ChatGPT – Can You Tell Me If You Want My Job?

by Jo Turner

This piece is in response to an article released last month in The Guardian about the first artificial intelligence (AI) physiotherapy clinic [1].

I’m not surprised that this tool has been developed. It was bound to happen. Reduce a service to its bare bones,simplify it to the point that a bot could do it and declare that a bot can do it. Clever.

I’m not outraged at the suggestion that AI can deliver basic advice and exercises as well as a human physiotherapist. see the advantages of computers assisting with admin, early assessment and client education, freeing up and preserving the energy of clinicians for the more empathic exchanges. We know that overwhelm is a big factor in burnout and this could alleviate some of the workload stress currently experienced by clinicians.

What infuriates me is that this is called an AI physiotherapy clinic, and the bot is called an AI physiotherapist. It might provide much needed assistance as a triage service to reduce waiting lists, but it is not physiotherapy.

And what I’m ashamed of is that we let this happen.

Last weekend, I stood at my childhood bedroom window. My parents are moving out of the home they bought when I was 11 months old. As I reminisced about growing up here, I remembered the feelings of passing exams, winning and losing tennis matches, dreaming of who I would become, and how much I could achieve. It was a place filled with hope. I was sure I could make things better. I didn’t know then that the vehicle for making things better would be physiotherapy. And I certainly didn’t anticipate such a bumpy ride.

I first became seriously frustrated at physiotherapy during an MACP lecture on Maitland Mobilisation in the late nineties. As my senior described applying gentle movements, ideally at a speed of 2Hz and at an angle of 50 degrees, I looked around. Did anyone else think this was utter nonsense? Apparently not, judging by their earnest faces. So, I decided to keep quiet. I dutifully oscillated spinous processes, pretended to eyeball joint angles and the rest of the time I just made stuff up. 

Somehow, against all the odds, and despite my disdain, I discovered the beauty and the art of physiotherapy. I fell in love with physiotherapy, my version. 

Over the course of my now 27-year career, the best of clinical practice has been in small, human moments. 

• Searching out pre-Tiktok puppy images to calm a teenage athlete, terrified of moving her elbow, and even more terrified of telling her dad she hates competing.

• Helping my Monday exercise group (average age 78.6) work out ways to get on and off the floor and hearing them call across the room to each other with a reminder of ‘what helped last week’ when someone gets stuck.

• Seeing the relief in a young man’s eyes when he realises that I understand how utterly terrifying his back pain is. And then seeing him move with more ease.

Listening, encouraging, building trust and confidence, using touch as a context for imparting knowledge and understanding, inspiring people to achieve more than they dared dream, teaching wellness and preventing injury, fostering independence. This is physiotherapy.

But we’ve been complacent. We’ve let others define what physiotherapy is. We’ve allowed a reductionist version of our beautiful services to be sold to a public, many of whom now think physiotherapy is just explaining symptoms and receiving a simple set of exercises.

As I look back, I can’t help but feel that my younger, hopeful self would be disappointed in me. I stayed silent about the Maitlands, and the importance of patient-centred rehabilitation. I watched as it was sidelined in favour of triage and single consultations. I didn’t speak up. 

But neither did our governing bodies. 

My present self is angry. How is it that I first learn about an AI clinic from an article that touts it as the next big innovation in healthcare? The CSP should be at the forefront of these announcements, leading the conversation—not just a token reference to balance the narrative. It's frustrating when the value we bring to our work isn't recognised or when the systems we've invested in don't seem to advocate for us.

I am angry at the MACP of the nineties who allowed me to believe I was lesser than those in the club. And that their near mythical skills were more valuable than my innate compassion and empathy, and my ability to draw the best from people. Physiotherapy is not always high science. Whilst that narrative might flatter us (we did get those great A-levels after all), at its core, physiotherapy is a basic practice, grounded in sound principles. What creates the magic is when it is delivered by exceptional humans. We forget this at our peril and to the disservice of our patients. 

And I am angry at all of us for our smug assertion that people will always need our brand of healthcare. The irony that such complacency might lead us to be one of the first professions deemed redundant is not lost on me.

Let’s shift gear and consider a positive perspective on the introduction of AI as a triage tool within the NHS. If, as the trial indicates, this is an effective way of managing waiting lists, could it mean that physiotherapists would have more time to focus on longer term rehab and promoting good health? Perhaps, but this would require a significant change in practice for a generation of physiotherapists who, through no fault of their own, are not used to working in this way. 

More cynically, the writing on the wall suggests this isn’t the real motivation behind AI’s introduction. One of the things that has angered me most over recent years is that it has been convenient to suggest the severely underfunded services we can now afford to deliver are considered best practice. I don’t dispute what is being delivered is the best that dedicated people can do with very little resource, but it doesn’t mean this is what the public deserve.

And what about those of us in private healthcare? We have massively let ourselves off the hook. It’s all too easy to criticise what’s happening in the NHS, conveniently ignoring our own shortcomings. Unlike our NHS counterparts, we have the freedom to be nimble, unburdened by bureaucracy and chronic underfunding. We proudly profess our devotion to patient-centred care and health promotion, but have we truly been as innovative as we could be? Engaging in arguments on social media doesn't make us revolutionaries. We know our delivery model could be improved and updated—are we really tackling that challenge as bravely as we should?

There is a strong business case for innovation. My inbox is constantly flooded with offers to buy my business from corporate investors. It feels like the wolves are circling, eyeing an opportunity where potentially hundreds of dissatisfied patients seek private physiotherapy. I don’t want to sell my practice to entities whom I suspect don’t want to make things better, just cheaper. Let’s start doing the things corporates won’t see the value in – building businesses with great culture, providing flexible services, based on the particular needs of individuals and the local community. Let’s be brave and innovative, not just for the sake of our profession, but for the well-being of our patients. Let's reclaim our voice, our value, and our place in the future of healthcare.

I love these words from Katrina Lake:

“I can see AI replacing the brain of exercise prescription and progression BUT I don’t see it replacing the complexity of human interaction.”

It would be easy to dismiss this Guardian article as nothing to worry about. And many have. Just a pilot, just a screening tool, just, just, just. But when are we going to get angry? When are we going to stop looking for someone else to solve the problem and start championing the very best parts of what we do? When are we going to get human again?

I invite you to consider being less polite, start demanding more advocacy and recognition for what you do. Start talking more openly and loudly about your brilliance. Be more committed to action and genuinely changing practice. And finally, be devoted to your own well-being. I still want things to be better, and for that, we need to be well.

References

[1] Marsh S. (2024) First NHS physiotherapy clinic run by AI to start this year - https://www.theguardian.com/society/article/2024/jun/09/first-nhs-physiotherapy-clinic-run-by-ai-to-start-this-year