It's about Clinical Reasoning

Posted by NAIOMT on Mar 19, 2014 10:12:26 PM


By: Brett Windsor PT, PhDc, MPA, OCS, FAAOMPT

It's about clinical reasoning. Nothing less. Put simply, the key to PT success is knowing what's really going on. Knowing exactly why a person is experiencing pain; knowing what structures are generating it and how each individual places symptoms into the context of their own lives. Directional preferences can work - sometimes. Clinical Prediction Rules can work - if you hit the patient jackpot. Bending a person this way or that way can work. But, there is simply no substitute for anatomy, biomechanics, and pathology. It's hard, sure. But nothing in life worth having is easy. At some point, you have to rollup the sleeves and work out what's really going on.

People say that the pathoanatomical diagnostic model is dead. No it's not. It's truly alive, and it always will be. Perhaps what's dead is the willingness to really, really work at thinking. Maybe what's dead is the desire to wade deeply into the anatomical literature, looking at the historical and contemporary pain literature, seeing the comparisons, looking for the contrasts. Is it possible that what's passing away is taking the time necessary to perfect a craft, failing so often you want to quit, learning from others who are better than yourself, seeking with an truly open mind? The patho-anatomical may have been pronounced dead, but it's alive and kicking.

The patho-anatomical ideal is not dead...Bogduk can show you that. The reams of literature (it's medical) substantiating the production of pain from discs, from facet joints, can show you that. Working hard in collaboration with physicians to fill the gaps the clinical examination can't get to can show you that. The satisfaction of a patient returning with imaging results that perfectly substantiate your in-depth clinical exam will prove that it still works. Seeing a patient's eyes fill with tears when finally, someone takes the time to work all the way through a complex, chronic case and figure it out? Priceless.

The easy road is likely here to stay. But, we know there are people out there, hundreds every year, who want more, who want the hard road. We love those people. If you've been reading this for a while, you're probably one of them. Deep down inside, you want to truly learn how to think and to reason and really get to the bottom of things. You can deal with ambiguity; you can accept that sometimes it's ok to trust your intuition. Join us. We stick with what we know works. We cherish the past. We don't try to explain it away. We'll constantly seek to improve. But, we're not going to apologize for taking the difficult road. Top left. Click it. Join us.

Topics: differential diagnosis, patho-anatomical, Clinical Reasoning, Uncategorized

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