#FutureShock 2: Physiotherapy Outsourced??

The following is reproduced with permission from Cinema, a former Twitter personality & blogger who left the social media world. The reproduction is intended to preserve & share insightful posts from Cinema's blog. This post was originally published in April 2014.

What follows are admittedly outlandish speculations (nestled specifically within the confines of Orthopedic Outpatient Physical Therapy) intended to spark questions and explorations on the many possible futures of Physical Therapy, and retrospectively consider how you and I can prepare for and adapt to the unpredictable. There will be aspects to this post that I have either overlooked or am unaware of, so please offer your feedback.

Evidence Based Practice (EBP) is a vital component of the profession moving forward, riding waves of data-driven scientific research. The push for standardized levels and modalities of patient care via development of Clinical Prediction Rules (CPR) and Classifications of Signs/Symptoms lubricate the clinicians’ decision-making process. Again, all are important components of the profession.

What happens if we take this to levels of extreme absurdity? CPRs and Classification systems inherently implement a binary decision-making process that may not require human involvement. Imagine a world with medical technologies that employ data-driven decision-making algorithms to prescribe individualistic Plans Of Care. What are the odds of this fantastic future manifesting itself? Higher than you can imagine.

The trend is already underway. Combining the zeitgeist for “hands-off” treatments with heavy emphasis on exercise prescription and tele-health, might consummate the first (baby) steps of automated Physical Therapy. Inclusion of analytical software to analyze objective movement measurements & qualities can progress the platform, thereby reducing timeframes between time of injury and initial assessment.

Proliferation of telehealth could outsource a surprising share of the profession. When the average PT (of course not you) makes decisions based on binary input and predictable decision trees, what prevents such a process from being automated? I would conjecture that no less than 30% of all PT cases could be exported via virtual sessions.

Early inklings of this reality are likely embedded into your EMR software. Classification systems based on signs & symptoms are associated with particular sets of treatment recommendations. Of course, you can exercise clinical reasoning to alter or turn down any or all recommended interventions, but a suggested framework is pre-set based on your data input. Research-based data is implemented into the software under the canopy of “Evidence-Based Practice”.

Telehealth provides venues of access and care that prior generations could not have imagined. Not only is it an element of the future of Physical Therapy, but is already a small and growing reality in the present. A transition from this point onward is mere logistics; moving “Physical Therapy” consultations offshore followed by software supplanting these telehealth PTs. Offshore? Yes. The future of telehealth consultations will cross geographic lines. There already exists a need for dissolution of arbitrary geographic divisions implemented by insurance companies; technology will likely force and accelerate the transition. Once patients habituate to distal care-givers, responsive and adaptive software will flag its allure via claims of greater efficiency and further streamlined costs.

Too far-fetched? Think again. Vinod Khosla, co-founder of Sun Microsystems and accomplished Silicon Valley investor, says that “Technology will replace 80% of what doctors do” and he put his money where his mouth is by investing in companies driven toward this eventuality. It might be worth your time to read his two-part series titled “The Surprising Path of Artificial Intelligence” and “Do We Need Doctors or Algorithms?” I love his closing lines in part two:

“The best way to predict this future is not to extrapolate the past and what has or has not worked, but to invent the future we want, the one we believe is possible!”

I can hear it already: “What about the complexities of the human body? Or the psychological and social influences? Or…etc” What about it? Tell me why this too cannot be automated. And, if the veneer of humanity can be replicated into cybernetic algorithms, then this trend could accelerate much faster than any of us can imagine; thereby capturing 30% of all orthopedic outpatient cases.

My advice? Be irreplaceable; that might involve unconventionality and a certain amount of “going against the grain”. Go on – invent your future.

What you just read are speculations intended to spark questions and explorations on the many possible futures of Physical Therapy to retrospectively contemplate how you and I can prepare for and adapt to the unpredictable. Again, there will be aspects to this post that I have either overlooked or am unaware of, so please offer your feedback.

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Jason Boddu