Why we need to be the best

What is best in clinical practice? How should i assume i am doing the best i am doing? There are many definitions of best- as a adjective it is ambiguous. We clinicians undoubtedly do thing for money. Hence most of the time we hide behind the veil of "patient satisfaction" and believe either we are doing the best or what makes the patients happy.

What makes patient happy is varied but we ideally it should be "recovered fully". But the path to recovery can be made faster, with less discomfort and less effort. That is where I think we tend to take short cuts and make grave assumptions and don't do our best.

The first assumption in PT seems to be "10 days" and "daily". You know what I am talking about. We all are conditioned to think LBP, Neck pain, heal pain, and much more - 10 days daily, then only you will recover. We all are taught 10 days is a magic number. Sadly we are never told what is the recover time for different conditions we treat. We also have this notion we cant say - every patient is different. The last statement is all time favorite statement euphemism for  " i did not go to college on that day" or what you have data for those, i have never read them. I just hope the uneducated "physicians" surgeons who "prescribe" PT and also the PTs who all want to be more than that can read and empower the patient about it.

Why this is important- well truth is what will set you free isnt it. Also that reduces the anxiety of the patients. We all have the patient who comes and tells us i went to mr. X I took the drugs for 10 days it has not reduced or I had IFT for 2 weeks still it has not got better. In this scenario- There are 2 issues- one is not making understand issues like OA, knee or PA shoulder or chronic pain is going to get better in "10 days" and apparently the low value care we all believe is next to god. i mean the IFT, IPT for lbp, or the rubbing of miracle points- I am talking about the nonsensically named trigger point, or -well we all know the list i usually put.

The next argument why we use is- The treatment I give is the best- that is it reduces the recover time and makes you comfortable. This is a common argument in surgical medicine also. I will stick on to conditions which we treat. Now as we don't know the recovery time so- this claim seems have no leg to stand on. We are never taught or take to read the natural history of many disease like LBP, Neck pain, stroke etc, and then without that we assume our treatment is better than no treatment or rubbing people claim it is better than cup and cup people claim they are better than IFT people and IFT people mostly are well that's is important how else will you get better. We also have never seen or shown any data one treatment is better than another- but we just accept that was some sort of truth when we hear it in the workshop or from the teacher- why?

The worst argument of all is- this is what my patient wants argument. Or my patients like it. My patients want "passive movements or stretching" is a common comment i hear from neuro PTs . Ortho practice is just full of these self defensive dialogues. As Balumahendra dialogue in marupadium goes something like this- Well for this song the audience may like it when all the dancers are naked- but i wont do it. Even when art is not catering to just what your patient wants health care cannot be just catering. You make the patient understand the treatment choices, make him understand when the treatment choices or unequal. When they choices are equal then you make him chose which rarely is the case in PT- but may be important in surgical medicine. 

So,  the best treatment is what science "proves" is the best. The best treatment is the one which makes recovery faster then natural recover or other treatments.  The best treatment is not the last workshop you attended, it is not the last treatment you learnt form a white person with a tie, or the well most of what you learnt in your college. 

The best treatment needs effort from the therapist to search, read and empower the patients. The best treatment many a times is active- it involves the patient - not just lying on the couch. The best therapist should be following the best available evidence when ever possible. I know many a times our hands are tied by the ortho- who as i have already stated need to go back to reading- then practice. But sadly the university or college hospitals - who is stopping you? why are you a bunch of uneducated wuss? why cant you read - most of they day you just sit and gossip why cant you read or supervise your students? why are you the worst of us? just sad isnt it and then we complain my son has poor teachers in school and well wait you send them to college- they will be taught by bunch of idiots like you.

omg- that was a angry rant- hahha. anyway- be the best- try to be the best, your patients deserve it

Love 

Hariohm