So why me?
Often we feel we need to justify ourselves. As clinicians. As experts. This creates endeavour. I recall numerous consultations with fellow healthcare workers: nurses, psychologists, medics. There is that little extra pressure to impress. Be knowledgable. Show your profession in a good light. People in authority like to impress. It holds a power gradient. It helps to have the latest idea. The cutting edge treatment. Trendy lingo. We strive for the most excellent skill set. I don’t endear to this naturally. I have written previously about a difference between good and perfect (La Méprise). Sometimes perfection leaves ethics behind. I try to deny the drive to be the best. Instead opting for the drive to be good. Do the right thing. As much as I am capable.
I am wary of the master of individual skills. Because individual skills are just that solitary. In a complex environment they are easily lost. Not they should be dismissed but need to be built into complex skills useful in context. Complex not in technique but abstract application of appropriate skills. In sporting examples it is not always the most skilful players who succeed. Impressive skill is different from contextually useful skill. Freestyle footballers have tremendous skill beyond most professional players. But they do not perform to the same standard in game scenario. As an ageing football player myself I have played 30+ games this year. In every single game I have played against someone much younger and faster than me. Yet I can count on 1 hand the number of times I have been given the run around. Because individual skills are not enough.
Mastery of complex skills require context dependence. Theory although important can only take you so far. It is context independent. Removed. There becomes a point where we need real context. Case studies. This is where we can develop expertise. Epistemology (how we know stuff) includes both concrete theoretical knowledge as well as abstract contextual knowledge. The latter can only be gained through cases. Many different cases. Learning from cases and experiencing cases are very different phenomena. Epistemology is concerned with methods of knowledge. In the same way it would be unwise to rely on one journal article if you rely on singular or few cases you are unlikely to build complex, nuanced useful knowledge. It will be shallow and narrow. But within a base of context dependent knowledge the single case study is rich in detail which adds to expertise. It is the quality more than quantity of case study that brings the richness to clinical expertise.
Beyond epistemology is the application of practical knowledge. How we apply things. This will in part be determined by previous cases. As clinicians or practitioners we are all unique in our approach because of this. Hopefully similar threads run through good clinicians. But what we say and do are not conforming to an ideal they are an outworking of what we have come to ‘know’ and how we have come to apply this. Whether we develop deep or wide knowledge depends on the cases we see. Are the cases homogeneous or heterogeneous in nature? Have we got the time and developed sufficient method to take the quality from these experiences?
So why me?
Firstly it is a very literal question. Should it be me? Do I have the appropriate skills? Is it an appropriate context? It may be that the person needs to see some other healthcare professional or be seen in a different environment. Secondly it is a contextual question. Why me? What is about me that might be able to help in this case? With this person? Do we recognise a pattern? A similar personality trait? A similar case? So long as you have appropriate basic skills it is more likely to be to do with your person than your individual skills.
This is of course of very human way of learning rather than a robotic application of rule and algorithm. Case Study learning can be a good way to develop clinical reasoning and to document success and failure. It may not make you the best or perfect. In fact I’m not even sure what that is.
This next series of blogs will be focused on case study and will look to expound from my recent talk at CauseHealth. The slides can be found on the link below.
Be more human. Be less robot.
Thanks for reading this far.
For any physiotherapists who would like to do this more and want a template the www.thebigphysiosurvey.com is a useful resource!