Blog | Allan Besselink Allan Besselink | Official Site Of The Smart Life Project, Smart Physio, Rhubarb Diaries, And Mobius Intermedia http://www.allanbesselink.com/blog Tue, 30 Jun 2015 09:48:27 +0000 Joomla! 1.5 - Open Source Content Management en-gb Learning How To Live http://www.allanbesselink.com/blog/smart/1310-learning-how-to-live http://www.allanbesselink.com/blog/smart/1310-learning-how-to-live 20150129_180437All it takes is a quick look in the rear view mirror of life to get as much hindsight and perspective as you can handle. I’ve found that what I see there is oftentimes crystal clear - in retrospect.

When I gaze back at the year 2014, I find myself looking at 365 days in which I was face-to-face with love and loss, frustration and friendship, challenge and consternation.  It was the Year of the Dichotomy. I swear it’s on the Chinese calendar.

With great adversity and challenge comes great awareness. That’s my story, and I am sticking with it. In no particular order, here are a few things I learned along the way.

When times are tough, we may feel the need to focus on survival, plain and simple. We can only draw upon our resources so much before we feel a little (or a lot) drained. We feel like we are only making withdrawals, and the deposits are few and far between.

Sometimes, the best we can do is to live day-to-day. When life gets really tough, when the hurts seem to mount or the mountains to climb seem Everest-like, we might find that living moment-to-moment is an epic accomplishment because that’s all we have in the tank that day.

Take care of today - tomorrow will take care of itself.

Our basic survival mechanisms, however, somehow remain intact. Eat. Work. Sleep. Lather. Rinse. Repeat. But how much "living" do we do? How much do we challenge our thinking? How much do we push the envelope of our beliefs? How much do we allow ourselves to face the raw emotion and vulnerability of a life lived on the edge? How engaged are we in being “the best me I can be”?

One moment at a time.

Does time pass us by unbeknown to us? Do we live in the moment, losing ourselves in the purity of it, appreciating it, embracing it, sucking every last ounce of feeling out of it?

Be present.

It doesn't have to be going to exotic places, or experiencing life at the edges of our planet. It could be simply facing life, alone or in partnership, and taking the moment and wrapping our arms around it.

Fully. Completely.

As we head down the road less traveled, hopefully we don’t become cynical or jaded. We can gain insight and levity from every twist and turn on that road - if we let it happen. If we are open to reflection and to learning, if we can keep our heart open to what could be, we have the potential to make great strides, to fill up our tank when the day gets dark.

Keep an open heart.

Some days, that is an easier task than others. Some days, it is so easy to lose sight of that - as many of us will do.

Now.

That’s all we have. Sadly we have to be slapped in the face by life repeatedly to realize it. There is no guarantee that tomorrow exists. Now is all I can ask for, or so I’ve learned.

For all the complexities of life, it gives us some pretty simple lessons. There is a beauty in each and every day. There is a peace to be found within. Dig down deep and find it. Share it. Live it.

No worries, my friends. We are just learning how to live.

Photo credits: abesselink

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ab@allanbesselink.com (Allan Besselink) Smart Physio Mon, 22 Jun 2015 02:29:18 +0000
Patient Access To Physical Therapy And Groundhog Day http://www.allanbesselink.com/blog/smart/1309-patient-access-to-physical-therapy-and-groundhog-day http://www.allanbesselink.com/blog/smart/1309-patient-access-to-physical-therapy-and-groundhog-day Groundhog Day Selfie with Punxsutawney Phil 2015When Punxsutawney Phil - the legendary groundhog - leaves his burrow on February 2 every year, he looks for his shadow. If he sees his shadow,it predicts another 6 weeks of winter ahead. That’s a pretty lousy thought when you live in a northern state.

If you are a patient, or a physical therapist perchance, in the state of Texas, there is a similar phenomenon that takes place every two years. It’s the physical therapy version of Groundhog Day.

Imagine emerging from the state capital and looking for your shadow. If  you see your shadow, it entails another two year wait to introduce yet another bill to address the same issue all over again. You have to start over from scratch.

