Oh, please let me keep my head
It wouldn't do you any good just hanging by a thread
I want to be the best I can
Nose to the ground, it's pound for pound or stick it to the man
- Man, by The Bird and The Bee
Metastatic Master Plan
This is the last day of 2024. It's been a big year. This year was the first full-calendar year working in the new Preston address, and it was a year full of education, development, and growth. It wasn't easy, direct, straightforward or even clear the whole way through. There were dark days, there were uncertain, even unprecedented times, and there were celebrations. I got to go to Perth twice for uni and work. I got to meet new clients, I got to set my own hours, and I made it to the end of the year without advertising, raising my prices, or nickel-and-diming people with treatment packages, lock-ins, or by in-referring. Last year, I wrote that practising independently is to subject my personal mission to the litmus test of the private market, by balancing the act of providing healthcare that is high-standard while also sustaining me through my business. That was incorrect of me to have written. The correct thing to write would have been that the challenge is to provide high-quality healthcare in a manner that helps my business, while operating in a situation where people are in increasingly precarious work situations, increasingly choosing between making food, paying rent, and their own dignity, and where the price of goddamn near-everything has gone completely ballistic. Meeting that challenge has been, in a word, hideous.
Everything has a price. A clinical session has a price in terms of dollars. Pain exacts a cost in terms of comfort, and sticking to a mission that I set for myself a year ago levies a toll against my peace of mind because I know that it's really easy to scare people into coming back, and doing so is monstrously profitable. I don't need to be dishonest, I just need to be strategic with the truth and to emphasise some facts while minimising others. This is the same reason I don't like advertising. I don't like the fact that when we mix marketing and medicine, the result is largely marketing with a medical twist. It's icky. In fact, I feel so strongly about that that I'm quoting those words directly from a post I wrote back in 2021 about feedback, which I've since updated with some more contemporarily appropriate details. I don't like the fact that doing a good job clinically is directly opposed to running a business profitably. It's a simple calculus - the faster and more comprehensively I solve a person's problem, the better it is for them, but the worse it is for the business. A healthcare clinic doesn't make money by fixing people's problems, because that eliminates that person's need to come back. If I wanted to make money, and I mean real money, I'd need to make suboptimal clinical decisions, decrease the effectiveness of my treatment planning, and accept the gradual corrosion of my soul in doing so.
Successful businesses make money. Businesses that are more successful make more money, grow, expand, and thus make more money, become more complex, more varied, and develop into something far beyond their original form. I do want to do more - to have a larger premises, to have people work for me, to have such a fat margin that I can sponsor artists, creatives, and community projects on an ongoing basis, but to do that requires reconciling the sanctity of the mission with the master plan. It's a balance I have to strike. Odysseus sailed Messina, and I have to right myself on the waves of the Market. When I applied for the business loan for my little office, my mortgage broker told me that I needed to write a statement for the bank, detailing my plans for my clinic. I told them I would just do physiotherapy practice. For them, that promise alone wasn't enough - the bank wanted to know how I would grow, what my plans were for the future, how I was going to get bigger, expand, and increase in complexity with time - what my metaphorphic master plan was. To me, a philosophy prioritising growth for growth's sake makes me think that my obligation as a business operator is to be more metastatic than metamorphic - to let the philosophy of growth, expansion, and the need to make lines go up with increasingly steep gradients a core element of my operation. What does that mean for my patients, that red-hot pain is just red-hot fuel for the engine of the development of my operation? What does that mean for my community, that I look at suffering not as a problem to be solved but as a means to further myself? If someone's hurting, do I extend a hand to them to help them up, knowing that I can bill them for it, or because it's the right thing to do?
How the hell am I supposed to do this in healthcare, where there can only be so much pain in the world, and where my moral, ethical, social, and personal obligation is to mitigate it definitively, while my obligation as a business owner is to maximise the value of each patient to the practice by getting them to come back repeatedly? Am I adding value to my patients' lives so I can support their individual human dignity or have a justifiable reason to keep billing them more? This fucking blows.
Making Meaning
To me, the translation of my ethical mission into clinical practice is an artistic pursuit. The dark secret of my past is that I was once a professional artist - shock-horror. I believe that art is the process of creative problem solving through which we engage with the Divine within us, thereby achieving catharsis through creation, which is itself a divine act. Statements like that are why my clients come back to see me. To me, the practice of physiotherapy is an art, where from the chaos of pain, fear, and disorientation, a person can achieve clarity, empowerment, and strength that helps someone inhabit their body more comfortably, and in that inhabitation, better navigate the challenges of their life. That's why my practice is called Atlas Physio - because an atlas helps someone find their way home. Helping someone, providing guidance and orientation, and being a patient point of reference are all core elements of a successful patient relationship, yes, but they're also human and interpersonal. I believe a clinician has to meet their client where their client is at, and be humble enough to engage with that person's lived experience. That's the Divine element - the meeting of, for lack of a better word, souls. The artistic pursuit is to do that in a way that upholds the dignity of the individual. Like George Lucas said, it's like poetry; it rhymes.
