In Pursuit of Understanding, Pt. 6

A Closing Note to the Clinician:

I get it. We went to school to look at a patient as a complicated system. We were taught to find something that is wrong and to fix/change it; the patient will feel better as a result. But we have to know better now. It is time to stop thinking about the patient as a complicated machine some of the time and a complex system – with variables beyond our control – only when it is convenient. It is time to move the profession forward.

Some patient’s pain complaints will improve. Sometimes it will be (in part) due to your intervention, other times it is an illusion (in which case, get over yourself, they were going to get better anyway). And here is another newsflash: even when the patient does get better, it is unlikely to be for the reason why you think they did.

How is it that when it is the patient’s fault, we blame a complex system beyond our control (they won’t stop smoking, they are non-compliant, they have ‘psycho-social issues’). How is it that at the same time we place accountability on complexity in those situations where we fail, we take take credit for the output of the same system when we think we succeed? It is sheer hubris.

If you want to continue to seek the one complicated approach that is better than all the others, I won’t discourage you from doing so. If, while using your favorite approach, you see a bad posture, fascial restrictions. an AIC, a less-than-optimal thoracic ring or a crossed pelvis, you are free to use whatever approach you see fit to try to provide your patient with novel stimuli to alter a neurotag. You are working with a complex system, after all, and you very well may have a profoundly positive impact on that patient – I hope that you do.

But, in the event that you are successful, keep your clinical reasoning to yourself, unless you also want to include in your humble explanation to the patient all of the non-specific and complex variables that also intervened, uncertainty and doubt included. Do not send them home thinking that you fixed something that was necessarily wrong, and THAT is why they feel better. Don’t you dare. You know better. You know that working with a complex system necessarily prevents that from being the case. You know that you have a responsibility to provide that patient’s nervous system with a scientifically valid and appropriate initial condition to live the rest of their life with, one with a defensible understanding of why they feel as good as they do.

In the end, we are residential electricians. Don’t overcharge the customer while telling them that you are responsible for the power grid.


3 thoughts on “In Pursuit of Understanding, Pt. 6

  1. Reblogged this on Chiroresearcher and commented:
    A thoughtful argument on why we ought to be humble in attributing patient improvement only to our intervention; it’s more complicated (or should that be complex?), than that…

  2. Keith, Thank you so much for writing these last 6 posts. I was previously unfamiliar with your blog, but now I will read your posts. Seriously, these were amazing. Well done, Sir.
    Dan Allen SPT

    • Thank you for the kindness, Dan. The response to that series of postings has been astounding and I couldn’t be more pleased that it has resonated with so many people and that they have shared it with so many others.

      Sorry for the late reply; locked myself out of my own blog.

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