Groundhog Day came early this year. Usually, it takes place on a day they call Sine Die: the last day of the legislative session. The session ends and all bills left pending - which typically includes a patient access to physical therapy bill - just fade away into the ether.

Special interest groups in Texas are like the blazing sun. They cast the shadow of campaign contributions over just about everything. And when they want a shadow, they make it so.

Every two years, physical therapists in the state of Texas invariably see their shadow, forcing the legislative equivalent of 6 more weeks of winter - two years at the Capitol - upon us.

HB 1263 died in Calendars Committee. Although it was voted out of the Public Health committee, it never saw the light of the House floor. You barely heard the whimper of its demise. You certainly didn’t see any legislative backlash on it from constituents or a scathing editorial or press release. It was as though it all took place in the dead of night.

In the words of Ernest Thayer in “Casey At The Bat” …

Oh, somewhere in this favoured land the sun is shining bright,
The band is playing somewhere, and somewhere hearts are light;
And somewhere men are laughing, and somewhere children shout,
But there is no joy in Mudville—mighty Casey has struck out.

So here we sit. Again.

For another 2 years, a patient’s civil liberties will be limited. They will be unable to freely, and of their own volition, make a choice related to their own health care.

For another 2 years, a physical therapist’s trade will be restrained in the state of Texas by a legalized monopoly disguised as things like “patient safety” and other disingenuous crap.

Punxsutawney Phil is a lucky groundhog. A 6 month wait sounds downright appealing these days.

Physical therapists around the state will be proclaiming that “we got a little further this time than last time”. Sadly, I find no reason for celebration in Mudville.

Winter has been in full effect for decades in Texas. It’s about time for a change in the weather.

Photo credits: Anthony Quintano

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ab@allanbesselink.com (Allan Besselink) Smart Physio Mon, 01 Jun 2015 03:17:24 +0000
Why HB 1263 Matters http://www.allanbesselink.com/blog/smart/1308-why-hb-1263-matters http://www.allanbesselink.com/blog/smart/1308-why-hb-1263-matters State Capitol at nightIn the state of Texas, the debate is upon us once again. HB 1263 - Patient Access To Physical Therapy - is to be heard in the House Public Health Committee on April 7, 2015.

It is time to push aside the fear-driven dialogue and logical fallacies that have clouded this issue for two decades.

Here are just a few reasons why this bill is so important to the health - and liberties - of all Texans.

1. Freedom of choice: A patient should have the civil liberty and the freedom to make decisions related to their health care - based on their own volition and free will.

Last I looked, the Declaration Of Independence defines “unalienable rights” as “life, liberty, and the pursuit of happiness”.

Health - and choice - are implicit to those rights and freedoms.

2. Who better to decide if a patient is appropriate for physical therapy than a physical therapist? As it stands right now, a patient requires a referral from a physician, chiropractor, or even a dentist, for treatment. None of these referral providers have any training in physical therapy.

Doesn’t that make it difficult knowing when it is “appropriate” or not?

3. Patient-centered care, Part I: Patient-centered care requires patients having the ability - and ownership - to make choices related to their care.

In 2013, the PEW Research Center found that 59% of US adults have looked online for health information in the past year, with 35% of US adults having used the Internet to self-diagnose a medical condition they have. Guess what? A total of 41% of “online diagnosers” had their condition confirmed by a clinician!

We don’t seem to be too concerned about safety issues with patients seeking self-diagnosis online - and you certainly don’t need a referral to use the Internet.

4. Patient-centered care, Part II: You don’t need a referral to be seen by any number of licensed and/or unlicensed practitioners. Throw hot stones on the patient, poke them with needles, wave a crystal over their forehead, no worries …

… but by golly, don’t let them be treated by a physical therapist, the experts in movement, exercise and function [insert sarcasm here].

5. Costs and the market: A free market forces all providers to bring their best skills and outcomes to the table for the benefit of the patient. Competition is always good.

The payers, be they the insurance providers or patients directly, will all benefit from better outcomes, more efficient use of health care resources, and ultimately, lower costs.

