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Why Physio Discussions Are Just Another Simpsons Episode

I recently stumbled across this video and dug the reference to Comic Book Guy from The Simpsons…

I recently stumbled across this video and dug the reference to Comic Book Guy from The Simpsons. I’ve often thought of Comic Book Guy while following online physio discussions, which is why the video really resonated with me. There is generally a moral undertone to the manner in which allegedly antiquated practices are criticized and an outrage in response to seemingly absurd things other professionals are doing.  This practice also manifests itself in reverse: those who bang on their moral drum the loudest often impose their intellectual will on those who disagree with them.  When one is morally certain, no dissenting intellectual counter is worth hearing.  This phenomenon transcends physio.

Two sides of the same coin…

Most people don’t want to be associated with idiocy so it can be tempting to repeatedly declare one’s allegiance to the side with the “good” ideas.  So many physio posts start with a caption like, “Can you believe people are still doing ‘X’!” These posts are probably emotionally satisfying but I’m not sure they do much to elevate the standard of care.  People are still doing “X” because collectively physio has not demonstrated a superior product and there’s still a market for practices that lack empirical and theoretical rigor. Moreover, contributors to these threads commonly point out that many people will regress to the mean/get better regardless of what interventions are performed. If that’s true why are we surprised that patients gravitate towards providers who offer simple (and often incorrect) explanations about their pain, disability, and compromised function?

I suppose intellectualism amongst providers is a good thing. Physio clearly has a branding issue though and I wonder if hyper-intellectualism further confounds physio’s message to the public. Sometimes it feels like even public service announcements are made more to impress other Comic Book Guys and elicit their “likes” than to garner the public’s interest. The message from informed physios is often effectively something like, “We do graded exposure (which is really what everybody else is doing, including the buffoons we despise) minus the bullshit explanations.” Does the public really care about the “why” as much as we think it does or would physio be better off worrying more about doing the “what” better than everybody else, albeit without advancing information that is known to be inaccurate and implausible?  Intellect is not always proportional to utility.  In clinical domains, greater intellect isn’t always better.  The balance probably lies somewhere between Comic Book Guy and Dr. Nick.

Unlikely to be swayed by logic…