I am, I think, a pretty good manual therapist and a pretty decent rehabber too, which puts me in a slightly odd position. Because in MSK, my manual therapy skills are apparently the butt of most of the jokes. We're all wandering around just rubbing things, creating voodoo dependency and spouting shite whilst the grown-ups get on with delivering evidence-based rehabilitation.
Maybe. But rehab has theatre too, and you've seen it.
The shoulder movement where the physio delicately grips the patient between thumb and forefinger whilst the remaining fingers float elegantly in the air as though suspended by invisible silk. The slow-motion squat assessment. The force plate printout. The glute pre-activation drill. That complicated exercise prescription which could probably have been summarised as "get a bit stronger." And come on people, what's with physios suddenly wearing scrubs and blue nitrile gloves?
Before the wonderful pro-rehabbers start pointing their lasers, this isn't criticism. It's an observation, because healthcare has always contained theatre. Patients don't just buy interventions, they buy into people. They buy confidence, certainty, explanations, expertise and trust, and sometimes the rituals surrounding treatment are part of how we communicate those things. The mistake we make is assuming only the other tribe has any.
Part of the problem is that a lot of us have become remarkably confident about research we've only partially understood. Most people don't read the paper. They read the headline, skip to the conclusion and then wait for someone clever to tell them what to think. A headline becomes a belief. A conclusion becomes a doctrine. Manual therapy is low value care. Case closed, ish. We all agree feeling better isn't the same as getting better.
Never mind that most of us couldn't explain the statistics section if our lives depended on it. ANOVA sounds vaguely familiar. P values are reassuringly small. Job done. The result is a profession that occasionally mistakes certainty for understanding, while the patients sit there caring far less about our ideological battles than we do. They simply want someone competent to help them get better.
So perhaps the question isn't whether healthcare contains theatre. Perhaps it's whether the theatre serves the patient or serves the practitioner.