UK: Physios for ME

I don't think we are physio-bashing really, the problems arise from the way their specialism is used in parts of the NHS. There's an automatic referral built into some care pathways (e.g. psoriatic arthritis), without enough consideration about whether it's necessary or even appropriate. That's not the fault of individual physios, the issues are with the commissioners and doctors who design care pathways and recruit staff teams.

As with my arthritis, there is no clinical justification for referring most ME/CFS patients to physios. There's little or nothing they can offer. But as the NHS is likely to refer them anyway because they rarely seem to question assumptions and practices, let's have the best informed physios possible.
 
That's not the fault of individual physios, the issues are with the commissioners and doctors who design care pathways and recruit staff teams.
The physios are allowed to say that there isn’t anything they can do for the patients. Like every other specialist has to do every day.

My eye doctor doesn’t keep seeing me because he acknowledges that he can’t do anything about my visual disturbances. The neurology department refused the referral because they saw no indication of there being (detectable) neurological issues at play.

For some reason, physios just keep using the rehab tool for everything. And that’s on them. It’s irresponsible, unethical and harmful.

They are responsible themselves for sustaining the belief of illusion that physios can always help.
 
The physios are allowed to say that there isn’t anything they can do for the patients.

Yes, which is exactly what mine did.

That doesn't stop the next patient with the same disease being auto-referred to the staff physios, though. And because there are some patients they're able to advise, the service provides some value.

Trouble is, nobody looks at the detail or asks what clinician (if any) could best help this particular patient with these particular problems. They just feed them into the sausage machine and keep ticking items off the list until all the boxes are filled.
 
Yes, which is exactly what mine did.

That doesn't stop the next patient with the same disease being auto-referred to the staff physios, though. And because there are some patients they're able to advise, the service provides some value.

Trouble is, nobody looks at the detail or asks what clinician (if any) could best help this particular patient with these particular problems. They just feed them into the sausage machine and keep ticking items off the list until all the boxes are filled.
Yeah, which is a separate issue.

I can see why in practical terms it’s better to have good physios absorb some of the patients, than to have no good physios at all.

The issue is that as the latest post demonstrates, physios have a hard time letting go of their tools and you end up with harmful advice even from the better situated physios.

But I think we’ve covered that already.
 
Dr Nicola Clague-Baker
‪@claguenjc36.bsky.social‬

1. Training of #hcps
People with #ME/CFS and #longcovid I need your thoughts and ideas please.
I would like to develop simulation training for all #hcps.
We now use a lot of simulation which means that we can simulate severe #ME and #longcovid in a hospital setting.

2. We use actors or videos or digital technologies to make the situation as realistic as possible.
What would you want to include in a simulation to train #hcps?

Thanks @physiosforme

Bluesky thread with ongoing discussion.
 
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Why can't they just talk to patients directly?

I have serious doubts that anybody who not had ME/CFS could reproduce a decent simulation of it. Quite concerned about the risks of this, actually.
Would agree but it’s the listening/hearing and respecting and taking on board what’s said rather gab the think they know better/we are to be managed if manipulated that’s the problem with hcps ie definitely not them doing the talking without knowledge.

Had a recent encounter with a physio for something else. The woman was vile and knowing what I had came in with a face like a slapped arse from the start and clearly thought I had nothing to offer. Pathetic but seems to be the way the few who could listen and interact like human beings sadly are moving (tho sometimes due to their own ‘issues’ that I thinks also prevalent in general pop of mental health or culture things since covid lockdown let them avoid people)

And definitely can’t be arsed with being expected to have answers about when is it too much - instead I got more bigot I assume to cover their pretending it wasn’t their gap in knowledge or doing their job with a belief ‘nothing is too much’.

Who knows what was wrong with her but yes it was bigotry and I had someone else with me who got to observe for once and it started before she’d even seen my face or heard a word. So strange. Tho she did say you can adapt exercises eg do them in bed , just seemed to have a pre-set idea in her head before I spoke that I’d be lazy/‘afraid to move’. That the only possible problem would be me not doing enough of moving it , the other way round of possibilities couldn’t possibly exist.

