On a scale of 0 to 10…

Every answer, thought, feeling, decision stems from a reference-point. A single value cannot bring meaning to an informed decision.  Ex: A 60 degree winter day is warm to those in Boston, and cool to those in San Diego.  An increase of strength by 5 lbs is a lot with shoulder external rotation, but not so much with a leg press…. or maybe it is a lot for the leg press in someone recovering from Guillain-Barré. Transporting in a wheel chair does not seem so good, unless you have been bed bound for the previous year.  So the reference is an imperative portion Continue reading

Tell me a story: A metaphor for understanding analogies

Start here, with this TEDtalk-

I like to use a story or analogy to explain things to patients.  It helps me come into their world and attempt to contact them on their own turf.

It’s not that patient’s are dumb, and can’t understand concepts or facts and figures. Stories are just a great way of conveying information. Adriaan Louw points out that when we are little children we have stories read to us (Aesop’s Fables and the like) that illustrate points, morals and teach concepts. You listened to the story and you got the point to that story, so it starts very young.

When you are on a cruise or on a bus or meeting people for the first time at a restaurant, why do you tell stories? Continue reading

Think about it…

How do I help my patient get better? It may depend on many things, the disease, injury, co-morbidities, etc. And in many cases it can be hard to ignore big factors that “stand in the way” of recovery. Some patient’s are just tough. Complex. Hopeless.

Of course, we make sure to keep a mask on. We attempt to prevent our patients from seeing Continue reading

The Power of Silence

Image Credit: NASA

It is the space between the notes that make the music.  A wash of sound and pitch and tone does not stir emotion or evoke dance and tears.  It is the time taken, and placed, between to the vibrations that add meaning.

It is the silence and expanse of nature and wilderness that allows the existence of city life.  It must be there, a place to go to, or the mind cannot breathe.

When looking at the earth from space, we do not assume the only activity or important part is the part that is lit up.  The darkened areas are alive as well.  This is also the case with fMRI.  Yes one part is lit up, but this says nothing about the importance of the less active or “silent” areas.  They too are playing an important role.

And so it goes for any meaningful interaction, and in particular, care-based interaction.  Silence is the time when the ideas can settle, when concepts can take root, when importance is emphasized.

Mark Reid MD PTBT

We all know that a good history can yield some superb differential diagnosis choices. This can only happen in environmentally appropriate silence.  We already know what we know.  Therefore we can keep quiet about it.  We don’t know what the patient knows… so we must listen.

Alan Ristic PTBT

Silence has a time component.  Perhaps that’s why it’s so hard to come by…

Give silence a chance.

Matt D

Therapy vs. Therapeutic

If you are grappling with concepts of treatment effects and how a technique works or if something is effective and what role it plays in your patient’s recovery… then this post is for you!

A few classmates and I recently attended a lecture on Music Therapy from Tracy Bowdish, MM, NMT Fellow, MT-BC.  We discussed some fascinating music therapy concepts in treating movement disorders, but  while discussing research paradigms she posed the question about Therapy vs. Therapeutic and I have been thinking about it since. Many answers lie in answering the question: Is this therapy, or is this therapeutic? Continue reading

Hey, Where is that Pain From?

Have you ever asked someone where they are from?  Sure, you have.  Have you noticed a breadth of answers in terms of history time-line?

For example: Some might say

  • “Oh, I’m from Hillcrest Neighborhood” (immediate History)
  • “I’m from Virginia” (current History)
  • “I grew up in Boston” (Childhood / Distant History)
  • “My family-line is from Poland” (Distant History)
  • etc… and on.

How far back do we normally go?  Perhaps it depends on who is asking the question, and what the context of the conversation is about.   Continue reading

Your hyper-vigilant SWAT Team. A Metaphor

We all have a nervous system who is our boss and our buddy.  One of it’s jobs, as an organ and part of the whole, is to protect us and alert us to danger.  This is biologically advantageous, no doubt. We want some level of protection so we don’t ignore tissue and other damage.  One way of protecting us is to limit movement in a predicted pain-causing manner, or to cause movement away from danger.

If you have too much vigilance, however, movements are stifled and restricted and life gets a little scary. The body environment becomes a little hostel while in this overly vigilant state.  To illustrate this, let me paint an image for you… Continue reading