I’ve finally figured it out, I’ve boiled it down to the simplest of terms: I dislike unsupported claims. From this simple seed, stems so many urges to engage in discussion, debate, conversation and reflection.
I could not figure out why listening to biomedical model explanations bothered me so much. I could not figure out why those using nocebic analogies drove me crazy. I did not know the reason that I loathed unsubstantiated predictions of the future (“You will need a knee replacement.” “You will have pain forever” etc). It comes down to the claim.
Maybe you could say I just enjoy truth, but truth is a complex part of this whole thing (personal truths, facts, outcomes, etc). To explain this best, allow me to use some math:
Credibility = Fact / Claim
The bigger the claim, the less I approve. Larger facts with smaller, more narrow claims, end in a nice result. Same goes for treatments:
Credibility = Rx / Claim
The Rx may be excellent. But if you expand the claims too far, you loose all credibility.
An example? So I hear that we have fascia in our body (fact). Tom Meyers loves treating fascia and claims it is the source of all our physical ailments. Wait.. what? I’ve heard that thought-model before. The model that says the thing I treat is the one cause of your condition: (Chiropractic or Acupuncture ring a bell?!) Result, bottom heavy equation, no credibility.
Heck, read the recent article interview with Brian Mulligan. He is obviously very smart, has contributed to the development of many people in the field, he has a nice Rx and really novel and cool way to get patients moving (SNAGs etc). But listen to his claims here. Sorry, you’ve out-claimed your Rx’s ability by a mile. Credibility = Rx / Claim.
This equation can ruin some things in daily life, even things I really like. I really like MobilityWOD and the stuff Dr. Kelly Starrett DPT put out there, heck I participated in and watched the whole damn Mobility Project (credit: my squat and overhead mobility is pretty boss). Kelly is super smart and has bridged the gap into the public realm being an excellent example of what PT can be. He was a huge influence in me wanting to become a PT. That being said, the predictive statements really ruin the credibility. The “if you move this way, you will be in pain” and the “posture” and the “we see athletes with this movement fault all the time.” Ask Prisca Jeptoo about movements faults. It becomes hard to support.
I know you have your opinions like this too. For example, Chiros can pop a t-spine and create an air bubble in a synovial joint and get an audible pop. But the claims they make based off that pop turn them into Used Car Salesmen. Credibility = Rx / Claim
We hear Surgeons telling patients about their future: “you will be in pain because of this X-Ray I took.” Ah yes, the crystal ball claim. The excellency, education, knowledge and skill of this surgeon is now tainted by the lack of credibility of his claim. When people tell me they’ve been told things like this I ask them to get the winning Lotto numbers from their surgeon, since there is a lot of predicting the future going on… it opens the doors to talk about what we actually know.
Keep your claims equal to the facts.
Maybe this equation can be used as “your razor” to trim off bad thought, as Dr. Erik Meira states here.
What if we just stick to what we know? When stating options for the future, make sure they are known to be options, and based off of [research, clinical experience, tissue healing times]. I work very hard, and reflect on my interactions, so that I do not mislead.
Yes people ask us for advice, and “how does this Rx work?” and some don’t like ambiguity or the fact that uncertainty exists in the world. Well, those people are well served in the medical community with practitioners making hard and fast statements. You just won’t hear it from me.
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