Archives for December 2013

Therapeutic analogies

Analogies are a great tool to explain a difficult, complex, or unfamiliar topics.  Much of what we try to communicate to our patients took years of foundational education, scientific inquiry, and clinical training.  Somehow we’re supposed to relay all this information to a patient within a short visit, and we’re attempting to do so with varying levels of background knowledge.  In short, clinical communication is a challenge, and something I’m always trying to improve.  Quality communication improves efficiency and outcomes.  Poor communication creates confusion, nocebo effect, and fosters disability and dependency (see last paragraph, but read the whole post).

I will try to remember to share more of the analogies I use, in hopes others will post theirs as well.  All analogies inherently have flaws, but if we can communicate concepts quickly and efficiently our patients and athlete’s will benefit.

Today’s therapeutic analogy:

“Your leg is the scoreboard and your back is the crowd noise.  We need to stay focused on the score, as this is a game we can win.”

After this analogy, the patient’s facial expression revealed immediate comprehension and understanding.  The path to victory was clear.  Other times I’ve spent longer than I care to admit struggling to communicate this idea.

Trying to explain centralization phenomenon to a patient can be a challenge.  Particularly when local pain gets worse and tinging/numbness in the extremity improves (ex.  back pain intensifies, but leg numbness resolves).  Numerous times patients tell me they can live with the numbness they just need the pain to go away.  Our pain centric ideas often get this one backward.  The extremity symptoms need to be resolved — a concept well taught in MDT (McKenzie) training.

Focus on what is important.

Ignore the distractions.