Is it normal to assume that whenever someone cancels their appointment, despite explicitly thanking you and saying they’re feeling better, you’ve actually made their pain worse, ruined their life, and they’re simply too polite to tell you how terrible a clinician you are?
What about when someone cancels their 8.30am appointment late the night before because they have to see their workplace clinician instead and then never responds to your email reminding them of the late cancellation policy whereby there is a fee to pay?
Is it normal to assume they hate you and will be telling all their friends and colleagues to avoid?
Now imagine this clinician receiving an actual email that says ‘you did not meet my expectations and therefore I’d like to cancel my appointment’. It’s me; this is my inbox. A patient whom I’d seen once a few weeks ago was now detailing that they had expected hands-on treatment and advice to use TENS. When I looked back through the notes, I knew what my response had to be. I couldn’t apologise for the treatment offered because I’d still do the same thing today - there seemed no soft tissue that warranted hands on treatment - and TENS wouldn’t have been my go-to either.
I think a past iteration of me would have wanted to make things right straight away - ushering this patient back in for some poorly reasoned manual therapy; in fact, it’s on the house! Instead, I located the stomach that had dropped out of my backside on receiving essentially a rejection email, thanked the patient for their honest feedback and wished them well with their recovery.
For me this is the classic expectation mismatch that we’ve seen throughout MSK care - certainly since I’ve been qualified: the patient arrives with expectations of traditional (and sometimes outdated) treatments while we attempt to balance their preference with evolving evidence.
For years, MSK clinicians have grown comfortable challenging expectations around passive treatments. We’ve become better at explaining why imaging isn’t always necessary, why hands-on therapy may not be indicated, or why pain isn’t synonymous with damage. But the landscape is shifting again. Patients are no longer arriving armed only with outdated beliefs; increasingly they arrive influenced with information, wearable data, AI-generated advice and wellness narratives that often sound sophisticated, evidence-based and empowering.
So what about future treatments? What about now in 2026 when patients arrive with expectations of new interventions and technologies?
The challenge for modern clinicians is no longer simply rejecting outdated ideas. It’s learning how to critically appraise the endless stream of new ones.
Cue June’s MSKMag.
Up first, Jack Chew puts freshly hyped, package-style lifestyle medicine under the spotlight and explores where innovation risks becoming performance and packaging in ‘Beware Concierge Healthcare’.
Tim Colledge makes the case for being open to the friction smoothing and meaningful improvements to care that AI can bring to health professionals in ‘AI in MSK Care: Useful Tool or Clever Distraction?’
In her piece ‘Fighting Talk: Grappling with Combat Sports Rehab’, Rosi Sexton reminds us that unfamiliar sporting populations require genuine expertise, not generic rehab principles.
Staff writer Tom Jesson returns to bring us back to fundamental clinical awareness on the topic of Peripheral Artery Disease in his article ‘Notes on PAD’.
Finally, Natasha Miszewski of Splose shares her practical advice on changing your practice management software with behind the scenes expertise. Read about what questions you should be asking in ‘Switching MSK Practice Management Software: what it actually involves’.
The uncomfortable reality of modern MSK care is that sometimes good clinicians will disappoint patients, and sometimes convincing ideas will turn out not to be very good ones at all. But whether it’s AI, lifestyle medicine, unfamiliar sporting populations, overlooked pathology or the systems underpinning our clinics, the common thread throughout this month’s issue is adaptation. Not blind acceptance of the new, nor stubborn attachment to the old, but the ongoing challenge of deciding what genuinely deserves a place in MSK care.