We’re not in the year 1950 anymore. The health care landscape is changing. The burden of proof isn’t on why patients should have access - the data to support this continues to grow on a daily basis, and has for two decades.

The burden of proof is on those who say that patients shouldn’t have access. Please tell me how it can be acceptable, in this day and age, for patients to have their civil liberties limited in a state that prides itself on the same? And, while we’re at it … where’s your data?

Let’s move into the year 2015. Over 10,000 Texans agree, having signed a petition in support of HB 1263.

The public hearing is to be held on Tuesday, April 7. Stop by the Capitol and drop a card of support via the House Witness Registration kiosks, preferably before the hearing begins at 8:00 am.

Demand that the Texas Legislature give Texans the right to choose.

Photo credits: abesselink

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ab@allanbesselink.com (Allan Besselink) Smart Physio Mon, 06 Apr 2015 04:16:24 +0000
The Flow Of Running, The Flow Of Life http://www.allanbesselink.com/blog/smart/1307-the-flow-of-running-the-flow-of-life http://www.allanbesselink.com/blog/smart/1307-the-flow-of-running-the-flow-of-life Go With The Flow [Sign]Running has a way of bringing some of the simple things in life back into focus.

Last month, I finished my 11th 3M Half Marathon. It was a beautiful day to experience the joy of reaching another finish line. Far more important, however, are the lessons learned along the way to those finisher’s medals. You never know when those lessons will make an appearance or provide you with an epiphany of sorts.

I vividly remember one day in December, a day on which I had scheduled a routine long run in preparation for this event. I awoke to a temperature of 40 degrees and rain.

I will admit that the thought of running was becoming less and less appealing by the minute. I just don’t do well running in the cold, damp weather. The weather forecast was for much better weather the next day. I crossed my fingers and pushed the long run back a day.

On that particular day in December, it was really ok to just let it go for today and see what tomorrow would bring.

The following day was, fortunately, a beautiful day for a run: 60 degrees, sunny, minimal clouds. It was as perfect a day as you can get for late December.

In times past, I would have stuck to the plan regardless of the circumstances. Discipline, right? Strength, yes? But was all of that just an attempt to validate myself as a “runner”?

Lesson duly noted.

Now, the task was to get out the door.

Inertia - “the resistance of any physical object to any change in its state of motion, including changes to its speed and direction”.

We rarely think of inertia in the context of our daily lives. Although it was a great day to be running, I found that inertia was making its presence known.

Through the first half mile, then a mile, then a mile and a half, the struggle persisted. My mind was trying to find ways to abort the mission. It was seeking excuses. It was rationalizing. It wanted to stop.

History was on my side that day. In times past, there has been a magical moment, not one that you can predict on a watch or a mile marker on the road, when the inertia shifts slightly. Just relax and let it happen. And it did - yet again.

Lesson duly noted. Again.

One moment, you can be struggling, and the next moment, you are caught in the exquisite state of flow. It repeats throughout a long run, or a long bike, or a long swim. It is rarely planned or predictable, and oftentimes inconsistent.

Just like life, as I always like to say. Running - or any sport for that matter - provides us with a microcosm of the world as we know it.

Sometimes we struggle. We fight the inertia of our day. Sometimes we find flow. Sometimes we are in it, we push, and we fall out of it. Sometimes we can be so focused on maintaining it that we lose "it" along the way.

Sometimes we have moments of greatness. Sometimes we face great physical and/or mental challenges. All along the path, there is the task of "managing" the powers that be, be they wind, gravity, soreness, inertia … or work, family, friendships, relationships, love.

Sometimes we feel the need to “be” the person that we were, or the person that we want to be, instead of simply being “me” right now.

Running has, at times, given me the opportunity to reflect on the beauty of life - while simply putting one foot in front of the other. Over and over again.

Just like life.

