotherapists have been forced to think more flexibly about where they might get their first few years experience. We in the large acute hospitals are unable to magic up a huge number of new posts, although we have done our bit to be creative.
Physiotherapists are now considering getting their first jobs in community posts or in small provincial hospitals. That should be good for the units concerned as it was always hard to attract applicants to what may have been seen as less glamorous areas of work.
This market is putting a huge pressure on the locum agencies, who are finding the number of posts available has been cut dramatically. We are in an intense buyer's market for the moment. As the manager of a department it is good as we get people queueing up to come and work for us and can take our pick of good candidates.
It is hard for those caught up in the process however. Many are finding they cannot be so casual about their choices anymore. Can you go travelling for a year and risk coming back when the next year's cohort is qualifying and looking for jobs?
The quality of applications is one of my little obsessions. Some are so bad I can't think they really want a job. You need to be good even to get considered at the moment, let alone appointed. The market is working it's cold magic.
Do we think we are normal?
Habits have a bit of a bad press. We all tend to concentrate on bad ones, usually when performed by someone else. They must have survival value in the world, be a useful set of behaviours to approach the many situations we have to cope with.
Sometimes we don't see that our habits have moved into another dimension, the dimension where they don't make much sense to other people. We cling to our habits, perhaps because we have so much of ourselves invested in them.
One of my customers was telling me about the communication difficulties he was having with his nearest and dearest. It's always difficult when you get one side of the story and I am very conscious of not giving advice about relationships. But exploring these things can be fascinating, and have impact on the therapy for the person.
On questioning (always a much more powerful technique than telling) he has specific and rather rigid habits. He likes all the dirty crockery and cutlery lined up and in particular containers. He does most of the duties about the house but complains his partner does not do enough.
How does his behaviour look to his partner? To me it looks a little obsessive and is probably irritating. However he has not asked her what she feels about the way he behaves. He laughed somewhat sheepishly when I pointed this out. He likes everything done a certain way and at a certain time (straight away - which tires him out) and very likely is unable to delegate and let someone get on with a job (or not).
Sometimes we are so much in the groove of our habits that we forget there is even the vague possibility of someone doing it differently. And that different way could be as or more valid than our own way.
Now all I need to find it someone to tell (or ask) me about my habits and perhaps I can change and be more effective too.
Physiotherapy jobs - that time of year again.
It's the time of year when people coming to the end of their training courses start to try and promote themselves into a job. Physiotherapy in the UK has overshot its required training numbers by an unknown but significant amount.
This leads to a very tight market in new physiotherapy jobs. It's already tight in the NHS jobs market and that's before this year's crop of 2000 or so new graduates hit the streets.
In my medium sized NHS Trust, an acute hospital of 830 beds, we have had over seventy enquiring letters so far, with the majority I suspect still to come. Anxiety about getting a job in your chosen area is a new feeling for physiotherapists.
Approaches by letter vary quite widely in quality and care. Good presentation is important in a competitive environment. A must is to give an email address, often surprisingly omitted. This makes it much easier, and less expensive, for us to reply.
Some people just promote themselves so badly it's hard to see them managing to persuade anyone to give them a job. The prizes will go to the good self promoters, the flexible, the persistent and the achievers. There'll be losers, unfortunately, who may get less responsible and rewarding jobs for the foreseeable future. It's hard to see what will happen next but I don't expect applications for physiotherapy training to take a dive.
Lifting Training Does Not Help Low Back Pain
All of us who work in NHS hospitals have a lot of mandatory training to do every year. It's part of our contracts and includes cardiopulmonary resuscitation, fire, child protection and manual handling.
There has been a big push to get manual handling training a higher profile and in our department no physiotherapist should touch a patient before they have this. Mainly this is for insurance liability reasons so the organisation can discharge its legal duties to the staff.
I've never been sure whether manual handling training prevents physiotherapists, or other staff, from developing low back pain. Yet it's always seen as "a good thing".
Now the British Medical Journal
has published a paper by Martimo et al in the January 2008 issue which reviews research evidence whether training or advice reduces the incidence of low back pain conditions.
They conclude there is no evidence that advice, training and using lifting aids prevents low back pain or the disability from it.
It looks like there may be reasons for manual handling advice and care but preventing back pain may not be helped by this. We don't know enough about what stresses physiotherapists and nurses physically and how this translates into low back pain problems.