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Majd’s Philosophy of Care

Published: 21 May 2019 - Injury Treatment and Prevention, Men’s Health, Physio Tips, Wellbeing, Women’s Health

Why are we all here? What’s life all about? What gives our existence purpose and meaning? These questions have been pondered by some of the greatest minds on Earth for millennia, and if they couldn’t figure it out in all that time then fat chance I can… well not until I’ve had my morning cup of caffeinated black-gold anyway! But if I narrow the field a little to the realm of physiotherapy, I might just stand a chance. So what is my philosophy of care and how do I apply it in my clinical practice? Well, pour yourself a dram of single-malt, pull out your pipe, and nestle into your chesterfield armchair as we discuss the 3 principles that underpin my approach to treating every patient that walks into my rooms.

Principle 1: Respect the Sovereignty of the Individual

This idea has its roots in the ideas of the German philosopher Immanuel Kant’s deontological principal… wait, WAIT!!! Sit back down, I’m about to tell you what that means for you. It means that you are the king and your body is your kingdom. Interested now ‘your majesty’?

The way I see it when most people come to see me it is because there is something wrong in their kingdom and they are seeking my council to get things in order again. Before you ask, yes I have been watching Game of Thrones. Even still, what this means in real terms is that as a clinician I have no power to force you to do anything; for me, that idea died with the 1950’s ‘prescriptive’ model of healthcare. I will never force you to stop an activity, change your work arrangements, or send you for a surgery or any other procedure. Instead, my job is to listen to what you want to achieve, identify barriers to accomplishing that goal, and help you formulate a plan to get there. If this involves any of the previously mentioned steps, it will be my job to convince you of why I think this is the best course of action. If you are unconvinced, it’s also my job to give you a plan B, and even C. You’ve enlisted my advice to achieve your goals, but only you have the authority and ability to bring them to fruition. So we work as a team and together we will take steps to restore peace and order to your kingdom. Winter is coming.

Principle 2: Clinical Judgement

Ever heard the morbid saying, “there are many ways to skin a cat”? Well, this idea is just as relevant in healthcare. There is often more than one way to achieve your health goal; just Google “how to lose weight” if you don’t believe me. So which is the best way for you? Obviously, that’s going to depend on exactly who you are, and exactly what you are trying to achieve. In science, the methodology used in the best studies are usually those that involve a lot of subjects being observed over a long period of time; when we apply this information in the clinic, this is broadly referred to as Evidence-Based Practice. This is a fantastic way to get a general answer to a question such as “how long will my hammie tear take to heal?”, and the timeframe the data gives us will likely be accurate. But will it be specific enough to factor in your unique circumstances? That’s unlikely. After all, it’s reasonable to assume that the time taken to heal from the same injury will differ from an athletic 16-year-old girl to an overweight 40-year-old man, and there are very few studies that measure this exact scenario let alone the millions of other conceivable variations. As a student, I spent nearly a decade at study in the tertiary education system, and since then I’ve lost count of how many weekend and day courses I’ve been to. But although this ‘Evidence-Based Practice’ is absolutely necessary for the highest quality, ethical healthcare, by itself, it is not sufficient.

The past decade of practical and clinical experience at sporting clubs, hospitals, and private practice clinics, has exposed me to countless ‘exceptions to the rules’. Some of these scenarios involved something that worked slightly differently from what they taught in the textbook. In other cases, you may as well have thrown the textbook out all-together. But each one of these ‘special’ cases sticks with you and teaches you something. In time, you begin to detect patterns that alert you to when a ‘special’ case might be sitting right in front of you, and as an experienced clinician, you begin to plan your strategy accordingly. If you get it right, a potentially long and drawn out process of trial and error can be fast-tracked to a solution that could otherwise have taken weeks or months to get to, saving the patient time, money, and unnecessary suffering.

This synergistic marriage of both Evidence-Based Practice and Clinical Experience leads to sound Clinical Judgement.

Principle 3: Collaborative Care

This leads me nicely to the third pillar upholding my philosophy of care; collaboration. I’ve just explained why clinical experience is so crucial to clinical best practice but doesn’t that mean that different clinicians are going to have different sets of clinical experiences? Yes, it does, and it’s a darn good thing!

No matter how much you study, how many sporting clubs you’ve worked at or how long you’ve been a clinician; you can’t see it all. At our clinic, we know that two heads are better than one, and five are even better still. As such, we have two formal discussion and professional development sessions a week where we have a round-table conversation about complex cases, and as a team, we come up with the best plan to tackle them. Countless informal discussions happen daily to the same end with a knock on the door and a “Hey, can I quickly run a case by you?” type culture being strongly encouraged.

Also, a good clinician has to know their limits. When something is over my head, I have to know when to call it. But that doesn’t mean I give up on you! No, that is when I comb through the pages of contacts I have made in my years of practice to find the best person to help you with the next step of your journey. This could be a GP, surgeon, pain specialist, psychologist, exercise physiologist, lawyer, or even another physio. If I feel that the next step in your journey is best served by someone else, I’ll point you in the right direction and make all the arrangements.

Collaborative Care is the principle that reminds us that the best practice medicine is not about the ego of the clinician, but the best outcome for the patient.

So there you have it; the three principles that govern my Philosophy of Care in clinical practice. If you’ve stuck with me this long, hooray for you, you modern-day Aristotle! Time to put the pipe down, get up from that armchair and carry on ruling your kingdom, and if I can be of service at all then I am at your call your majesty!

Although… perhaps just one more dram first…

Written by Majd Rezkallah, Director and Principal Physiotherapist, Back In Motion Rowville.

Majd completed his physiotherapy degree at the University of Melbourne and joined the Back In Motion family in 2016 after 5 years in private practice. Majd has an affinity for the less common physio ailments such as Benign Positional Paroxysmal Vertige (BPPV) and Tempoero Mandibular Dysfunction (TMD), i.e. jaw problems. Majd is also a qualified personal trainer and sports trainer. 

Back In Motion Rowville provides Physiotherapy, Exercise and Rehab, Massage and Clinical Pilates for clients in the Rowville and surrounding areas. Their 5 fantastic physios offer one-on-one and semi-private classes and their bright and bubbly reception staff make your visit as close to seamless as possible.