My moral dilemma: is it appropriate for me to buy a car as a physiotherapist? by Thomas Mitchell

The above is my mental hook, it invades my thoughts repeatedly, I can’t get free. Nudged by daily prompts, from dreamy motoring sequences, attractive-yet sensible-finance packages, the freedom of the road beckons from all media voices at all times. This quandary has haunted me since May 2017 when my dream car (a 1984 Saab T16) was TWOKED; stolen and found burnt out in a field in Mansfield.

It has now been a year in which I have lived without ‘individualised motorised transport’. This reality seemed inconceivable as I was a modern citizen, independent, solvent and paid up member of the car club, with rarefied opinions and sensitive to all the different brands. Initially this absence was an act of financial necessity, however as the months marched on, something has changed in my centre; the scales fell from my eyes, and a strongly held conviction that life is improved by, and is unliveable without, motorised transit, slowly shifted, drifted, then washed away.

How then has such a certainty been lost? Through this realisation: I did not understand the true nature of what a car is, what it means for our health, and how its mass usage affects our society. The regretted, undesired, enforced car-abstinence enabled me to experience the world as a citizen affected by vehicles impact, rather than as a driver zooming past. The findings of this participant-observation study of one, have been shocking. I was dimly aware driving was damaging us through pollution of both air and noise, but, simply looked the other way. One cannot ignore the brutality of these effects when one feels them every day as a pedestrian. The way in which we build our infrastructure becomes a vital and real issue too. It becomes obvious town planners discourage non-car transit; walkers are a poor relation sent on circuitry routes, cyclists are just expected to fit in. Finally, one sees that driving is correctly associated with stress, littering and road rage, all of which I encounter daily (drivers seem so entitled, and super angry!).

My individual ideological shift is all well and good, but does it have wider implications to my role as a physiotherapist in musculoskeletal health? Well, in the past twenty years of clinical practise, I have seen the UK population sicken, balloon in weight, become less physically active, be diagnosed with an ever-increasing number of co-morbidities, have longer prescription lists and present with vaguer, more widespread and difficult to treat conditions, often with pain of no mechanical origin. I attribute this in part to the mass increase of car ownership and driving as people’s fitness degrade as they no longer have to walk or move as they did. I have also seen scores of severely injured whiplash patients having a miserable time, which does start to sink into the consciousness of the unwanted side-effects of vehicles. In clinic, the first task I have with most patients is to get them moving, and I am convinced everyday activity is the most effective way of providing robustness against many of these illnesses of sedation. As such, ten times a day I am urging patients to reduce or stop driving, sitting and move more to help their physical condition. People are suffering pain, poor health, social isolation and even reduced years lived without disability due to inactive habits which are encouraged by car industry lobbying and advertising, with the acquiescence of, or even encouragement from our political leaders.

I often find that when the personal and professional overlap, my clinical practise improves. My own injuries have armed me with first-hand experience which I believe enhances my insight and empathy when dealing with patient’s issues, facilitating communication for the shared therapist/patient clinical journey. The absence of the motor car in my life has also seen changes in my interaction with patients, in that I now speak authoritatively of bringing daily activity of transport in my clinic interactions and allow the hegemony of ingrained car necessity to be challenged. This differs from what I observe when I hear other physiotherapist talk about transport. Mostly they moan about a lack of car parking (especially at hospitals!), whinge about traffic jams or boast about their particular new car purchases. I believe we need to move on from this if we are really interested in making a difference to the musculoskeletal health of our nation and by-gum, do we need it!

Following one year of car-free living, I’m fitter, weigh less, have less back pain, am more engaged with my local community and am financially better off. This year has changed my interactions with my patients, and even brought out some mild social disobedience in that this forty-one-year-old man who now pushes the pedestrian crossing buttons every time he passes one to make driving seem more frustrating and more unpleasant in the hope of more converts!

So, have I become an anti-car zealot? It seems so, but I do acknowledge their benefits for rural communities and disabled people. Up to this point, I admit to having a blind spot around active transport and public health due to my love of cars and see this repeated widely throughout my profession. I argue there is a need for a proper conversation about the health of our nation and to acknowledge the true health impact that sedentary comforts. Accordingly, I advocate physiotherapists thinking outside the treatment room and to lobby to change political policy, prioritising and rewarding active choices, removal of the barriers between citizens and active choices, and to stop subsidising unhealthy and damaging adjuncts such as driving, just as we did with smoking. What physiotherapists do one-on-one in treatment rooms is great for health promotion, however if we are the lone voice competing with the profit-motives of the motor industry it is crazy to think we have an equal bearing.

So, is there a moral component in car ownership for me as a physiotherapist? I’d argue yes, as I’d be giving implicit approval to cars through my own ownership, which would make my voice weaker when encouraging my patients to kick their sedentary habits and live their lives more actively. I don’t want to lose this powerful counter to the assault of inactivity. So, should I buy another car? Well the Top Gear dream of the freedom of the open road is just a fantasy on this crowded polluted island, however it still pulls me in… but, for now… NO! As ever, the great John Cooper Clarke encapsulates my dilemma:

‘Automatic or manual shift,

I’m symptomatic of a moral drift.

I got the climate people miffed…

Until they need a lift!

Tearing up the countryside

I’m to blame for everybody who died.

My shame begets your pride…

Until you need a ride’

(The Motorist – John Cooper Clarke)