MSK disorders and Economic Inactivity

Ok.. let me make an admission. I think I’ve deskilled massively in MSK. In fact, there are quite a few areas which I’m de-skilling in by virtue of the way the health system is evolving. Here are a few:

• Gynaecology - Firstly, I’m a male and this means that lots of patients don’t want to see me! This is despite my experience in gynaecology (spanning six intensive months) and the practice in my GP surgery is to funnel gynae issues to my female colleagues!
• Mental Health - Aside from doing depression and anxiety reviews, I don’t feel I add much more value. 10 minutes isn’t enough time to have a meaningful conversation even though I think I can help. My wife says I’m a good listener so I think that’s my superpower? Lucky her!

And of course.. musculoskeletal medicine. First contact physiotherapists (FCP) by all measures have been found to be incredibly effective. Bringing physiotherapists onto the front line was an evidence backed measure that has really sped up the identification and treatment of musculoskeletal issues.

Whilst the current unemployment rate in the UK is 4.1%, 22.2% of the UK population has been deemed as “economically inactive.” This includes 16-65 year olds that are unable to work due to the following reasons:

• Being a student
• Being retired
• Being a stay-at-home parent
• Having a disability
• Not being able to afford childcare
• Giving up on finding a job

This number is rising and unfortunately one of the main drivers of this is due to having a disability. A few weeks ago, we commented on the Darzi report which focused on this category of patients. Lord Darzi mentions that the two main drivers of health-related economic inactivity are mental health problems and musculoskeletal problems.

Why are we de-skilling?

The answer is first contact physios. This is absolutely not intended to be a dig on the service as it is truly excellent. Instead I want to highlight that as we funnel certain patient groups into relevant services, it means generalists like primary care, A&E and AMU clinicians can start to lose their confidence in certain areas.

I experienced this for a long time, especially in the world of MSK. It is quite common for reception staff to not always refer patients to the FCP and these patients end up seeing a GP, ACP, physician associate and other AHP staff. Due to our lack of experience we end up taking a poor history, limited examination and limiting our management options to ibuprofen cream, NSAIDs or exercises.

In such a circumstance I didn’t feel like I was giving the patient great care. This was due to a gaping hole in my own knowledge on the diagnosis and management of common MSK disorders. I decided to correct this by shadowing some MSK specialists in A&E and outpatient clinics where I obtained a fantastic insight into diagnosing and managing such conditions in a more effective way.

So.. how do we up-skill in MSK?

Myself and Kameel realised our own weakness’ in our MSK practice and after doing a period of shadowing, we wanted to bring this teaching to other professionals.

We felt that it was important to look back at the fundamentals of history taking, examination and management of core problems involving the shoulders, wrist, hips and knees.

We also wanted to also clarify how the treatment of MSK disorders work. Escalation and referral to further services are part of the treatment pathway but there is some vagueness around this. Throw in the “magic bullet” of steroid injections and the treatment becomes more convoluted.

Lastly, there’s also the role of physiotherapy in the elderly. I enjoy doing home visits but noticed that the MSK health of most patients at the end of their lives is not emphasised. These patients typically reserve themselves to staying in their chair all day, despite having the capacity to mobilise and it’s important to help restore their confidence and encourage them to get more active.

To achieve all of this, we have invited Mr Sikandar Kiani, an experienced physiotherapist who is currently retraining as an ACP in secondary care. He has been merging his knowledge as a physiotherapist and contributing to the elderly virtual ward service as well as contributing to MSK clinics in the hospital. He will be delivering a comprehensive presentation on MSK disorders and as always, the presentation is externally CPD accredited with the ability to watch it again in your own time.

You can read more about this online course here

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Originally published on Substack.