Photo credits: Dave Dugdale

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ab@allanbesselink.com (Allan Besselink) Smart Physio Fri, 27 Feb 2015 22:42:58 +0000
Own, Disrupt, Transform–Or Else? http://www.allanbesselink.com/blog/smart/1306-own-disrupt-transformor-else http://www.allanbesselink.com/blog/smart/1306-own-disrupt-transformor-else 20150104_173233The phrases resound throughout the annals of social media regularly. Owning our profession. Disrupting PT. Solving PT. Transforming society. It all sounds great, doesn’t it?

As much as I agree wholeheartedly with the premise underlying all of these phrases, I fear that they are becoming nothing more than hollow words, platitudes upon which we hang our professional hats while our profession is defined by those outside the profession and not from within.

Physical therapists would probably agree that in a clinical environment, you have to crawl before you walk, and you have to walk before you run. The same applies to our professional woes.

Nothing of value comes easily. However, the ramifications of the failure to do so are even worse.

You have to own before you can disrupt. You have to disrupt before you can transform. If you put things in the proper order, the long-term potential is huge.

Self Image: Before we can own the profession, we must address our self image. We are a profession in need of a cognitive behavioral intervention or two or ten.

A prime example is perpetuating the myth of direct access in all 50 states. I keep asking how Texas fits that definition. I keep asking if anyone has asked a patient lately. While it sounds good, it is a blatant fallacy to a consumer. This is self-sabotaging behavior, a hallmark of low self image.

Another example is the logical fallacy of access being useless if we aren’t reimbursed. Reimbursement isn’t a necessity before access - it will become a secondary effect of it. Autonomy is autonomy; how you are getting paid for it is a separate issue. This is yet another self-sabotaging behavior.

While we’re at it, we also need to own the harsh realities of our legislative world. Simply raising more money won’t win the battle - not when you are working against lobbying powerhouses that will ALWAYS have more money in the legislative coffers. Period. While whining about the need for more money, we fail to make a concentrated effort amongst consumers themselves. Consumers equate to votes for, or against, legislators. Again, self-sabotage.

Just Say No: Owning the profession then evolves into a need to stand up and say “no” - to those who continue to define our profession from outside. As the saying goes, “If you don’t stand for something, you will believe in anything”. We talk a lot about our value, but then we won’t stand up for it when push comes to shove.

You need to have enough people within the profession that will stand up for what they believe in. Sadly, I don’t think we are anywhere close to critical mass on that yet.

Disrupt, Solve, Transform: Ownership is critical before you can even ponder disrupting PT or solving PT. How can you disrupt when you don’t own what you are trying to disrupt? And even if you have found some sliver of answers for any of this thus far, then how are we ever going to transform society with what we have left?

Or Else? Yes, we need to crawl before we can walk, and we need to walk before we can run. Right now, the profession is in the crawling stages, full of talk and lovely platitudes and meetings full of hope and light. We are experiencing some serious developmental delays. There are some hard choices to be made. There will undoubtedly be some short-term pain before we attain the long-term gain.

“If you don’t like change, you’re going to like irrelevance even less.” (General Eric Shinseki)

If we don’t own it soon, if we don’t have the courage for Vision Now, we will forever lose the ability to disrupt. Transformation will become an afterthought. And so will we.

Photo credits: abesselink

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ab@allanbesselink.com (Allan Besselink) Smart Physio Fri, 06 Feb 2015 06:06:26 +0000
Civil Rights And Your Health http://www.allanbesselink.com/blog/smart/1305-civil-rights-and-your-health http://www.allanbesselink.com/blog/smart/1305-civil-rights-and-your-health MLK's houseSome twenty-odd years ago, I stood outside the Lorraine Motel in Memphis, reflecting on the tragic events of April 4, 1968. I have looked out over the National Mall and Reflecting Pool from the Lincoln Memorial, imagining what it must have looked like on August 28, 1963. Fifty-two years later, his words still have the power to bring me to tears.

Today, we remember and honor Martin Luther King, Jr. and his fight for civil rights and for freedom.

Many of us think of “civil rights” in terms of equality. But it is so much more than that for all of us, regardless of race or gender. In Texas, we hear a lot about property rights and the right to bear arms. But perhaps more importantly are those unalienable rights, those rights that we all share and the foundation upon which we all live, as noted in the Declaration of Independence.

