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Why You Aren't Fixing Your Patients

In a nutshell...if you cannot sufficiently address (improve) your own body and its do not understand how to fix another's. Therefore it is time to power down the automaton and regain some awareness. For the non-TL;DR folk, let us get some perspective from a theoretical physicist

In 1965 the Nobel Prize for Physics was awarded to Richard Feynman and two others. Feynman predated the commensurate notable didactic physics icons, Carl Sagan and Neil DeGrasse Tyson. Dr. Feynman was known colloquially for his unparalleled ability to communicate complex information in a way that was wholly graspable, and professionally for his work in the quantum world of electrodynamics. I find myself of late, contemplating a specific quote (written) of his. It was found, scribbled in cursive, on his blackboard at the time of his death in 1988. "What I cannot create, I do not understand."

“What I cannot create, I do not understand.”
-Richard Feynman

And written underneath:

"Know how to solve every problem that has been solved."

It is convenient to infer Feynman's "I" to mean "us". We cannot terraform Mars. We do not understand Alzheimer's disease. We cannot explain the pain. We can't help you with your sciatica.

As inconvenient as it may be, an enlightening albeit uncomfortable change is to apply Feynman's literal "I". I cannot improve your low back pain...(therefore) I do not understand low back pain. I cannot create mobility in my own hips...(therefore) I do not understand how to improve someone else's hips.

The essence of Feynman's words is simply a call to self-reflection. Some clinicians out there are timid or tacitly expressing their expertise due to a feeling of Imposter Syndrome, while many more (my assumption) loquaciously pronounce the ostensible Dunning-Kruger effect. In other words, we are often not as good as we think we are.

What is the point of this guilt trip? To wake up. To realize we haven't reached our destination, yet are continually 'on the margins of a potentially great harvest of future knowledge and wisdom'.

If you cannot touch your toes, realistically how effective can you be instructing others on flexibility? If you do not understand your own nagging chronic low back pain, how can you claim to rid another's? If you cannot slow the progression of your own hallux valgus (bunion), how can you restore a patient's problematic foot? If you cannot estimate a timeline for your patient's recovery, how you can manage their expectations?

I intend not to preach from a soapbox, rather attempt to self-reflect on Feynman's words.

I cannot create a relief of all headaches, therefore I do not understand headaches.

I cannot create an ideal posture, therefore I do not understand posture.

I cannot guarantee pain relief, therefore I do not understand pain.

I sometimes fail to create patient compliance, therefore I do not understand my patient.

To be fair, we will never be able to create everything, to guarantee everything. It isn't sensical to assume we can understand what is unknowable or even understand everything that is knowable (As Hemingway puts it: "How little we know of what there is to know."). Regardless, this is where the second sentence on Feynman's blackboard becomes fundamental:

"Know how to solve every problem that has been solved."

Unfortunately, human function and performance aren't as unambiguous as mathematics. Nevertheless, there are experts and specialists the world over who unequivocally hold a greater understanding of aspects of the musculoskeletal system than ourselves. We must continually seek to ask Feynman's questions of ourselves. If not for growth, at least for some semblance of humility and limitation of hubris.

Richard Feynman also said: “The first principle is that you must not fool yourself and you are the easiest person to fool.”

So where do we go from here? Well as some science fiction book has most certainly proclaimed: Never waste a good pandemic. This is as good a time as ever to reflect upon where you are in your career. Ask good questions and answer them honestly. Here are some examples:

1. Have I created the clinical environment I imagined as a curious and inspired grad student?

2. Using Feynman's criteria, do I have a fair understanding of the majority of complaints that present in my office?

3. