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I enjoy this article as well. I think a huge part of how we as clinicians can “improve the lives” of our patients is by being present and practicing with intention and mindfulness of the patient in front of you. This idea of mindfulness has been a mantra of mine since I read Dr. Langer’s book and is a concept that I think is applicable to not only our daily interactions with people but with patients volitional seeking our help as physical therapists. In Dr. Langer’s book she shares her results from a study that shares the profound impact of mindfulness. In this study, two different groups of symphony musicians were asked to play a piece of music for the same audience. These musicians were selected for this study because they had expressed boredom within their jobs due to the monotonous nature of symphony performances. Musicians in one of the groups, labeled the “mindful” group, were each asked to apply subtle personal changes to their parts; a slight deviation from the written piece to “make it their own”. The control group was asked to simply replicate a previous performance they enjoyed playing, without any variations, deemed as a mindless activity. The audience, which listened to both groups of musicians, overwhelmingly preferred the “mindful” group’s performance over the control group. People could consciously feel the “mindful” group’s efforts or their applied mindfulness, while playing. The result was not only more satisfying for the audience, but for the musicians as well. This study also shows how mindlessness can occur even when performing skillful tasks and its ability to mask the brilliance of their work as musicians.
What I love about this study is that it sheds light to what it can mean to show attention to detail and how the power of intention can affect those around you. I feel that our effort towards treating patients shouldn’t be any different. I also think it shows the potential for even the most talented and knowledgeable _____PT_____ (insert any profession here) can have unfavorable outcomes based on their inability to impart mindfulness. I feel as though not only are we doing a disservice to our patients but also to ourselves when we don’t take advantage of the placebo effect that we as clinicians can have. Ok, sentimental post over!
Reading these posts and reflecting on the common themes reminds me of an APTA slogan that I personally love, “The Science of Healing. The Art of Caring.” It reflects to the unique patient care we can provide and clinicians we can become.
Utilizing the SCRIPT tool I can improve my “science of healing” and drive improvement in hypothetico-deductive reasoning which is what I feel is most lacking in my professional experience and where I have the most room for growth. It will also help remediate my similar tendency to want to prove initial hypotheses rather then test them and avoid mindless pattern recognition during patient care. However, what I’m also seeking through this residency is how both the science and the art of the physical therapy practice meet. The science to utilize the evidence available and the art of providing patient centered care. In our profession where some of our interventions, diagnostic tests, etc. aren’t backed with profound evidence I seek knowledge and skills from those who are expert clinicians, with years of applying their “art” under their belt.
After reading this article one of the first statements that stood out to me immediately was “This greater understanding (sound clinical reasoning) reduces the risk of diagnostic error, overly aggressive, and poorly tolerated physical therapy sessions.” After just 3 days of patient care I have walked away from a few patients having very similar concerns. Am I missing something? Am I progressing them appropriately to optimize recovery? Am I being patient-centered enough? I almost feel like this bull in a china shop. Eager, all over the place and possibly a little reckless. No I’m kidding, but the concerns are note-worthy.
On a more serious note, reading this article was extremely reassuring and confirms everything I seek to achieve through this residency program. “Sound clinical reasoning, to include using a systematic patient tailored approach to data gathering and forming early prioritized diagnostic hypotheses, followed by a carefully selected interactive patient history taking and examination to test hypotheses.” This is my goal. I’d like to be more effective, efficient and successful evaluating and treating patients. I enjoy and feel confident evaluating and assessing patients for impairments and functional limitations but often times feel I’m just left with a laundry list of dysfunctions, faulty mechanics, etc. and I’m at a crossroads. Where do I go from here? What should I prioritize from this list? Is this the most effective skilled intervention? I mean seriously the list goes on and on. I’m seeking professional growth by building confidence and advancing my clinical reasoning skills. Feel more like a stealth lion, less like a bull.