From the Pond: Illiterate

We are underbred and low-lived and illiterate; and in this respect I confess I do not make any very broad distinction between the illiterateness of my townsman who cannot read at all and the illiterateness of him who has learned to read only what is for children and feeble intellects. We should be as good as the worthies of antiquity, but partly by first knowing how good they were. We are a race of [small]-men, and soar but little higher in our intellectual flights than the columns of the daily paper.

On Tuesday, I had an hour to spare between patients, so I elected to grab an old friend, my composition notebook and a pen and sit down with a cup of hot tea at my local coffee house. As I was adding a couple packages of sugar to my drink, I saw her out of the corner of my eye and hoped she wouldn’t see me – the eatery is large enough that if I could quietly find my way to the other side, she wouldn’t likely see me.

In less than 20 seconds, she was standing by my side and encouraging me to join her at her table with her friend. Without much recourse, I fulfilled my social obligation and followed her to her table where she was sitting with another. They are both physical therapists. They both work part-time. Both are former colleagues from the outpatient clinic where I last worked.

As I sat down, each briefly glanced at the articles in my hand. One said, “What is that for?”

“Just doing some studying between patients,” I responded.

“Why? Are you taking a course or something?” she inquired further.

“No,” I continued, “but I listened to a really fruitful podcast recently and I came to realize that my clinical reasoning skills were insufficient compared to those in the field with academic and clinical experiences that exceed our own, so I decided to really hunker down and work on…”

She interrupted me. “Oh, so you are just doing it to be smarter. Okay.” Her and her friend then returned to their conversation about their christmas shopping, the challenge of finding good-babysitters and how smart their respective children are. I sipped my tea and stared at my unopened book, realizing that I was about to waste the next 45 minutes of my day due to the forces of social convention.

Neither know who David Butler is, nor have they any understanding of what neuroscience has begun to inform us about the pain that each of our patients experience. Yet they continue to practice, attend the minimal number of weekend courses required to keep their respective licenses and are happy “helping” those in need..

*quoted passage from Walden


10 thoughts on “From the Pond: Illiterate

  1. Keith, Because the same thing has happened to me countless times in the clinic I’ve grown silent and am thought grumpy. I don’t know what else to do. Thanks for this. I shared it on Facebook but we need to get it on Soma Simple as well.

    • Thanks for sharing, Barrett.

      I almost re-wrote this after I was finished – I thought it might have to much Dorko-tude.

      Nonetheless, I posted as is…it is a genuine representation of how I feel today after this experience.


  2. Keith,
    I admire your professional furvor. Although I fear you could be missing life lessons that do not neccessarily come from a podcast or a research article (although these are essential). Maybe in addition to striving to be ‘as good as the worthies of antiquity” you could try to find the lesson in all situations, and maybe even walk a mile in their shoes. We need PT’s to keep striving for knowledge and evidence and to keep writing and sharing. We also need PT’s who genuinly care and connect and relate to the people around them. Life is richer with varied perspectives, even if you don’t agree with the value system of another, there is something to learn.

    • Thank you for reading, Natalie, and for taking the time for your thoughtful response.

      The value system of these therapists (who I have extensive experience with) is not one that I can support or appreciate. They have mortgages; so do I. They each have 2 children; so do I. They each have approximately 10+ years of clinical experience; same here. They treat patients in pain, the same as I do. We walk in VERY similar shoes.

      The problem is that they have no idea who/what to read, and even when an opportunity presents itself to make an inquiry or to potentially learn from their own experiences, they shy away from it. Such attitudes are a reflection of their inability to genuinely care for a patient beyond sporting a smile and a positive attitude for each patient who walks through their doors while practicing the same way for the last 8 years with an outdated understanding of why their patients experience what they do.

      One CANNOT responsibly provide care as a PT if they take a MDT Part A and Part B and think they are now expertly qualified to treat a patient with spinal pain. It is no different than listening to Rush Limbaugh for one week and thinking you understand the answers to the difficult and complex problems that face our country today.

      I wish I could, but CANNOT apologize for someone who thinks their ‘care’ is ‘good enough’ and does not understand that they owe more to their patients, their profession and themselves. These clinicians DO NOT strive for knowledge or evidence. They exchange the occasional hero-story only with themselves as the protagonist, as if it was their own nervous system that finally relieved the patients of their symptoms.

      I fail to see how their patient’s lives will be any richer from these clinicians ‘varied perspectives’.

      Sorry, Natalie…it has just been a long week, and I don’t see any merit in what they have to offer our field.

      Thanks again for reading/replying, it is sincerely appreciated.


  3. Keith, Natalie’s response, to me, reveals a remarkable naivete. Excusing the behavior of these PTs is what got us into this mess. You already said everything I would have.

    You and I might not be all that popular with other PTs, but to the patients, we are what we are supposed to be.

  4. Perhaps I am naive Neil, I have been accused of worse I suppose. I think I can change the world…it doesn’t get more naive than that.

    From my blog: A brilliant friend of mine gave me the book “Change or Die” By Alan Deutschman. The premise of the book is that real change comes slowly. Like the cultural shift away from smoking where after realizing the adverse effects, it took years to change people’s perception enough to change their behavior.

    Below is the link to my blog that is about trying to change the world from unhealthy living to healthy living.

    We need to change the behavior of the industry from one of anecdotal or non-evidence based to evidence based treatment supported by true caring.

    All of us who realize the importance of taking the profession to “the next level” need to relate and encourage and mentor those not yet on board so that we lift them up, not just dismiss them. We need to figure out why the behave the way they do. Why did people continue to smoke when they knew it would kill them?

    Kieth, Thank you for your professional respone. It is always unnerving putting yourself out there with a conflicting viewpoint because no one wants to look like a fool or be criticized (well most people don’t). But without people taking the risk, dialogue can not continue and that is how learning begins.

    Keep up the good work.

    • Natalie, there is a lot of emerging literature from the cognitive sciences re:belief and biases. Almost everything I have read is unfortunately not promising when we consider how we might change the perspectives of those already in the field.

      Your intentions are admirable, but I am far more pessimistic and cynical. It is one thing to try to shepherd someone toward the recent (last 20 years) insights that neuroscience has provided us, moving away from a strictly Cartesian view of pain, but to lead them on a path where they need to value learning in-and-of itself? I am sorry…I simply lack the patience. Kudos to you if you do, and good luck.

      I hold out hope, however, that new professionals in the future will look at their practice with a more skeptical eye than their predecessors and push the profession in the right direction. Unfortunately, that leaves about 25-30 years for patients to wait for already licensed clinicians to die or retire…taking their outdated ideas regarding ‘care’ with them.

      That is, as Barrette points out, that is a long time for patients to wait.

      I have no solutions to the problem, myself. Just an occasional overwhelming frustration with what many thinks it means to be a ‘therapist’.

  5. Natalie, It wasn’t Neil, it was me.

    How long do you suppose our patients in pain should wait?

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