Blog | Allan Besselink Allan Besselink | Official Site Of The Smart Life Project, Smart Physio, Rhubarb Diaries, And Mobius Intermedia Tue, 26 May 2015 07:14:26 +0000 Joomla! 1.5 - Open Source Content Management en-gb 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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]]> (Allan Besselink) Smart Physio Mon, 06 Apr 2015 04:16:24 +0000
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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]]> (Allan Besselink) Smart Physio Fri, 27 Feb 2015 22:42:58 +0000
Own, Disrupt, Transform–Or 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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]]> (Allan Besselink) Smart Physio Fri, 06 Feb 2015 06:06:26 +0000
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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]]> (Allan Besselink) Smart Physio Mon, 19 Jan 2015 22:34:05 +0000
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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]]> (Allan Besselink) Smart Physio Fri, 02 Jan 2015 01:16:12 +0000
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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]]> (Allan Besselink) Smart Physio Tue, 23 Dec 2014 22:09:05 +0000
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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]]> (Allan Besselink) Smart Physio Wed, 10 Dec 2014 05:23:27 +0000
If MDT Doesn’t 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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]]> (Allan Besselink) Smart Physio Thu, 04 Dec 2014 05:26:46 +0000
Giving Thanks 2014 IMG_20141127_104539_972Thanksgiving is upon us once again. Thanksgiving always provides us with a day to eat turkey, catch some lovely fall weather (fingers always crossed), and take in another University of Texas football game against some unspecified cross-state rival (Texas Fight Texas Fight Yeah Texas Fight).

None of my family live in Texas. They are all still in Canada, so they celebrated Thanksgiving Day in October, otherwise known as Columbus Day in the United States. I don't mind celebrating two Thanksivings, especially if doing so provides the potential for more turkey.

Thanksgiving Day is followed by Black Friday, a day of retail specials and sales. Ugh. The best part of Black Friday is that it reminds me of a great song by Steely Dan, but I digress.

But with all kidding aside, Thanksgiving is a day to Give Thanks.

This year, I find myself acutely aware of  the meaning behind the holiday. It has, admittedly, been one of my most challenging years on the planet. In retrospect, I definitely see the importance of giving thanks for what we have in the here and now because, frankly, it might not be here tomorrow.

The challenging days of our lives make us who we are. The man that sits here tapping away at another blog post is but a product of his life experiences. As challenging as they may have been, they make me the man that I am. Lincoln once said "there is no failure, only opportunity" and I couldn't agree with him more. I am thankful for the life experiences I have had, be they good or bad, because they have made life vivid, brilliant, and memorable.

Family and friends are the glue that hold it all together. Sometimes I don't see them as often as I would like. I miss them when I don't see them, and I laugh with them when I do.

If I didn't have laughter and the levity contained within, I would be lost. I am thankful for laughter in my world. Without it, I would be ... not laughing. Go ahead, laugh.

In the quieter moments, I am thankful for the capacity to reflect on my world. It has lead me down the avenue of creativity and the boulevard of self expression. If I had never gone there, I wouldn't have ever written my first poem or played my first notes on the guitar.

If you are fortunate, there will come a time when something you have written resonates with someone. With that said, I am thankful for the support and inspiration of each and every reader of this blog. It makes a difference in my world, and I am forever grateful and thankful for it.

So I ask you to do this today, even if  this isn't Thanksgiving in your part of the world. Pause for a moment during your day and reflect. What are you thankful for today?

When you establish this, take another moment and share it with those around you. Make it real. Smile. And truly enjoy Thanksgiving.

Photo credits: abesselink

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]]> (Allan Besselink) Rhubarb Diaries Thu, 27 Nov 2014 20:46:25 +0000
Patient Education: Behavioral Change Or Clinician Monologue? With A Megaphone By A WallHealth care is chock full of a lot of telling. Telling the patient to do this or that. Telling the patient to not do something. There is a lot of telling going on around the health care world.

Health care has its share of intelligent people doing the telling. And I have no doubt that there are many that are telling patients a lot of good things.

But one problem exists. We mistakenly focus on adherence and compliance with all the telling and immediately assume that behavioral change goes right along with it. A faulty assumption, indeed.

Bob Pike, author of the book “Creative Training Techniques Handbookalt, has spoken extensively on the topic of adult learning. One of his "Laws Of Adult Learning" is this:

"Learning has not taken place unless behavior has changed"

When it comes to chronic conditions such as diabetes or obesity or osteoarthritis, long-term changes in behavior are critical. Go ahead and focus on the short-term stuff all you want. However, the true long-term impact in terms of health care costs and quality of life lies in lifestyle and behavioral changes. This requires an approach to care that has a strong cognitive and behavioral component, one that emphasizes independence, mentorship, and active strategies.

The same rules apply throughout musculoskeletal care as well. Frankly, there is no reason to think otherwise.

But our world of health care is full of telling - with little to no assessment of behavioral change or patient-focused value-added benefit. It amounts to a mentality of "just do it because I am the clinician with the degree". Clinical care becomes a series of monologues, first clinician then patient. It is one soapbox moment followed by another.

There is a difference between talking at someone and having a dialogue, between saying "patient-centered" and acting in accordance with it.

Effective adult learning involves the participant being active in their learning and in charge of it. This is well-established. So why does the majority of patient education run afoul of this core principle of adult learning?

Does your patient education take on the look of a lecture series? Or are you having a true dialogue with the patient and allowing them to be an active participant in not only their care but in their life-long learning as well?

Photo credits: garryknight

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]]> (Allan Besselink) Smart Physio Wed, 19 Nov 2014 06:09:05 +0000