The thing with poetry is that it's not just about rhyming schemes. It's about tempo, texture, theme, cadence, subtext, and so much more. The rhyme structure of a sonnet is like a skeleton that becomes clothed in flesh that moves at its own crawling, walking, or trotting pace to take the reader through that storied arc and its progression. Poetry is an art. Physiotherapy is an art. I can abbreviate both down to P-T-Y. A clinical session has its criteria like the scheme of a villanelle, sonnet, or ballad, but beyond that, the freedom to create is dynamic, engaging, and lively. I have to run my business in a way that makes money. I have to fulfil my legal, professional, financial, social, moral, ethical, and interpersonal obligations when working with my patients, and I have to do this every single time, in every single consultation, for every single person, who sees me every single day. Every day, I have to balance structure with substance. Every day, I have to navigate these competing demands. Every day, I have to empower, direct, and encourage my patients in a manner which engages with fundamental human dignity, self-image, and perception. Every day I sail Scylla and Charybdis. That takes skill. It takes performative flair. It takes artistic aplomb. It takes humility, to get someone to that point and let them take it the rest of the way, and to keep an even keel.
There is no empirical measure that determines how "good" art is. There is commentary, review, and valuation, but art means different things to different people. Meaning is different to different people. People make decisions based on different value structures and, I guess so long as the decisions people make aren't hurting other people or causing damage, that's okay, but then how do you define hurt or damage in a subjective sense - I don't know. What I do know is that art of any kind holds a mirror up in front of us and lets us engage with memory, feeling, emotion. A child's drawing of their pet is heartbreaking in its sincerity. A performance of Holst's Cloud Symphony is breathtaking in its glorying chorus. A love-heart drawn on bare skin is as powerful as an oath under law. To create art in clinical practice is to hold a mirror in front of my patients and let them see themselves, empirically, anatomically, socially, occupationally, individually, and reconcile the person they see with the person they are, to let them inhabit that reflection, and therefore make it the truth. The making of that truth is the equilibrating of self-image with reality, and when the two meet, that means a person is themselves, feels themselves, sees themselves, and to make that meaning means a person can make their own meaning - to make space in their own life from surpluses of time, energy, bandwidth and make art, joy, and comfort.
Canvas
Earlier this year I was lucky enough to attend a lecture hosted by the Forensic Engineers Society of Australia, wherein the host was a visiting professor from the United States who discussed the collapse of the Francis Scott Key Bridge in Baltimore, which occurred despite the presence of safeguards that had been installed. The discussion arrived at the conclusion that the engineering controls that were in place to prevent a ship striking the bridge were insufficient, because they hadn't been updated to keep pace with developments in shipbuilding that happened over time, where ships became bigger, steered differently, and required different safeguards. No assumption survives time. No great work survives time. No person's body, legacy, or work survives time. It's hideous then, because time is all any of us have. Psalm 90, 10 reads that the days of our years are threescore years and ten; and if by reason of strength they be fourscore years, yet is their strength labour and sorrow; for it is soon cut off, and we fly away. We fly away in time, and time flies away from us - Tempus Fugit, as Vergil wrote.
To live is to make meaning from life. Life is the time we have. The time we have is the space in which we can make meaning, on large and small canvases. That meaning is individual and subjective, philosophical, practical, and lifelong. It's going to the gym. It's listening to music. It's a pint shared with friends on a Friday night. It's giving your loved one a bigger slice of cheesecake because you've got to savour the little things. It's scratching a cat. It's getting scratched by a cat. It's what we make of the shot that we have. Pain shouldn't get in the way of that. Fear shouldn't get in the way of that. Money shouldn't get in the way of that. My shot through my clinical practice is to give my clients the tools to inhabit their bodies, their communities, and their world more comfortably, so that they can make the meaning they want to, be that lifting a hundred kilos overhead, running the hundred meters sub ten, or reading a hundred books in a year. The time I take to reflect now is time spent taking stock of the decisions I've made this year, and knowing that in the next year I'll have just as much of a shot to make a difference. It's up to me to make the most of that time, and in doing so, translate the ethical mission of my clinic into practical results through professional work.
So it's at the end of the year that I'd like to extend my thanks to my patients, my friends, and my peers, for continuing to put your trust in me as your clinician, for that little time. You've all seen me develop from my Fairfield practice to where I am in Preston, where I have the privilege and positioning to do my job in a way I want to and help those who need it. I couldn't have done it without your having put your trust in me, without your having spread the word about my work, and without your having been patient with me as I go through my own education and development in my career. It's my name on the mortgage, but it's your victory as well, and I'll never be anything less than sincerely grateful for allowing me to make your trust the bedrock of my and my family's livelihood.
Have a Merry Christmas and a Happy New Year, from my family to yours.
See you all in 2025.
Cheers,
Alex
I want to be the best I can
For me, for you, for every man
But I can slip, I lose my place
This shamefulness is hard to face
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