So she couldn’t be an adult ever of hearing what always happens later which is if I do a little bit too much for me the whole body area flares up and goes backwards. Which means they don’t want to deal with us because if you have decided before you start that you won’t hear or see fact or truth if what happens because the Chalder-esque vile slurs are in their head as if we are made ‘phobes for no reason’ you can’t do a job.

I’m bored of being ignored like my voice is just there to pause whilst u speak then ignore and carry on as if I’m an interruption they’ve been told or just got in their head wasn’t worth wasting their ear energy on. It’s hard to describe how strong a person you have to be to take such behaviour designed to psychologically injure and make you nothing and that shouldn’t be allowed. So I’d be tempted to do a test equivalent to the ‘how did they speak to the receptionist when they came for a job interview’ type thing and catch out behind the scenes chatter to find out those who just intend to ‘deal with us’ etc.

But I don’t think they stop to think or get a simulation of what it’s like to have what they think should be water off a ducks back ten times a day for thousands of day in a row. And how we only get the horrible side of people they claim are supposedly nice underneath. Which shouldn’t mean we have to call them nice or with good intentions. People seem strangely confused by that - that they should be judged on how they act.

Yes there is a danger the ignorant take it as learning to manipulate the situation and patient (or their words) to get what they want . So any assessment probably needs to be explicitly looking out for that disrespect (understatement of a word) and requiring resits ie failing hcps doing the course on that basis - instead of listening to be interested listening to be sociopathic at best and at worst twisting someone’s words in notes etc.

Problem is when talking about severe me/cfs even when it’s needed for something else we have to even consider whether something at home with a physio so kind it hardly exists would take out of us. Just a conversation is a lot and even being manipulated causes me huge payback to the actual body part as well as others no physio would think logical. So if it is trying to train lots of hcp I can see why it needs to be simulated , particularly if training is at a hospital.

But how do you get that point across to someone - that the simulation of some poor severe person having to travel to a hospital for it is definin current system likely to happen but it doesn’t mean it’s sustainable or good - and not to kid themselves because we turn up with a smile the first few times, (because we really are the biggest try-hard kind people underneath that’s why it’s so shocking the snarky dismissing slurs we had) and try and give ‘positive’ feedback because we want to be open minded that it isn’t a typical pattern that by the 3rd, 4th onward it’s starting to do a lot of harm and it’s only by then we are sure it really is that and no we will have checked it’s not how we are doing it etc.

Plus the journeys will be biting massively. I don’t know how that’s solved with the nhs set-ups, how much control those attending said course have other any of those factors and whether it’s in any hcp control to offer home visits video, and really understanding how important time of day options is vs of course every patient will say that. I’d spread them further apart too.
 
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I have serious doubts that anybody who not had ME/CFS could reproduce a decent simulation of it. Quite concerned about the risks of this, actually.

I think I would agree here.

Sever ME/CFS consists of a set of symptoms, which you cannot simulate. All you could do would be pretend to have symptoms and arguably that is the last thing professionals should be trained on.

And I think that the idea that there is some stereotype ME/CFS case that people can learn about all other ME/CFS cases from is dangerous.
 
I don’t think it’s a bad thing, for reasons Bobbler has said, we do sometimes need to interact with physios for non-ME reasons.

Even removing the “big old explanation of what ME is” because they already have an understanding, is something helpful.

I don’t see any reason why an actor can’t simulate the experience of being a severe ME patient, no it might not be perfect, but for a HCP to have a tangible experience (that will probably blow their mind) that ME is “not like other illnesses” and you don’t default to encouraging people to push, you don’t engage in long back-and-forth negotiations about what people can and can’t do, because that’s exhausting for the patient, and no it is not the time to drop in your NHS sanctioned questions about healthy eating/weight/5 a day either.

Honestly this kind of training would be useful for all HCPs. It’s less about a medical simulation and more about experiential learning how ME is different.

Like many things, it’s not that difficult to understand how ME affects a patient. Anyone with a reading age of 11 could review a simple list and gain that knowledge. Part of the reason they don’t just absorb the facts then amend their behaviour is that they don’t see it, they don’t understand what they see, they don’t consolidate the knowledge so…they just fall back to thinking its depression/attention seeking/lies.

Notwithstanding that acting as a Severe ME patient in a hospital is difficult because there are no beds in the UK for S/VS ME and people avoid hospitals at all costs…so an empty bed would represent most pwME!
 
