This past week I had a few instances that made me feel quite inadequate as a therapist. The first was a patient with knee pain and the other was a patient with neck pain. In both visits I managed to use up everything I knew, every decision path and subsequent treatment solution. And I got… no within session change.
As it happens I was stuck with the uncertainty of their treatments, their prognosis, and the uncertainty of my ability to be effective. I knew what bothered them, I thought I knew the mechanisms of irritation and their complaints were appropriate for physical therapy, but past that… heck. I then over-heard a senior therapist lamenting about an evaluation that had not produced results. He said he had tried repeated movements, had applied clinical decision rules and had treated off of those rules and got… no within session change. Dammit.
So it’s not just me. It can happen at any time. Sometimes we don’t know what to do, even though we think we should.
One of the above patients came back in a few days later and was interestingly without pain, despite what we did (It’s not ALL about us!). So what did I miss?
It has been said before; about becoming comfortable with being uncomfortable, and becoming used to uncertainty. I was reminded that I need to embrace this uncertainty. It’s a much bigger part of practice than we like to admit. The “I don’t know.”
I was also reminded that I am actually not comfortable with it. I say that I am, and I understand that I should be, but deep down I am not.
This ‘unknowing’ is the same for patients that are asking questions of us. They want to know “what structure is gone wrong in my body?” and we are supposed to say “I understand all that, it’s your flactoids that are irritated. Here, now I am going to rub it this way, and you are going to perform this movement.”
Patients are searching for certainty, and so am I. We share that mirrored experience together. We also lack patience in seeing results from our actions. It is a pitfall that I am not immune to. Learning to trust the process, have patience and give it time is difficult in our fast-paced atmosphere.
So we need more knowledge, and patience. We search for answers from clinicians, research, continuing education, etc, all to lessen the chances that we get stuck. Perhaps to some degree the negative feeling of uncomfortability drives us to be better. The more we feel it the more we are urged to learn.
As a student, I am free-er to say “I don’t know.” Will I be saying it in a month when I am no longer a student? I hope so, since it is honest.