Have you considered your health as one of those civil rights?

It might not be an obvious link at first. Step back for a moment and consider the following.

There is no better place to start than the Declaration of Independence:

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

Follow that up with the Bill of Rights, and more specifically, the Ninth Amendment:

“The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.”

Just to clarify, the Bill Of Rights Institute notes …

“The Ninth Amendment implicitly refers to natural rights, which the Founders believed all people were born with as the gift of God or nature.”

And this brings me to health.

Health is an integral part of “life, liberty and the pursuit of happiness”. Health is also an issue of self-ownership, perhaps one of the most important of the “natural rights” of the Ninth Amendment. We talk of patient-centered care and the inherent values contained within. We talk of informed decision-making and patient empowerment.

All good stuff, indeed. All principles that we often take for granted.

But legislators have created arbitrary limits to a patient’s freedom of choice in which a patient cannot choose their health care provider freely and of their own volition.

In Texas as in most states in the United States, you simply don’t have the freedom to choose ANY provider for your own health care based on your own informed decision-making about your health. When it requires the legal permission of a third party - one who may or may not have a vested interest in your choice - then it’s no longer a right.

You can’t go halfway on “unalienable rights”. You have them or you don’t. Period.

“Our lives begin to end the day we become silent about things that matter.” (MLK)

On Martin Luther King, Jr. Day, a day in which we celebrate a man that had such a profound impact on civil rights, let us remember the most elemental, unalienable rights of life, liberty, and the pursuit of happiness. While we’re at it, how about the natural right of self ownership along the way? That extends to making choices about your own health and health care.

With this in mind, I challenge legislators nationwide - and specifically, within my home state of Texas - to put patients and their unalienable rights first and foremost.

“The time is always right to do what is right.” (MLK)

Life is health. Self-ownership is paramount. A patient’s right to choose is a constitutional issue, not a lobbyist issue. Let us not forget King - not just for equality, but for what he represents to all of our civil rights – including our health.

Photo credits: drquoz

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ab@allanbesselink.com (Allan Besselink) Smart Physio Mon, 19 Jan 2015 22:34:05 +0000
Think Big, Act Big http://www.allanbesselink.com/blog/smart/1304-think-big-act-big http://www.allanbesselink.com/blog/smart/1304-think-big-act-big BIG BENWelcome to 2015. Once again we find ourselves on January 1, the start of a new year, with a blank slate in front of us. It's that arbitrary date when you sit down and formulate plans for the year ahead and resolve to make any number of changes in your world.

With any luck, these resolutions won't fall by the wayside by week's end.

New Year's Day can also be a time for a ton of platitudes. We talk a big talk when the New Year arrives.

You'll undoubtedly throw lots of big ideas out there today, plenty of big hairy audacious goals for the upcoming year. Great resolutions lie ahead. But are you truly ready to make 2015 remarkable?

Talk is cheap. Sure, we talk a big talk on New Year's Day, but then our behaviors reflect something far smaller.

We think big. We act small.

Given that our behaviors and actions are undoubtedly consistent with our self image, what does that say about each of us?

How often do you spend more time and energy seeking permission to change the world instead of asking forgiveness after you have done so?

How often are you more worried about ruffling some feathers, or being concerned about what everyone will say if and when you do?

How often are your decisions based on the absence of negatives rather than the presence of positives?

Are you thinking big? Perhaps more importantly, are you acting big?

Seth Godin has written about the importance of artists and of creating art:

"An artist is someone who uses bravery, insight, creativity, and boldness to challenge the status quo ... Art is a personal gift that changes the recipient. The medium doesn't matter. The intent does ... Art is a personal act of courage, something one human does that creates change in another.” 

I once read the phrase "If you're not pissing someone off, you probably aren't doing anything important". You know what? Go ahead. Piss someone off, not because that's the primary goal but because when you create art, when you change the world, someone is, without a doubt, going to be upset by a challenge to the status quo. There will be someone whose self image will no longer be validated by the status quo.

