Physiotherapy as a pill

Neil - Doctor of PhysiotherapyBlog, Health, Physiotherapy, The Kettlebell Physio0 Comments

In the film The Matrix when lead character Neo meets Morpheus for the first time he is given a choice of taking a blue pill and continuing to live in a synthesised, fictional, computer generated world, or taking a red pill and joining the real world and escape from the Matrix. Watch it here.

In the script, Neo is described as feeling awkward nervous and confused. Here’s how the scene plays out between Neo and Morpheus:

MORPHEUS
I imagine that right now you’re feeling a bit like Alice. Tumbling down the rabbit hole?

Neo is listening closely.

NEO
You could say that.

Morpheus smiles. He walks behind his chair.

MORPHEUS
I can see it in your eyes. You have the look of a man who accepts what he sees because he is expecting to wake up. Ironically, this is not far from the truth. Do you believe in fate Neo?

NEO
(without hesitation)
No.

MORPHEUS
Why not?

NEO
Because I don’t like the idea that I’m not in control of my life.

MORPHEUS
I know exactly what you mean.

Morpheus sits and crosses his legs. He plays with a metal box in his hands. Neo is intrigued.

Let me tell you why you’re here. You’re here because you know something. What you know you can’t explain. But you feel it. You’ve felt it your entire life. There’s something wrong with the world. You don’t know what it is, but it’s there. Like a splinter in your mind. Driving you mad. It is this feeling that has brought you to me.

Pause. Morpheus stops playing with the box.

Do you know what I’m talking about?

NEO
The Matrix?

MORPHEUS
Do you want to know what it is?

Neo nods. He is at the edge of his seat.

MORPHEUS
The Matrix is everywhere. It is all around us. Even now, in this very room. You can see it when you look out your window, or when you turn on your television. You can feel it when you go to work, when you go to Church, when you pay your taxes. It is the world that has been put over your eyes to blind you from the truth.

Neo gets closer to Morpheus.

NEO
What truth?

Morpheus gets closer to Neo.

MORPHEUS
That you are a slave, Neo. Like everyone else, you were born into bondage, born into a prison that you cannot smell, or taste, or touch. A prison for your mind. Unfortunately, no one can be told what the Matrix is. You have to see it for yourself. He opens the box and looks inside. What is inside cannot be seen. Morpheus takes the contents, puts the box on the table and leans forward. He stares at Neo.

MORPHEUS
(solemnly)

This is your last chance. After this there is no turning back. You take the blue pill-

Opens his left hand and reveals the blue pill.

-the story ends, you wake up in your bed and you believe whatever you want to. You take the red pill-

Opens his right hand and reveals the red pill.

-you stay in Wonderland and I show you how deep the rabbit hole goes.

Pause. Morpheus has both his hands open, holding one pill in each. Neo hesitates, then quickly reaches out to grab one.

MORPHEUS
Remember-

Neo stops. The red pill is reflected on one lens of Morpheus’ sunglasses, the blue is reflected on the other. Neo is reflected on both, his hand over the red pill.

-what I’m offering is the truth, nothing more.

Neo takes the red pill. He slowly grabs the water glass from the table and drinks it. Morpheus smiles, satisfied. Thunder roars in the background. Neo finishes the water. Morpheus takes the blue pill in his hand and stands up.

MORPHEUS
Follow me.

If you haven’t seen the Matrix, watch it! It’s a classic.

Here’s how Physiotherapy, both as a therapist in Private Practice and a consumer, is similar to the blue pill vs red pill choice presented to Neo.

The blue pill represents something which appears to make sense. It sounds logical. Plenty of people have experienced the blue pill. They wake up day after day and continue to believe whatever they want to believe. If they get better after taking the blue pill they attribute that change to the pill – a post hoc fallacy – and for them the story ends. They continue to take the blue pill as long for as they’re told to because they believe it works. In healthcare terms, blue pills are given by well-meaning salesmen and women who sadly remain ignorant of contemporary evidence and changes in best practice. Blue pill treatments represent low value consumer care. The blue pill has no specific effect on the consumer. It is a placebo which provides some reassurance while nature does the work. The label reads ‘500mg natural history’ and people generally tend to get better regardless. Consumers generally grow to trust the seller and blindly believe in the power of the blue pills. Blue pills are not free of charge. Blinkered by ignorance providers continue to *sell* them as a matter of course in large quantities. Sellers knows that the blue pills can’t do any physical harm and they’re good for business. Very good. Consumers never realise that the blue pills are no better than sham and in time, seeing people getting better, sellers start to believe in efficacy that doesn’t exist and so continue to passionately recommend them for more and more conditions.

Red pills cost the same as the blue pills. Those selling them are not slick salesmen and women but well-respected scientists and academics with credentials who comparatively are few and far between. Unlike their counterparts, red pill sellers are poor self-promoters which makes the red pills a largely unknown entity within the consumer market. People aren’t talking about the red pills and red pill sellers which makes potential consumers somewhat sceptical of them, with trust in both the pill and the seller lacking. Red pill labels are blank and although the sellers speak of their effects with confidence and assurance, they’re hesitant to give guarantees of the intended outcome. Because red pill sellers are academics and scientists, they know a lot of ‘stuff’ and explanations to the consumer about how their pills work can be overly confusing. This creates unhelpful hesitation and doubt. Unlike the blue pills which are easy to swallow with a gulp of water, perhaps the biggest drawback of the red pills is that they need to be self-prepared before they can be consumed. They come with clear instructions of course, but that requires time and effort on the part of the consumer, and like a course of antibiotics, people need to stay the course for them to be effective. Effort quickly dampens the initial sparks of enthusiasm and frequently people just give up and stop taking them.

So what’s all this about?

The two active ingredients in the red pills are knowledge and physical activity (exercise). Examples of two inactive ingredients in blue pills are core stability and posture.

Here in Australia the data indicates that people are generally lazy. Far more people choose the blue pills simply because they’re the easiest option and presented as a solution to their problem. They require minimal effort (passive therapy) and the pill and the sales pitch which accompanies it tick all of the right emotional boxes. It’s a real tragedy though for all concerned – consumers, providers, the healthcare system and our professional – because after choosing the blue pill, that’s where the story ends.

“Many practitioners rely too heavily on the “art” of medicine which can lead to large inconsistencies, sub-optimal outcomes, and, frankly, a huge waste of the patient’s time.” (ref)

Much like Neo meeting Morpheus, people seeing a Physiotherapist for the first time may feel awkward,nervous and confused. Taking the blue pill is the easy option. It’s the world in which we continue to believe that the earth is flat and that the sun rotates around us. To the uninformed, those explanations seem to be the most logical explanation for what we see, but it’s a cop-out because we know those beliefs are invalid. A child may think that way, but as adult we’ve learnt better (hopefully). Blue pills appear to work, but we know their ingredients are inactive.

Choosing the red pill takes a leap of faith for both the provider and consumer. For the provider, it is the rabbit hole Morpheus describes but it is a Wonderland from which there is no turning back – understanding pain for example. For the consumer, what we’re offering is the truth, nothing more. Trusting in the red pill, trusting in those selling them and staying the course is all it takes.

I used to take the blue pills and all they do now is give me the shits.

 

 

 

 

 

 

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