Opening My Own Practice, and the Small Thing That Made It Real

Leaving the Big Practice

For eight years I worked at a large physiotherapy practice in Durban, the kind with four treatment rooms, a receptionist who knew every medical aid scheme by heart, and a hydrotherapy pool that always smelled faintly of chlorine. It was a good place. I learned a great deal there, and I am not going to pretend I left because of some dramatic falling out. I left because I was thirty four and I kept lying awake thinking about what it would feel like to have my own name on a door.

That is a strange sort of ambition to explain to people. When I told my mother, she asked me why I would give up something stable to take on rent and risk. I did not have a clean answer. The honest one was that I wanted to make my own decisions about how a patient should be treated, and how long a session should run, and whether I could spend twenty minutes just listening to someone before I laid a hand on their shoulder. At the big practice the diary ran the show. I wanted to run the show myself, for better or worse.

So I handed in my notice, shook a lot of hands, and walked out into the uncomfortable freedom of being my own boss.

A Room With Nothing In It

The space I found was small. Two rooms and a little reception area in a converted house in a suburb of Pinetown, sharing a driveway with a dietician and an accountant. The rent was manageable if I was careful, and careful became my whole personality for a few months.

I do not think anyone tells you how many tiny, unglamorous decisions go into setting up a practice. You imagine the big things, the plinth, the ultrasound machine, the signage. Nobody warns you about the afternoon you will spend standing in a hardware shop comparing two kinds of coat hooks because one costs eleven rand more per pack and you have suddenly become a person who cares about that. I bought a second hand treatment plinth from a chiropractor who was retiring, and I drove it home myself in a borrowed bakkie, sweating and swearing on the N3 because it kept shifting in the back.

The waiting room was the part that defeated me for weeks. It was just an empty rectangle with a window that looked onto the driveway. I had four chairs I bought from a school that was closing down, sturdy but a bit institutional, and I painted the walls a soft green because someone once told me green is calming and I had a tin of it going cheap. I hung a print of the Drakensberg that my sister gave me. I found a low table at a second hand shop and sanded it down over a weekend until my hands ached.

And it still felt like nothing. It felt like a room pretending to be a waiting room. I could not work out why.

The Hundred Small Choices

People think a physiotherapist's job is bodies and muscles and exercises. It is, but when you run your own place it is also plug points and light bulbs and where the tissue box goes. I spent one entire evening deciding where to put the hand sanitiser so it was visible but not in the way. I agonised over whether to have a radio playing softly or to leave it quiet. I bought a kettle, then realised I had nowhere sensible to put it, then bought a little side unit for the kettle, then realised I needed mugs.

I kept a running list in a cheap notebook, and the list never got shorter because every item I crossed off revealed two more underneath it. Appointment cards. A card machine that worked with the medical aids. A sign for the gate. A doormat, because the driveway turned to red mud when it rained and I did not want the whole practice tracked through with it. Curtains for the treatment room, because the afternoon sun came in hard and patients lying face up did not want it in their eyes.

None of these things were exciting. None of them were the reason I became a physiotherapist. But together they were the practice, and I began to understand that a clinic is really just a very large collection of small kindnesses arranged in a room. Somewhere in among the boredom of it, I sourced the practical bits too, the sort of thing you order online at midnight, and I remember pricing out water dispenser bottles alongside the curtains and the doormat as if they were all equally momentous, which in a way they were.

My First Patients

I opened on a Monday in March with three appointments in the diary, all of them people I knew. A former colleague sent me a runner with a stubborn calf. My neighbour came in with a sore neck, mostly, I think, out of loyalty. My third patient was a retired teacher named Mrs Naidoo who had found me through a small advert in the local community paper, and she was the first complete stranger to trust me, and I have never forgotten her for it.

I was more nervous that first week than I had been in years. Not about the treatment. I knew how to treat people. I was nervous about everything around it. Would the card machine decline? Would the room feel professional enough? Would someone look at my four school chairs and think this man does not know what he is doing? I overcompensated by being early for everything and by cleaning surfaces that were already clean.

Mrs Naidoo sat in the waiting room for ten minutes before her session because she arrived early, and when I came out to fetch her she said, gently, that it was a nice quiet spot but that I should think about giving people something to drink. She said it kindly, the way an aunt corrects you. And she was right. I had thought about the print on the wall and the colour of the paint and I had forgotten that people come to a physiotherapist because something hurts, and a person in pain, or a person who has just done a hard set of exercises, is often simply thirsty.

The Thing That Made It Real

That weekend I sorted out the water. It sounds almost too small to mention, but it was the moment everything turned.

I bought a water cooler, a plain white one, nothing fancy, and I arranged a supply of the big refill bottles, the 18.9L water bottles that sit upturned on top and glug when someone fills a cup. I put it in the corner of the waiting room next to the low table I had sanded, with a stack of paper cups beside it. I stood back and looked at it, and for the first time the room stopped pretending. It became a place where people were looked after.

I cannot fully explain the effect it had. A waiting room with water in it says something a waiting room without water does not. It says I thought about you before you arrived. It says you can stay a while, you are not being rushed, help yourself. Patients started arriving early on purpose, filling a cup, sitting with it, letting their shoulders drop before we even started. The runner with the calf told me it was the only physio he had been to that felt like it was not in a hurry. A mother waiting for her son's session with a rugby knee poured herself a cup and said, without any prompting, that it felt like a proper practice.

I kept a small routine around it that I still keep. Every couple of weeks I check the level and swap in a fresh one, and I order the water cooler bottles in a modest batch so I never run dry, and there is something grounding about that small act of restocking, a quiet marker that the practice is still here, still open, still expecting people.

What I Understand Now

It has been two years. I have more chairs now, and better ones, though I kept two of the school ones out of stubbornness. The Drakensberg print is still on the wall. Mrs Naidoo still comes in, mostly for maintenance, and she always fills a cup on her way in and gives me a small nod as if to say, see, I told you.

When people ask me what the hardest part of starting my own practice was, they expect me to say the money, or the fear, or the loneliness of it, and all of those were real. But the truth I keep coming back to is smaller and stranger than that. The hardest part was learning that a practice is built out of a hundred unglamorous decisions, and that the ones that matter most are often the ones that have nothing to do with your training. A cup of clean water in the corner of a quiet room did more to make my patients feel cared for than any certificate on my wall.

I put my name on a door, in the end. But it was the water cooler that made the room behind it feel like mine.