I am always reminded of the words of a good friend and mentor of mine - "Never let yourself regress to the mean". Instead of raising their game, many will simply regress to the mean and take you with them. One thing our world doesn't need is more regression.

Think big. Act big.

Do it now. You can change the world and, better yet, it will be a better place because of it.

Photo credits: Never House

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ab@allanbesselink.com (Allan Besselink) Smart Physio Fri, 02 Jan 2015 01:16:12 +0000
The Passivity Hypocrisy http://www.allanbesselink.com/blog/smart/1303-the-passivity-hypocrisy http://www.allanbesselink.com/blog/smart/1303-the-passivity-hypocrisy upward movementPhysical therapy is a movement profession. We are undoubtedly the experts in movement, exercise, and function - and our professional training reflects this.

Subsequent to this, the vision of the American Physical Therapy Association is "transforming society by optimizing movement to improve the human experience". Let's take a moment to consider the meaning of this statement fully.

Since the dawn of mankind, an integral part of the human experience is function and movement. Neither of these are passive by definition.

In order to transform society, we need to focus on the active.

But there is a hypocrisy to be found deep within these words. If we are focusing on the active, then why do we continue to put such a heavy emphasis on passive interventions?

It is a troubling thought for me at times, a strange conundrum and hypocrisy that befuddles me to this day.

Movement is not, by definition, a passive activity. Optimizing movement demands observation and analysis, education and coaching, feedback and review.

Yet our profession spends a lot of time focusing on gaining what amounts to a toolbox of passive strategies. Worse yet, we are focusing on passive interventions that may have little to no relevance to the problem at hand, or have little evidence to support their use.

Sadly, we perpetuate passivity at the most elemental level of our thinking. 

Meanwhile, we spend little time focusing on how the mind works or how we (or our patients) think. We rarely focus on our own logical fallacies or cognitive biases and their impact on our own clinical reasoning. We spend little time discussing how to be a better teacher, better mentor, and a better facilitator.

The latter skills are as teachable as the former "tools". But the former reign supreme.

Why do we continue to advocate for, promote, and actively perpetuate the perceived necessity and value of passive interventions?

The profession of physical therapy has perhaps some of the greatest core knowledge in any health care profession. It ranges from anatomy and physiology to spinal cord injuries and sports medicine. We have the capacity to transform society, without a doubt. But there is the hypocrisy of passivity. For transformation to occur, it will need to be active.

We need tools, yes - the ones that allow us to be better teachers, better facilitators, and better mentors.

Forget about the adjunctive passive therapies. The answers lie not in the stuff we do to people or on people, it is the stuff we do with people.

Let's put an end to the hypocrisy. If we are going to be the experts in movement, exercise and function - if we are going to "talk the talk" about transforming society and optimizing movement - then let's get our actions consistent with that premise once and for all. It's time to walk the walk.

Photo credits: frozenchipmunk

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ab@allanbesselink.com (Allan Besselink) Smart Physio Tue, 23 Dec 2014 22:09:05 +0000
Your Own Worst Enemy http://www.allanbesselink.com/blog/smart/1302-your-own-worst-enemy http://www.allanbesselink.com/blog/smart/1302-your-own-worst-enemy Yes, YOU!There are a myriad of common excuses that we can all find for not living the dream we so desire.

It is someone else's fault. I am unlucky.There is too much stress. I have too many exams coming up. I am not good enough.  

But you know what? I hate to say it, but they are all just - excuses. More often than not, the real problem is simple.

Your own worst enemy is you. The best part, though, is that you are your own best friend and ally as well.

It becomes pretty easy at times to look outside of ourselves for the answers and the reasons, the rationalization for why things are they way they are. We always seem to find ways to mold any degree of convoluted logic to confirm just about reasoning we can conjure up.

While doing so, we fall prey to the scourges of cognitive bias and logical fallacy. Daily. And frequently it is all done in the name of our own self perception.

Conversely, how often do we look inside ourselves for our share of the problem, our responsibility in the dilemma, first and foremost? And even when we do, how often do we not only accept ownership of it but then choose to do something about it?

