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17/8/15

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“The first principle of science is that you must not fool yourself – and you are the easiest person to fool” – Richard Feynman

Welcome to my blog. My idea here is to add occasional stuff that adds to some of the topics that commonly come up at the clinic.  I’ll try to keep it interesting, informative and light hearted.  We shall see.  Controversial blogs seem all the rage, but blogging is really just graffiti with punctuation isn’t it? (that quote is from a movie, but I can’t remember which).

Anyway, back to that Richard Feynman quote. It’s a quote I picked up at a recent Adam Meakins seminar.  

A translation of that quote in a sense is this: The only way you know you’re doing your job right is by always trying to prove yourself wrong

Ever since I graduated from Chiro college I’ve been pretty much a magpie when it comes to looking for the ‘best’ way to treat back pain – picking up other clinicians shiny bits and using them as my own (“Good artists copy – great artists steal” said Picasso). I suppose that’s what comes from not working with other chiros or having a boss. On the whole I think I made good choices when it came to choosing the right shiny bits.  I would hear a knowledgeable speaker at a conference and like the way they seemed to be finding the challenge of diagnosing spinal conditions and treating them so damned easy. 

How could I get to be like that? 

In the end, the answer was always that I had to hit the books hard, study and refresh the stuff I’d learned at chiro college.  I had to know just that bit more than anyone else, I had to be able to spot the stuff other clinicians had missed. I had to be the guy who got the patient better when nobody else could, I…I…I…me,me,me...

Then I stumbled upon the whole world of pain science and what is known as the ‘biopsychosocial’ (that’s so tough to type, let’s call it BPS) model of pain and I found that so much of the stuff I was looking for (and had actually come across before but it hadn’t suited me back then or whatever). 

At the heart of loads of the BPS stuff is the realisation that the role of the clinician has to change completely.  The ‘doctor knows best’ approach is outdated.  The ‘surgeon as God’ situation needs to be abolished. 

The patient is boss.  100% of the time.

So it’s no longer me, me, me.  It’s always you, you, you.  For example, Socrates was this amazing teacher who never answered any questions , only asked.  He’d ask his students endless questions until they worked out the answers for themselves.  Now I’m not comparing myself to Socrates (I’m rubbish at football) but I’m trying to follow what’s called a Socratic approach.  I’ll open the door for you, but you’ve got to go through it.

I’ll admit it’s a process that is sometimes difficult to get absolutely right.  How do I deal with a salt of the earth type who’s had back pain all his working life and who insists that I ‘click his spine back in’ and achieve a hole-in-one miracle treatment???  I suppose I just have to set my stall out and do my best to explain what I think will work for him and how long it will take and how many lifestyle changes he may need to make.  Will he like it? Nope. Will he stick with it? Maybe.  Will he jump at the chance if I back down and tell him we can try the miracle prodding and poking stuff? You betcha.

But the BPS approach works.  It works on a level that overarches any method of prodding, poking, pulling, rubbing, popping, clicking and stretching.

Is the BPS the only thing that works? No, it’s part of a bigger picture.  Anyway, some of the prodding, poking, pulling, rubbing, popping, clicking and stretching is an integral part of the BPS approach so we won’t totally abandon it.  But there are so many cases where the hands-on stuff is not helping and if anything prevents the patient from getting over the problem. When it’s possible to re-frame the problem in a helpful way that makes meaningful sense to the patient then they can find the answers to the problems themselves.  That’s the Socratic approach.

Back of the net!

Thanks for reading.

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Hedd

PS – I just Googled that quote, It’s from Contagion - a 2011 movie with Jude Law in it.

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