I think they mean simulating the experience putting the non disabled person into the situation of the disabled person- we did a session at work years ago about visual impairment with different sets of glasses that showed a wide range of different vision issues.
 
I think they mean simulating the experience putting the non disabled person into the situation of the disabled person- we did a session at work years ago about visual impairment with different sets of glasses that showed a wide range of different vision issues.

I think that is probably a rather different exercise. I imagine the idea is to get actors to pretend that they are experiencing symptoms of severe ME/CFS. I see that as problematic because the one thing we need to get away from is having health professionals with an image of someone pretending when it comes to ME/CFS.

Nobody can simulate an experience for someone else. We never have any experience of others' experiences. All you can do is simulate a response to an experience.

The problem with pretending was very salient to me when watching Jennifer Brea's 'Unrest'. I realised as it went along that a lot of the filming of her mobility and cognitive difficulties was acted. It had to be. That could be legitimate but only if it was explicit. In contrast the footage of J T-B obviously showed real physical disability due to longstanding damage to muscles involved in standing.

When I watched 'Unrest' I was 'on board' and took it as legitimate. But it struck me that it might badly misfire if shown to people who were not. Over time I became more ambivalent about the whole thing, which was unbalanced in a variety of other ways.

Thinking of myself as a trainee, whether physician or physio, I am pretty sure that if faced with people acting the part of severe ME/CFS I would come away thinking the whole thing was a con. I came away thinking that when I briefly got involved with 'patient partners' for teaching about RA. It encouraged a lot of bogus medical folklore that should never have been there.
 
Bluesky thread with ongoing discussion.
This just isn't clear enough. There's already confusion here.

Are they (1) simulating dealing with a patient with severe ME (from the viewpoint of HCPs), or (2) simulating what it is like to be a patient with severe ME from the viewpoint of the patient?

I am assuming (1) because (2) doesn't seem possible without subjecting the subject to harm.
 
This just isn't clear enough. There's already confusion here.

Are they (1) simulating dealing with a patient with severe ME (from the viewpoint of HCPs), or (2) simulating what it is like to be a patient with severe ME from the viewpoint of the patient?

I am assuming (1) because (2) doesn't seem possible without subjecting the subject to harm.
Subjecting who to harm? An actor or a physio?
 
I think they mean simulating the experience putting the non disabled person into the situation of the disabled person- we did a session at work years ago about visual impairment with different sets of glasses that showed a wide range of different vision issues.
This is what I thought at first, but now I think it's probably more along the lines of what @Jonathan Edwards is suggesting.
 
Both google and publications talk exclusively about putting the HCPs into scenarios where they will act out what they would do if they were the HCPs in the real situation.

So I’m guessing it’s not putting on partial blindness glasses, but rather how to deal with a patient with partial blindness.

I don’t think that’s going to be useful. It’s not difficult to adapt to the needs of pwME/CFS once you’re aware of them.
 
The problem with pretending was very salient to me when watching Jennifer Brea's 'Unrest'. I realised as it went along that a lot of the filming of her mobility and cognitive difficulties was acted. It had to be. That could be legitimate but only if it was explicit. In contrast the footage of J T-B obviously showed real physical disability due to longstanding damage to muscles involved in standing.
Yes, I think parts of Unrest are certainly dramatized. In fact Jen Brea in my opinion does not look like a typical ME/CFS patient. The fits and collapses are not representative of my experience. I suppose we only saw the 'highlights' (or 'lowlights' perhaps). Most of us are much more boring than that!
 
There will be physicians who were open-minded or on the fence about ME/CFS before watching "Unrest" who will come away thinking it is entirely psychogenic. That it was & continues to be promoted by charities and advocates is just astonishing to me.

"Have you ever had a fit or seizure?" is a good screening question, actually. Anyone who answers "yes" should not be a participant in ME/CFS research - or feature in public advocacy efforts.
 
There will be physicians who were open-minded or on the fence about ME/CFS before watching "Unrest" who will come away thinking it is entirely psychogenic.

What made that impossible for me was the short takes of J T-B. I met both Jen Brea and J T-B at the House of Lords at the launch. My understanding of ME/CFS has been deeply influenced by that short sequence of Jessica, meeting her and reading what she has written.
 
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