Healthy Life: My Dream 2 (892)
Healthy Life: My Dream 2 – Low Fee
蘇鎮邦 (Christopher So)：
舒整物理治療師 (Manipulative Physiotherapist) 人類工程師 (Ergonomist)
Why is it necessary to be low fee?
On the whole, a physiotherapy fee without health benefits can be expensive and unaffordable especially for long term management (i.e. more than 10 treatments). In my experience, many patients ask on the first appointment, “How many treatments does it need to recover”? This will put undue pressure on the physiotherapist who may be forced to increase the dosage of the treatment in order to get a quicker result. However, for younger physiotherapist with less clinical experience, this could have the opposite effect. Moreover, a lot of patients will terminate their treatments before it is fully recovered. Then, the chance of recurrence of the injury is very high.
For example, triticeous nodule or stenosing tendovaginitis (Fig. 1) in the flexor tendon of the palm can be resistant to treatments. In my experience, I can only try to decrease the pain and restore the function of the hand. I cannot remember I could remove the small nodule in the tendon for the patient before the patient decided to stop treatment as they felt better and could manage daily activities.
(Fig. 1) stenosing tendovaginitis (www.miamihandcenter.com)
Actually, I got the same problem once. Obviously, I treated myself everyday with ice, ultrasound, laser and deep friction. After two weeks, the nodule had not reduced but pain had subsided to a large degree and grip strength was almost normal. As a physiotherapist, I refused to stop treatment. Fortunately, I do not have to pay for the treatment. To my surprise, after three weeks the nodule was getting smaller. Unfortunately, by the fifth weeks, the nodule started to get bigger again and pain returned. I could not think of anything that I had done anything to cause it. That is why I would not be surprise if patients insisted that they did not have any incidence that caused their injuries or problems. At one stage, I considered to have an X ray done to see whether there was calcification or not. However, I persevered with the treatment. It took me almost four months before the nodule completely disappeared and had not returned. I am relieved because it caused minor problem holding a tennis racquet. If I cannot play tennis, it will be a blow to my general health. I can imagine many patients would have given up a long time ago especially as the cost of treatments would be a great hindrance to them.
Another example is my knee problem. Once I had to play too much tennis because my club needed an emergency player. It was on top of my regular doubles tennis games. Moreover, I had to play singles against a sixteen year old boy with super tie-break. Unfortunately, it was one all and we had to play the tie-break. My knees were quite sore afterwards. When I squatted down I could feel quite a bit of pain and was unable to stand up because of the pain. The first thing I did was to play less tennis and rest a bit more. I treated myself with massage, ice, ultrasound and interferential therapy. After two months, I still felt sore after tennis especially during squatting and climbing stairs. After four months, the pain on squatting and climbing stairs subsided substantially. However, I found my left knee could not straighten fully compared to my right knee. It took another two months of treatments before I could straighten my knee comfortably. I can imagine if I am not a physiotherapist, I would have given up playing tennis a long time ago. It did happen to many of my patients who used to play a lot of sports but stopped because of injuries.
The above examples show that to be completely cured in many instances patients need more than 20 – 30 treatments. Therefore, if the physiotherapy fee can be kept low within a reasonable range, the chance of patients continuing treatments will be higher. However, I would not agree to have free treatments because people will abuse such arrangement. There will be people who have nothing wrong who would like to have some massage and physiotherapy treatment. Resources are limited and it should not be wasted. Moreover, patients will not persevere with their own management of exercises. Then, no matter how many treatments, recovery will never be complete.