I have been thinking a lot recently about how we guide our thinking in practice.
There tends to be a dichotomy in thinking between instinct and knowledge, while in reality, our practice relies on a fluid combination of both.
My recent reading has lead me to Malcolm Gladwell’s Blink, which explores the phenomena of snap decisions. He describes through numerous examples how we tend to inexplicably know things without necessarily being able to pinpoint why. Sometimes something just doesn’t look, or feel, quite right, and his arguments tend to weigh in favour of following the gut instinct.
I think such thinking is essential in clinic, and whilst it may sound a rash perspective, it in fact is a practice which develops with years of experience. Of course, our knowledge of anatomy and method is the absolute foundation of whatever we do. Over time, this knowledge can be guided by our own memories and experiences, and create ‘shortcuts’ to the answers we need.
One woman I worked with recently needed such an approach. I was treating a women with fibromyalgia who had come to me for help with chronic pain in the thoracic spine. Ongoing treatment was effective but in one instance it was clear the pain had worsened. As we sat before beginning the day’s treatment, it was clear that there was pain and swelling coming from the knees. This is not however something the patient would have mentioned, thinking it irrelevant. On instinct I started working from the knees up and her condition improved considerably.
Of course it can be hard to run away with these feelings. When we see patients day in day out, we have to remind ourselves to keep our methodology close. Instinctively, we can often tell what is ailing a patient simply through postural assessment, and the instinct is to want to get stuck in and fix. I have to remind myself to pause, think ‘science’, and then continue with a guided treatment.