It all started, like everything nowadays, with a Twitter conversation. Like Columbus embarking on The Americas, entering the twittersphere was a strange experience full of new sights and sounds. An initial watching brief found the natives to be enthusiastic, prolific and very diverse. Thankfully the land is full of people passing through making new onlookers inconspicuous. After delving into their wonderful array of manuscripts and familiarising myself with their language, culture + emoticons I began to engage. First with the more approachable natives before the savages. The journey has been a fruitful one, taxing the mind, creating doubt from clarity and confronting ignorance.
This particular conversation went something like this:
@TaylorAlanJ: Pain artist @lee_eugenie asks …
“Clinicians are people too, aren’t they?”
#Physio #ThatIsTheQuestion ????
@neil_maltby: maybe outside the clinic…. 😁
@lee_eugenie: what are they inside the clinic then?
@neil_maltby: ha! Robots. Clinical reasoning machines. Some better than others at being human. 🎭
@neil_maltby: sorry. Over cynical maybe. I know a lot of good therapists out there. (Maybe speaking more from personal history!)
Meanwhile another journey being made by healthcare professionals is into the territory of Evidence Based Practice (EBP). There is no doubt that EBP and research has added some much needed rigor to healthcare and has many uses including weeding out ineffective treatments, and improving the understanding (or lack thereof) of pathology and epidemiology. At first an irresistible voyage but recently doubts + questions are starting to be raised, all of which are essential for progress. Ongoing discussion about its nemesis causality (especially in complex disorders such as LBP, fibromyalgia, CFS), the law of diminishing returns, claims of over reliance on significance levels, homogeneous populations studied and poorly designed trials have blighted the EBP landscape. An excellent overview of the benefits of EBP by Kenny Venere can be found here.
It is concerning that in proclaiming Evidence Based Practice (EBP) we can be tempted into a whole new realm of Evidence Ish Practice (EIP). In this new country each native remains staunch to their instincts as they starve on a few choice manuscripts for sustanance. These are savage isles that see only empire and have not known peace nor reconciliation. Here everyday robots collect in herds to listen anew to their leaders mantra. Ideas are strictly forbidden and discussion nor questioning are permitted.
My worry is that a Sherlock Holmes phenomena strikes healthcare. Let me qualify this. At first I am wooed by this proposition, as an introvert who probably finds logic more natural than interaction. Sherlock is obviously gifted in logic and reasoning and I agree that becoming more robotic and machinistic may help quantitative data interpretation within the scientific process. But should this transfer into a clinical healthcare system? Could a robot replace us as healthcare practitioners? (Unfortunately in some cases this may be true!) Should we leave our emotions at the door?
Sherlock may be a master of multiple causality but also of pissing people off. This may be one of the reasons Arthur Conan Doyle scripted Dr Watson alongside Sherlock, someone with far more social skills. Thankfully I don’t see healthcare professionals being replaced by robots any time soon. That being said if we leave our humanity at the door then perhaps one day we will be usurped. To maintain balance it is important to recognise that emotion has the potential for harming our profession if our bias is left unchecked or it is used unwisely, but I think our healthcare patients are looking for connection. It may be the difference between the patient passively or actively engaging in their own healthcare.
So where does being more human help us (and our patient) on this healthcare journey? Well I want to start a series of blogs looking in detail at the subjective assessment. The part as a junior I rushed through as a formality to get to the nitty gritty of the objective assessment and treatment. It could be argued that technology or a robot could be more accurate with objective assessment (eg BP, RoM etc). The subjective is different. Its the main time we get to connect with the patient, understand them and their story, and form a therapeutic alliance. It’s fair to say my subjective assessment has become more important and probing over time and contextualises the objective assessment and treatment stages (and even continues through these stages). If we disengage from the subjective assessment we risk becoming robotic and disengaged from the patient, often missing vital information. With current research showing heterogeneity in clinical presentations and strong psychosocial factors with pain, pathology and recovery the subjective assessment should be a valued area of assessment.
Be more human. Be less robot.
Thanks for getting this far.
where humans beat robots (the last paragraph is particularly interesting)
this blog by @SpencerMuro about the importance of the subjective assessment
Miles et al (2008). Evidence-based healthcare, clinical knowledge and the rise of personalised medicine. http://bit.ly/1GvOL5iebpmiles
Venere (2015). In defence of evidence based practice. http://bit.ly/1GvP3tbvenere
Albarn (2014). Everyday Robots. http://youtu.be/rjbiUj-FD-o
Elkins (2015). Business Insider UK http://bit.ly/robotjobs1
BBC (2015). http://bit.ly/hero6healthrobot