What do you think it is?

While at university I had a lecturer who would consistently say during most lectures or tutorials that “as a physiotherapist, you are paid for your knowledge” whenever someone would query why we had so much directed study. It is a mantra that has stuck with me and I have always tried to stay true to it. Why I have started this particular blog post in such a manner will quickly become apparent.

A friend was recently referred to physiotherapy after developing pain which consistently referred down the left arm on most movement which on a scale of 0 to 10 for pain would consistently reach either “Oh My God” of “F*** me, that hurts”. Like most of the general people with access to a smartphone they Googled their symptoms which ended up with results beings generated such as (and in no particular order):

  1. *Heart Attack.
  2. Carpal Tunnel.
  3. Ulnar Nerve Dysfunction.
  4. Repetitive Strain Injury.

After a time, this friend arranged an appointment with their general practitioner who then provided an urgent/priority referral to a musculoskeletal physiotherapist with instructions to be seen by a senior physiotherapist. Following the initial assessment with the senior physiotherapist my friend received a set of home exercises to do with the “three times a day, 10 repetitions per exercise and a five second hold” standard. However, upon getting further information about the contents of the assessment one thing caused me concern. During the assessment, the senior physiotherapist asked the following question:

“What do you think the problem is?”

What do you think the problem is?! As a patient, these are words you do not want to hear at any point. Especially from a professional who has as an air of seniority about them, both in experience and, importantly, their job title. A patient wants to be able to trust their physiotherapist and be assured that they know what they are doing. I both appreciate and understand that the area of differential diagnosis (or clinical reasoning as I have come to call it) can often surmount to a series of degree level educated guesses but there should never be an admission of uncertainty to the patient. Any degree of weakness or uncertainty that is exhibited to the patient always increases the likelihood that you will lose the patient, once you have lost that patient it will be all but impossible to get them back. First impressions count. Throw away questions such as the one above are a cardinal sin in my book. There is always a chance of being wrong, but you have to convince the patient that you are mostly right.


Health professionals are paid for their knowledge, the patient is not, that is why they come to us. They see us as the experts and the gatekeeper to the relief of their presenting symptoms. For a patient to be able to maintain trust in their health professional’s ability it is essential we exude confidence in our work and our knowledge. Knowledge creates confidence and trust. Without that knowledge, how is the physiotherapist (or any other health professional for that matter) meant to inspire confidence in the patient about the standard of care they receive. We train for years, racking up hundreds of hours on placement and doing self-directed study. We are the ones with the degree, not the patient. No patient should ever have to field an inept question such as this. They are there to find out what is wrong and get it fixed as best as possible.


If you are paid for your knowledge and expertise it is essential, as a health professional, that you maintain and always try to expand upon it.

As always, thank you for taking the time to read.

 Alex Curran LinkedIn Profile

*In situations like this, Google is both an asset and a liability, please use under advisement and with caution.

Read more from Alex :

The importance of being honest 

Master Manipulators



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