TUNGKOL SA EPISODE NA ITO
In this episode of Chewing It Over, Jack is joined by Andy McDonough, consultant physiotherapist and incoming co-chair of the Advanced Practice Physiotherapy Network (APPN), for a wide-ranging discussion about what advanced practice actually means.
Andy argues that advanced practice is a level of practice, not a job title, profession or collection of technical skills. Being able to request imaging, take bloods or administer injections doesn't automatically make someone an advanced practitioner. The distinction lies in the clinical reasoning, diagnostic breadth, autonomy and responsibility underpinning those decisions.
The conversation explores the increasingly contentious issue of undifferentiated patients, including debates about which professions should assess them and how physiotherapists can develop the knowledge required to manage more complex presentations safely.
Drawing on his emergency department experience, Andy shares examples of serious pathology initially presenting as apparently routine MSK complaints, highlighting the importance of broad differential diagnosis, multidisciplinary supervision and knowing the limits of one's competence.
Jack and Andy also examine the governance of advanced practice, including credentialing, professional regulation, education and the use of titles such as advanced practitioner and consultant physiotherapist.
A particular concern is whether these titles can become misleading when used without clear standards or appropriate assurance, especially across different healthcare sectors.
The discussion concludes with a call for stronger professional collaboration, transparent governance and greater recognition of the contribution physiotherapists can make across healthcare.
Ultimately, advanced practice isn't about moving beyond physiotherapy. It's about demonstrating what physiotherapy can achieve at its highest levels.
5 clinical/professional takeaways
- Advanced practice is a level of reasoning, not a list of procedures. Taking bloods, requesting scans or delivering injections may form part of an advanced role, but the advanced component is knowing when those interventions are indicated, how to interpret the findings and what decisions follow.
- Managing undifferentiated presentations requires diagnostic breadth. Patients don't arrive with confirmed diagnoses. Advanced practitioners must be capable of considering serious non-MSK causes of symptoms, particularly in settings such as emergency departments and first-contact services.
- Supervision should extend beyond professional boundaries. Learning from medical colleagues and other disciplines can expose clinicians to different diagnostic approaches and improve their ability to manage uncertainty and risk.
- Governance and titles matter. Terms such as advanced practitioner and consultant physiotherapist carry expectations for patients and colleagues. Their use should be supported by appropriate competence, accountability and transparent professional standards.
- Advanced practice should strengthen physiotherapy identity, not obscure it. Progressing into complex diagnostic, leadership, research or governance roles doesn't mean leaving physiotherapy behind. Andy argues that clinicians should be proud to demonstrate what physiotherapists can contribute across healthcare.