We all like to attribute our successes to something WE did. But the failures - oh no, not my doing, no way.

Until they are.

We are limited by our self perception and perceived self efficacy, especially when the chips are down and our comfort zone is being pushed.

We become self fulfilling prophecies built upon our self talk.

If we tell ourselves that we won't play well, or that we won't perform well, or we won't do well on the next exam or job interview, then we should expect exactly what we tell ourselves. We won't.

Your own worst enemy is you.

How can we expect to excel when we are telling ourselves all the negatives? How can we achieve greatness when we are overwhelmed by thoughts of failure? How can we perform when we choose to not challenge our comfort zones, and do so with diligence and vigilance even in the darkest moments? Worse yet, how can we attain these things when we won't choose to own the fact that it happens?

And even then, failure doesn't exist anyways. As Abraham Lincoln once said, "there is no failure, only opportunity". I couldn't agree more.

Your own worst enemy is you. Fortunately, we have the power within us to transform ourselves. It requires a choice -  to re-program our self talk, to believe in our capacity, to accept ownership of it, and to take a step-wise path towards growth and transformation.

Ah but yes, that can be the hardest choice of all.

Your own best ally is you. And don't ever forget it.

Photo credits: steelight

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ab@allanbesselink.com (Allan Besselink) Smart Physio Wed, 10 Dec 2014 05:23:27 +0000
If MDT Doesn’t Work? http://www.allanbesselink.com/blog/smart/1301-if-mdt-doesnt-work http://www.allanbesselink.com/blog/smart/1301-if-mdt-doesnt-work ThinkingIt is a question that I hear regularly when talking to clinicians and students: what do you do if MDT doesn't work?

The question usually causes me to shake my head and take a deep breath before venturing forth into a response. I wish I could say that it is only posed by those with little to no training in the method; however, I've heard this from more than a few MDT-credentialed clinicians over the years.

Let's start with the foundation for a response: MDT is not a treatment. It is a way of thinking.

Examine the question from the context of the person asking it. It will help us understand why the question ever arises in the first place.

If you view the world of physical therapy (or musculoskeletal care as a whole) as just an assortment of treatment interventions - many being applied arbitrarily on an irrelevant patho-anatomical model - then it is easy to understand how MDT might not work. If you view MDT as "just another treatment intervention", and that treatment intervention isn't successful, then of course, you would ask "what do you do if MDT doesn't work?".

In that context, the question makes perfect sense. But it also professes a misunderstanding of what MDT really is in the first place.

MDT is a non-palpation-based system of assessment and treatment. The key word, the oft-forgotten word in fact, is "assessment". It is not a series of exercises applied arbitrarily to a patho-anatomical diagnosis. There is consistent clinical reasoning underlying its classification algorithm, with mutually exclusive categories and operational definitions. The clinically relevant treatment intervention generated is a logical byproduct of the system of assessment.

MDT is a way of thinking.

I always like to say that MDT always works - which always inspires the ire of many a clinician. I am reminded that there isn't a treatment that works for everyone. Well, you are right - there isn't a TREATMENT that works for everyone. The clinical reasoning and assessment process that are inherent to the approach does work for all patients. It provides a framework for the assessment of all musculoskeletal problems, be they spinal or extremity.

Sadly, if you don't fully comprehend the value of the MDT assessment process and what it provides for the patient and clinician, then you will always be looking for "something else" that is bigger or better to help "fix" the patient. There is a perception that surely there must be some "next great thing", some technique, some new "tool in the toolbox", that will lead you to the promised land. I could give you a list of 100 options. But simply maintaining a consistent line of clinical reasoning within the MDT framework will almost always provide sound answers, and they are oftentimes far more simple than perhaps many want to believe.

Before asking the question, stop and think about the patient's assessment and what it tells you about the mechanical loading capacity of the patient. Merge that with the patient's experiences and their responses to loading strategies. Listen. And guide. MDT has an answer, you just might not be asking the right questions along the way.

Photo credits: wadem

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ab@allanbesselink.com (Allan Besselink) Smart Physio Thu, 04 Dec 2014 05:26:46 +0000