Clinician's Compass | Staying in Our Lanes, Driving the Same Road

A physio’s reflection on mutual respect, better referrals, and when surgeons start handing out exercise sheets.

May 25, 2025

We’re all driving toward the same goal: better patient outcomes.
But when surgeons start prescribing rehab protocols without assessment—or physios send vague referrals—it’s time to talk lanes, scope, and mutual respect.
A practical guide to collaboration (with a few A4-sheet war stories along the way).

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The A4 Sheet Moment

It’s always a bit of a moment when a patient walks in clutching an A4 sheet of exercises from a previous healthcare provider – usually dated, often generic, and sometimes mildly tragic.

How To Organize Recipes: Real Life Ideas — Watch out for A4 sheets of recipe-based rehab from 1990.

It’s even more of a moment when you realise it’s come from a well-meaning Surgeon who, for all their brilliance in the operating theatre, has just waded into your lane with the clinical equivalent of a 1999 glute bridge printout. Or the 2020s version, a public facing website with a series of recipes for various conditions.

Screengrab from an Orthopaedic public-facing website. An example of an “exercise program” coming soon below.

We’d normally carefully prescribe specific exercises for the particular patient in front of us based on a thorough assessment (often with fancy gear like dynamometry), often just 2-3 exercises done well - especially for the busy 40yrs+ cohort.

So you know why we’re dazed and confused (just like the patients) when we see they’ve been given something like the below handout (or encyclopaedia), without assessment, and without a planned review to reassess how they’re going:

Not a parody, a real thing given out to Rotator Cuff Pain patients - 12 pages of 20 exercises - and the patient wonders why they’re sore.

I recently spent an entire on a weekend course on lower limb tendinopathy. Predominantly for Achilles and Patellar Tendinopathy, it was a masterclass on the dark arts of assessing and prescribing tendon targeted interventions (or “exercises”) for these tendons.

Just so you understand the complexity, here’s the overview of just one of many frameworks on how to manage Tendinopathy.

diagram, timeline — Highly recommend Peter’s courses and his website.

But if an athletic Achilles Tendon somehow made it’s way into a Physicians room, they might walk away with the following on a dusty A4 sheet:

Things are a bit more complex than “Eccentrics Fix Cranky Tendons”.]’

I once had an entire room of GPs try to outdo each other in front of me to demonstrate their best Tennis Elbow can of beans exercise that fixes all of their elbow patients (or at least allegedly so - they rarely follow up because “it’ll go away in a year”). That memory will forever a bit of a giggle for me given the complexity in managing that condition.

Now, let me be clear: this isn’t a Doctor-bashing blog. Many of the GPs and Orthopaedic Specialists I know are absolute legends – collegial, curious, and fantastic at what they do. Their surgical expertise is world-class, and the volume of procedures they need to perform each year to maintain competence is staggering. A dedicated ACL surgeon who does multiple reconstructions per week will, of course, be sharper in that space than a generalist who dabbles. That’s expected.

Generated image — It shouldn’t come as a surprise, Surgeons are highly-skilled and experienced at Surgery - but might not be as skilled or experienced at other jobs.

So let’s flip the mirror: when it comes to conservative management of musculoskeletal conditions – assessment, diagnosis, rehab planning, and progression – I’ve simply done more reps. It’s what I live and breathe. I’ve spent years refining these skills, obsessively staying on top of the evidence, and managing these conditions every week. I’m not offended when a surgeon hands out an exercise sheet with extremely outdated and incorrect information; I’m just quietly amused. Because that’s not really their jam. And that’s okay.

Different Lanes, Same Road

The better metaphor isn’t turf war, it’s traffic: we’re driving in parallel lanes, heading to the same destination. We want the patient to get better.

We want them to avoid unnecessary interventions and, when needed, we want them to get the right one. But just like you wouldn’t want your Exercise Physiologist triaging you for a fresh traumatic knee instability injury, it’s probably not ideal for a surgeon or a GP, or even a Sports Physician to manage the nuanced, non-surgical pathway of a complex tendinopathy.

Why It Happens

Well, for starters, the Doctor might just be trying to help.

The patient could’ve been referred directly by a GP, or the physio referral might’ve been vague or non-existent. Maybe the surgeon doesn’t know there’s a competent rehab clinician involved. Or maybe their past experiences with rehab have been disappointing.

Let’s face it: if all they see are failed rehab attempts, they’ll assume most rehab isn’t great.

That’s the survivorship bias problem.

Surgeons rarely get to see the wins. They don’t see the meniscus injuries that never needed surgery, the labral tears that settled, the wobbly shoulders that unwobblefied themselves following months of solid rehab.

They see the breakdowns, not the breakthroughs.

Making a Good Referral Great

None of this is fixed by finger-pointing. The responsibility lies with all of us. Physios and rehab clinicians, should write good referrals. Show your working - tell the story, discuss your clinical reasoning. Don’t just say "failed rehab, please assess and advise."

Tell the surgeon what you’ve tried, why you’re referring, what you’re hoping for, and what your plan would be.

That context is gold.

It lets the surgeon back you, and helps the patient hear a unified message.

The Illusion of Authority

Doctors still carry a kind of inherited cultural clout.

Patients trust the white coat and the competence . And honestly, who can blame them? It’s a compelling image: the decisive doctor, sweeping in to save the day with clarity and confidence. But here’s the rub (from a glorified massage therapist, no less):

At our local uni, medical students get a few short months of MSK (musculoskeletal) training - if that.

We spend 4–5 years studying it, then build careers specialising in it, and still squeeze in hundreds of CPD hours a year to stay sharp. Yet somehow, we’re still playing second fiddle in some patients eyes - and funnily enough, in some GPs eyes too.

Some Doctors think we’re an item on the shelf: “Oh well, that didn’t work, how about you try some Physio”.

Driving Forward – Together

At the end of the day, we’re not adversaries.

We’re professionals trying to get patients better.

We stay in our lanes, yes – but we drive the same road.

And when we do it well, the patient doesn’t even notice the handover.

They just feel like they’re getting where they need to go.

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