Empathy? is it the conner stone of medicine?

The other day, I gave a talk to incoming students of PT, and to my surprise I was pleased with my talk. I thought why those students should only have to listen to my rambling, let me put it out in the ether. 

Our tale commences with our ancient predecessors, the Australopithecus, emerging some 3 to 3.5 million years ago and embarking on the journey of walking on two legs. While it's possible that other species in our evolutionary lineage also had bipedalism, I'll focus on the Australopithecus. These guys were relatively diminutive, lacked our expansive brains, and certainly couldn't run at impressive speeds. They probably hid in the tree for most of the time. As time progressed, we became more upright in posture, bid farewell to arboreal habitats, and saw our brain sizes expand.   We also had major disadvantages as we evolved into hominids. 

What were and are our disadvantages? 
Adopting an upright stance introduced new challenges during childbirth and increased the likelihood of “falls”. Yet, against these odds, we managed to thrive, spreading beyond the African continent's borders. Our footprints reached as far as South America and Australia roughly 40 to 50 thousand years ago. In the process, it seems we're also burdening this pale blue dot we call home with the weight of our burgeoning population. 

These accomplishments were not random strokes of luck; They were rooted in myriad of reasons:  from cognition to adaptability, but I will stick to one or 2 factors. Please remember that our offspring are uniquely ill-equipped to fend for themselves for an extended period after birth, and the process of childbirth frequently demands assistance—a sharp departure from the norm in the animal kingdom. We are effective in hunting alone, as we don’t have claws, or hoes or great ability to run fast. So, what makes us good is working together. Remember we are social animals.  Archaeological finds, spanning thousands of years, offer evidence of our enduring capacity for empathy and care. Healed fractures from the past, like the femur fracture discovered in Spain dating back around 15,000 years, tell stories of individuals being tended to, perhaps for months, until they healed. 

Empathy, camaraderie, and altruism have been constants throughout our history—not just a product of modern socialist ideologies. These qualities seem to be innate, woven into the very fabric of our success story. From aiding in the rearing of children to supporting the weak and the infirm, we have consistently extended our compassion and support to members of our own tribe. It's a thread that runs deep within us, contributing significantly to our journey through time. 

This I think with time became medicine, So the basic quality you need to have to be a therapist is Empathy and altruism. Unlike many things in “spirituality” like equipoise or being with material wealth may be anti- evolutionary- hence we all struggle to achieve it. But, compassion, looking after the weaker, having empathy is in our genes. It is what will make our society more productive, healthier and happier. Sadly, capitalism and privatization of health is slowly removing these qualities from us, and it is completely gone at the time we join a job. So, we need to start afresh, and teach our students the value of empathy and compassion.  

Next comes following science and not be a Jack ass and flow some random “science” you say on social media. Following evidence, I believe will come if we have empathy and understanding of patients and suffering. Otherwise, we will be some random guy who operates a switch in the op or cracking the spine and feeling proud of it.  
 

Don’t ask me if I have empathy and compassion towards my patients- of course I will say yes, but I am sure my patients will not agree (at least some of them ha-ha) 

 

 
As you might have guessed, this is not an exact transcription of my words, this is A certificate blog the talk was kids, so... 

P.S.: The Homo genus comprises numerous species (there are too many for me to recall all the names), but those I remember are: Homo erectus, Homo floresiensis (referred to as "hobbits" due to their unique nature), and Homo neanderthalensis (with whom we interbred, resulting in most of us carrying around 2 percent Neanderthal genes, except for some regions of Africa). Additionally, it's interesting to note that chickens also exhibit a bipedal gait, although their foot posture is different. 

Let go to learn, science- based Physiotherapy.

 When a scientific disciple is “Soft” it invariably has schools of thoughts.  Physiotherapy is no exception to this. In our field, we refer to these different perspectives as approaches, named after their proponents, or sometimes using names that sound scientific like craniosacral therapy or sensory integration.  

In medicine, well in biology finding casual pathways is difficult, probably easy if it's infectious disease.  As the systems are complex and nonlinear what are the causes for the symptoms is difficult to ascertain. This is compounded by the 2 uniquely complex systems we deal with: movements and pain. Both are poorly understood by scientist and always make clinician feel like they have understood them even if we don’t have a clue.  

Birth of Approaches in neurology:  

As theories on how movements are controlled in healthy individuals were developed- clever PTs with intuition, and experience developed ways to use that in neuro-rehabilitation. From proximal to distal, cephalic to caudal, developmental sequences, facilitation to inhibition with sensory inputs were some of the ideas which were fixed in different manner to invent approaches.  

If you look closely these approaches looked at sensory systems as the dominant boss of movements. Dealing with sensory systems alone has the advantage of dealing with a complex system. It makes the approaches which were developed look clean and probabilistic.  

 They rarely talked about the perceptual systems, learning, importance of practice to change the system, long term change or patient centric change. These are complex phenomenon and need far more than just facilitation or inhibition, proximal to distal.  

When never understanding of movement control and behavior started emerging, which took into the account the complexity of the system, we have a different set of schools or approaches.   
 
As we have empirically tested these “approaches” and we have a slightly clearer path to walk forward. So, what does this mean? It means the schools or approaches must go to history of PT. It means from Bobath to pseudoscience like sensory integration should be in our history of PT not in syllabus. They should all go the sterilizer way- you know the one we sterilized the syringes and needle for injection. 

Sadly, that is not going to happen, we are unable to throw them out. When I was small all the hospitals will have a sterilizer.  Can we change:
When I taught at a college in Pondicherry some years ago, the focus of the entire day was on encouraging students to think critically and identify flaws in their judgments. One topic of discussion was the supposed effects of ultrasound on tissue. I questioned why ultrasound couldn't produce any of the intended effects, and someone responded by referring to experiments on how cavitation is generated when applied to tissue. They argued that if there were such experiments, how could I claim it was wrong? 

I pointed out that while we had indeed read about those experiments, it was worth noting that they were all conducted in vitro. However, when in vivo experiments were conducted on live humans, cavitation could not be observed. 

Curious about the reasons behind the lack of cavitation in live human experiments, I posed the question to the group. However, since it was an open question, I opted not to provide an immediate answer here. I invited the five people who read this to think about it and respond to me via WhatsApp. 

During the thinking workshop we had, I had a valuable experience. I cannot say for certain whether anyone liked it or had a change in their thinking. However, what saddened me was the concluding remark during the vote of thanks given by a staff member. They emphasized that everything discussed throughout the day was merely a school of thought. I had to use so much energy to stand up and tell him ““He is the best idiot I have ever seen in my life", but did not. I still don’t know why I did not.        What to do to change: 

Being angry aside, I think the PT staff was afraid to let go of Ultrasound, PNF and all other things I was poop poohing on that day. We are afraid, to say something is wrong or right. Lack of this confidence sadly stops from developing interesting never ideas. We still think US, IFT, Bobath and all we learn in school is PT. Not really as you know what makes your patient better is PT. Let go, we will grow. Let go nothing is ours. Bobath is not our god, let go, Traction and IFT are just a bunch of motors and wires, they are not PT, let go. Let go off most of the syllabus and we will grow. Let go- better science which helps patients will occupy the space. 

 

With so much love Hariohm

 
 Let's see school of thoughts in relation to pain some other time as this one is long.