Where do we go from here?
I am not necessarily advocating for therapists to necessarily change what they do in the clinic, but I am insisting that they approach each encounter with the awe, humility and respect that a complex system should engender, appreciating that their job is not to get a patient “back” to where they once were, but to bring them forward to where they want to be. If the therapist is able to maintain that perspective in each encounter – with every patient – they can come to the realization that they do not rehabilitate so much as the educate.
We must understand that what therapists say and do with their patients at any moment not only impacts them today, but also tomorrow. Therapists create explanations and expectations, nocebo and placebo; they create a context through which a patient experiences each and every pain for the rest of their life. It is of utmost importance that the physical therapist appreciate that responsibility.
[It must be made clear that (even when computer models are utilized)] they are unable to predict the results of the system once and get the answer. What happens is you have to run the system many times, because most of these systems are sensitive to initial conditions. So through the computer simulation you get an understanding of the space of possibilities. But initial conditions have their own dynamic, [called] path dependence, which is [to say] what happens in a system depends on his history.
Every encounter, everything that a physical therapist says and does must be presented to a patient with the understanding that the therapist is introducing a new initial condition to a complex system. Every time a therapist provides the patient with a complicated explanation for an output from a complex system, they fall woefully short of providing appropriate care for their patient. They conflate correlation for causation. They reinforce their own cognitive biases and poor pattern recognition while instilling those some biases in their patients. They change the foundation on which the patient builds the rest of their life, and the lives of their patient’s friends, families and acquaintances. The responsibility of the physical therapist is not only to get their patient better, but to prepare that individual, with their complex nervous system for the rest of their life. The patient should walk away from a clinical encounter not with the notion that the therapist ‘fixed’ them, but that the therapist helped them fix his or her-self.
Complexity is ordinary, it is a different way of thinking into a science that is quite young, so we don’t have answers for everything and it wouldn’t be just if we said that we did…If we understand the characteristics of complex systems, we can work with those characteristics. If we don’t understand them, we can actually inadvertently block them and go against what we want to achieve.
Tomorrow – A Closing Note to the Clinician