Master Manipulators


As a physiotherapist one of my main goals is to help whoever comes through my door while making an honest living trying to do so. I love my job, as one colleague said to me “the best thing about the job is the patients, the worst thing about the job is the patients”. I am probably best clarifying the latter part of that quote. For every patient who will do their utmost to adhere to a treatment plan i.e. home exercises, home management plan and an ability to turn up on time for every treatment session,  there will be another patient who seemingly does everything in their power to frustrate you by doing the opposite (this is a topic for another posting).  I will always do my best and try to use everything I have within my skill set to help my patients achieve their goals (if possible) through physiotherapy.

 That is why I have find it particularly galling to come across stories concerning health professionals who seem to be entirely profit driven. Recently, I have come across multiple patients who have told me stories about expensive initial assessments followed by a course of expensive treatment sessions.  For the purpose of this blog (and from my own perception) I would define expensive as being in the region of £60 and above. I appreciate that the term “expensive” is open to interpretation, so I would say the price I have defined is when the cost of an initial assessment or treatment session becomes excessive or blatant profiteering off the misfortune of others.


Apart from my surprise when I hear the prices some patients are being charged for their treatment sessions I find it even more alarming when treatment programmes are heavily reliant on manual therapy. While manual therapy has its use as a therapeutic modality the long term ability to successfully manage a recurrent problem will depend heavily on the often touted home exercise plans. When these patients have explained to me that the physiotherapist they have seen has failed to provide them with a home exercise plan to do in conjunction with treatment I cannot resist the need to provide a look of disappointment  upon hearing things like this!  "No home exercise plan?!"


Exercise is the gold standard of anything that may exist in the physiotherapy toolbox, especially when it comes to the long term management of most recurrent conditions. It gives the patient the opportunity to develop a locus of control over their condition and should reduce the need to go back  for further physiotherapy in the long term. Failure to provide this creates a reliance on manual therapy in patients who may feel that regular treatment sessions are the only way to consistently manage their symptoms.

From a moral standpoint, I find it to be abhorrent when a physiotherapist purposefully deprives the patient of an effective long term management plan. I can appreciate that people need to achieve what I referred to as an honest living, however, achieving this at the expense of the patient by artificially creating a need for regular treatment sessions is not appropriate. It is entirely unethical for the physiotherapist to use this dependence on manual techniques which keeps the patient coming back time and again. Their repeated treatment sessions are rendered ineffective by a need for additional treatment. A patient should become empowered by their physiotherapist, not dependent upon them.

From the unscrupulous therapist's standpoint there is no profit in providing home management advice and a home exercise plan. Creating a reliance on the physiotherapy means greater patient retention and in turn, greater profit. This approach is wrong and something that should be struck out from the profession. I wish to clarify that while I am not against the idea of fair payment for professional services, excessively profiting off individuals who are often in a vulnerable state through instilling the idea that relief from persisting symptoms will only be achieved through extensive treatment sessions. While it may be okay to manipulate a patient's spine (as long as it is not contraindicated of course), it is most certainly not okay to manipulate their wallet. Patient’s place their trust in us and our ability to facilitate and manage improvements in their condition. 

Please do not exploit this trust.


 Alex Curran LinkedIn Profile

Read more from Alex :

The importance of being honest 

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