The keystone of team work is communication. Inefficient or incorrect notes, messages, etc. will lead to a breakdown in effective care. All it takes is for one member not to complete the notes in a timely way or to forget to inform a team member of a change of routine and the whole thing falls flat. And who suffers? You guessed it – the patient.

Another barrier to cohesive working is poor knowledge of colleagues’ expertise. I’m not saying you should attempt a full psychologic profile of the patient before referring to a psychologist but knowing what they will do will vastly decrease the number of embarrassingly inappropriate referrals made. A nice way to do this is to spend time with the professional. Make friends with them, talk to them, i.e. communicate!

You are likely to meet professionals who appear not to value the contribution of other team members; this is tricky! Maintain your integrity – they are the ones at fault as they clearly don’t understand and respect other roles. The best way to defeat this kind of inappropriate behavior depends on who is affected. If it is just your feelings then swallow your pride and continue to provide top-notch care to your patient and stop caring about what other people think. If it is affecting patient care then speaking to a senior will help resolve any professionally related issues. Alternatively, more senior colleagues may advise that you speak directly to said ignoramus to resolve the issue. This is generally good advice but this must be done with the explicit support of your senior physiotherapist – don’t try to “wing it” on your own!

Evidence-based practice is a big deal for physiotherapists. In the 1980s and 1990s the profession was rightly criticized for not providing proof that our techniques work; of course, we had empiric evidence, in that we observed improvements in our patients, but little in the way of published scientific research. Now, I am glad to say, more and more physiotherapists are making use of their scientific training and providing high-quality research. Some of the techniques have low-grade evidence and therefore are no longer used by conscientious professionals. However, the more we as a profession break down research barriers and develop our skills, scope and practice, the more we and our patients will benefit.

Sources of research are all over the place, just visit your library journal section and prepare to be bowled over! Now, as you are hard-working people who have already completed large amounts of scientific study, I don’t need to tell you that you can’t just take an article, read the abstract and conclusion and be happy that you are now up to date on that particular subject. You always need to search the databases and gather as much research on the topic as you can and extract the most relevant research before selecting the best study based upon a number of criteria using a standard appraisal tool and rank them by their quality. Usually a high-quality randomized controlled trial (RCT) or systematic review with meta-analysis of RCTs is considered the gold standard in research and case studies are simply used to generate a hypothesis rather than prove treatment efficacy. Alternatively you can see if someone has done it for you on the Cochrane database (a high-quality service providing reviews of past research). Thorough, objective and systematic searches are essential to produce nonbiased conclusions regarding treatment of a condition.

While you are at university it is advisable to get together with friends and form a journal group. The idea is that you pick a topic, let’s say physiotherapy treatment of lateral epicondylitis. Then you all brainstorm for possible search terms such as “manual therapy,”“lateral epicondylitis,”“tennis elbow,”“electrotherapy,”“physical therapy,” etc. and for databases to search such as Cochrane or Ovid. Then, between you, you share out the possible treatments. The idea is that you all go away and carry out the search as per the set criteria and gather the results. Once you have siphoned out the irrelevant stuff, you will be left with a few highly relevant and useful papers. With these, you write a synopsis and present back to your group with a conclusion as to whether or not that particular treatment is clinically worthwhile. By doing this, you are ensuring that you are always on the ball with current thinking and theories. Starting this at university will set you in the right direction for when you begin work and this type of behavior is expected from you.

Fig. 13.1.

Get your portfolio under control as soon as you can. The longer you leave it, the harder it gets.