Magic Kisses or Rational Hugs?

I loved reading this article:

The morality of magic kisses: Ethics and placebo in physiotherapy


Neil O’Connell wonderfully discusses the ethical implications of using placebo in treating patients.  He talks about using:

“magic kisses” (a placebo he  gives out freely to his daughter; or in physio speak: passive modalities such as acupuncture/dry needling, mobilisation/manipulation, electrotherapy etc.)


“rational hugs” (therapeutic approaches like advice, pain education, Cognitive-Based Therapy, lifestyle adaptation, which push patients to re-evaluate their symptoms and alter their behavioural responses).

On the one hand, we are committed to reducing suffering and placebo can sometimes fulfill that.  However, we need to be transparent and the patient has the right to informed consent. Part of the placebo process requires some sort of deception that undermines the patient-physio relationship.

Since the clinical effects of placebo are generally small, is it worth it to undermine trust in the therapeutic relationship?  How many things do we offer our patients that could be classified as ‘placebo’?  And, how many “rational hugs” having you been giving out lately?

It’s Not About The Nail

“Don’t try to fix it. I just need you to listen.”

This video is actually about the differences between men and women.

But, I think it’s a classic example of what we as physiotherapists sometimes do to our patients – or let’s face it – to people in general.  We’re more focused on ‘fixing’ the problem, instead of trying to move past the surface view of the problem, LISTENING and then moving forward with the person.  Sometimes things make so much sense to us and the solution so obvious that we feel the need to make the person ‘see’ it.  But that’s not what they always need…

Yes it’s a bit random, but it illustrates the point beautifully.


So, how well do you listen?

Week 1: Empathy

My objectives for the course; the difference between Empathy and Sympathy; and why Empathy is relevant to us – as humans, and as health professionals.

Let’s start with my course objectives.  Here we go…

  • To explore my own personal and professional  ethics, with the other course participants, so that I can better understand and practice what it means to be ethical.
  • To broaden my own thoughts and feelings by interacting with the participants – their blog posts, comments and ideas; and by listening/reading/watching various sources of information regarding ethics.
  • To post weekly about the topic for that week, reading other’s posts and engaging in open-minded discussions.
  • To continuously re-evaluate my personal viewpoints during the course.

This is definitely the right time to do the course since we use ethics everyday in our interactions with others.  It is relevant.  It is current.  I’ll know I’ve accomplished these objectives by completing the course, getting my Professional Ethics badge and completion certificate, and by (hopefully) growing in the process.  How cool is it that the course content comes from our blog posts and links?  I’m thinking super-cool.

Empathy – The ability of blurring the line between self and other.














So, Empathy vs Sympathy.

People are often confused by which is which.  Here’s a short and sweet (but very good) video explaining the difference…

Sympathy = comforting, safe and warm BUT you risk smothering the person you are sympathizing with.  It can frustrate or annoy rather than empower the person.

Empathy = still warm, comforting and safe BUT there’s enough space for the person to feel comfortable and open up.  It can empower them to be brave and step out of their situation.  Or at least change the way they feel about it.

Do yourself a favour and watch some of the other videos in Ed Stockham’s series on Empathy.  They’re whimsical but still contain some really deep truths.  Plus, I dare you not to smile when you watch them!

Empathy, why is it relevant to us?

While watching a great presentation about Empathy on physioellen‘s blog; I wanted to smack my fist on my desk and shout: “Hurrah!” in agreement with Jeremy Rifkin (not the coolest thing to shout but something to that effect).  It just made so much sense.  Being empathic is the way we’re wired.  Funny that all of us are on this journey course to learn what empathy is.  Shouldn’t it come naturally?  What’s going on in this world that something which should be a natural ability is so foreign to most people?  And perhaps more importantly, how can we revive our empathetic selves?

After reading an excellent article on Connecting with Patients, I realized anew that being human and being a health professional are one and the same.  We like to pack our Physio selves into one little box and our true selves into another.  It’s easier that way – or so we think.  What we fail to realize is that we could be MORE effective by merging our little boxes into one box and using it to interact with EVERYONE, patient or no patient.  The excuses for not doing this are many – “I don’t have time!” “It’s too draining!” “I only invest in my friends/family, patients are just there to pay the bills.” ” I wouldn’t know where to start!”

The author, Colette Herrick, cites recent research to address the time factor: Empathic expression does not actually take more time if it is accomplished effectively.  The key for me is “if it is accomplished effectively”.  Now that’s something I need to learn. Who wouldn’t want to save time while being empathetic?  My opinion differs from Colette a bit though.  She sees emotional intelligence and empathy as skills that one can learn.  I believe that it is more a way of being, of doing. When we get taught at varsity, we learn things that we never knew before. We acquire knowledge.  But when we discuss things like empathy, or practice it, I think we are just reminding ourselves about what we already know.  It’s there, inside us.

But how much is too much?

Some think that empathy and professional distance are on opposite ends of the spectrum.  I believe they go hand in hand.  The hard part is to constantly make sure that we are exercising both.  While Googling “Empathy” and “Professional Distance” I came across this helpful albeit hippy site.  After a bit of relaxation and imagery cues, they get down to some useful statements.  These statements are good to keep in mind when trying to figure out how professional distance and empathy fit together.  Here are some:

  • You show respect for others by not taking on their problems.
  • Empathy is to show compassion for the struggles others might be going through.
  • Your role is to offer support but not to fix.
  • You can offer tools and support to give people the opportunity to fix their own problems.
  • You are not being helpful if you are offering solutions. (That’s a tough one!  We think we’re so good at it.)
  • You can help others identify their strengths, and encourage them to use their strengths to problem solve.
  • You can show real compassion by understanding while remaining neutral.
  • You are the most effective in your professional role when you are neutral and you take care of yourself.
  • It is okay to stop thinking about clients when you leave work; in fact, it is essential.  (Hmm, need to work on this)
  • You do not have to feel a client’s emotions to empathize.
  • You can be neutral and still understand and offer support.

How many of those hit home?

Introducing Me

Hi to everyone doing the Professional Ethics Course!

My name is Alexa Pohl.


I’m a Physiotherapist working in Secunda, Mpumalanga in South Africa.  I graduated from the University of the Western Cape in 2007, then did my Community Service year at Evander Hospital in Mpumalanga.  I worked in private practice for 4 years before opening my own practice a little over a year ago.

I did the OMT1 (Orthopaedic Manipulative Therapy) Course in 2011 and love working with patients with orthopaedic or sports related injuries.  I’m a club hockey player myself and enjoy anything active or outdoorsy, from Pilates to mountain biking.  I am passionate about my profession and represent it by being the Chairperson of the Gert Sibande District (1 of 3 districts in Mpumalanga Province).  I’m a member of the OMT, Sports and Dry Needling Special Interest Groups of the SASP (South African Society of Physiotherapy).

I am Christian.  I believe that one’s faith impacts one’s decision-making profoundly.  It forms the yardstick with which you measure things.  We all have different faiths, experiences, feelings and interpretations that influence how we decide where to draw the line.   Right and wrong is universal, but the interpretation of where the black blurs into white differs.  It’s always interesting to hear other people’s perspectives and ideas on different situations, so I’m looking forward to this course.

I also love the wonderful age we live in that makes doing a course in this format possible.  It’s so exciting that we’ll be sharing our thoughts and ideas while sitting on different ends of the earth!


A closing link to make you think…

(Can you guess who’s viewpoint I favour?)

Freud and C.S. Lewis on ethics and morality