24 Jan The key lessons learned from practicing antipodal…. Will Howard – Physio, Ocean Physio & Rehab
The key lessons learned from practicing antipodal….
Earlier this year I returned with my family from New Zealand having spent 2 years working in a Physiotherapy Clinic on the North Shore of Auckland. In this blog I intend to summarise the key features of this experience that have helped develop my practice.
We left the UK in September 2015, and via Singapore arrived in Auckland. Four days after leaving Heathrow I was seeing patients and taking a crash course in Real Time Ultrasound. As a family we had landed with a bump, quite possibly under-estimating the task in hand! Prior to embarking on this two year venture, I had spent three years working in professional sports environments within the UK. I had been offered the job in Auckland the previous April, after being recommended by a Kiwi rugby player playing professionally in the UK. I was attracted to the clinic (not least by its location!), but also by the principle physio Chris McCullough, who has 35 years clinical experience and has seen time as the All Blacks physio, attended five Olympic Games, numerous commonwealth games and finished up Team New Zealand’s Lead Physiotherapist. On top of this Chris had been the president of Sports Medicine New Zealand, as well as being inducted as an Honorary Fellow and a Life Member. Upon learning this about him, I thought he may have a bit to offer and set about the registration/visa headache! 5 months later, there we were and it was colder than the brochure said it would be!
Auckland is a very sporty place. Getting off the plane the notable level of lycra got me wondering whether (as an ardent surfer) my salt crusted boardies were going to cut it! My caseload was set up to be partially sports and partially general population, I was relishing the challenge of returning to a mixed caseload. From the outset, I was made aware that the clinic’s reputation attracts a wide variety of athletes and I was not disappointed. This hugely varied caseload helped me as a practitioner broaden my scope significantly. Although I was still within my comfort zone with the steady stream of rugby players from teams associated with the clinic (up to provincial level), when international sailors from Team Vodaphone, America’s Cup teams and Volvo Ocean Race teams started coming through the door, I had to start thinking a lot more about the varying demands of their sport, schedules and the limited resources Volvo sailors in particular may have at hand when managing chronic injuries at sea! I worked with US collegiate basketball scholars vying for places within NBA teams, national level track and field athletes, skiers…the list goes on. I became more adept at adapting return to play/function protocols to become more sports specific and justifiable to managers and coaching staff.
Alongside this, I was able to see a more general caseload of patients through New Zealand’s unique Accident Compensation Corporation (ACC) system. Through the ACC the majority of any treatment cost for any injury deemed an ‘accident’ will be covered by this government fund. As a result, any person who receives an injury and can remember the exact time it happened, can have their treatment subsidised, and importantly, it works on a self-referral basis. If you’re injured, you walk can into a physiotherapy clinic and can be assessed and managed straight away for a small subsidy fee. This is not the case in the U.K. and the difference to early patient outcomes was notable, I feel this is down to the practiced, high quality early management of significant injuries. Patients under the ACC system get good acute management thus ensuring every aspect of the healing/rehabilitation paradigm is optimised and understood by the patient, leading to appropriate loading, faster healing times and a more sustainable recovery. As a practitioner this experience significantly improved my ability to manage the injuries of a more generic caseload. Although this is a huge part of the role when working with athletes, on the whole their management is easier, as if you ask them to do something, they will do it to the nth degree! With the demands of modern living and pressures of life, its not so easy for us mere mortals and it is an art-form getting that information to a patient in a tangible format. This taught me the importance of getting the ‘front-end’ of the rehabilitation process dialled-in to achieve good prognosis. This is something that the UK system could improve on, all too often the patient has to wait lengthy periods for input, leaving some conditions to become unnecessarily chronic and allowing compensatory mechanisms to become a problem. It was clear, the early intervention and the patient understanding of this, has a significant positive effect on the patients return to function.
In addition to this, access to relevant radiology was excellent within the ACC system. As a Physiotherapist in NZ, you are able to refer a patient for a subsidised X-Ray or Ultrasound Scan to one of the many radiology clinics and have the results in your hand within the same day. This gives us a huge step forward in objectivity, although it is not always necessary, when it is required, its use in determining relevant pathways is invaluable. As a learning experience for me, I realised I had previously underutilised the use of Ultrasound Scans as a method of objectifying the severity of soft tissue damage. Access to this service has allowed me to regularly parallel my diagnostic testing against the objective reality, to see how accurate I was, this adjusted my practice where necessary and has hopefully improved my diagnostic accuracy. It has been a pleasant surprise to return to the UK and work at Ocean, who have been pro-active in forging links with radiology clinics with the aim of providing the highest level of service when necessary.
Finally, the last key learning point from my experience has to be attributed to the melting pot of patients I worked with. I was able to meet people not only from all corners of New Zealand and Polynesia, but the world. This meant having to work with a huge variety of cultural and health beliefs, which at times can be a challenge! I enjoyed every minute of the diversity. However, on the whole I should pay testament to the level of health education in Auckland, the vast majority of the patients were well informed, sought early advice and played an active role in the process of their rehabilitation. This led to better outcomes and their positivity was infectious.
Leaving New Zealand was a tough decision. However, to return and work in an environment like Ocean is something I couldn’t have scribed better. I am surrounded by a huge pool of talent and now (finally!) we are settled back in, I am looking forward to running with the challenge and working with the varied caseload between the University and Woodbury Clinics!
Will Howard, Chartered Physio, Ocean Physio & Rehab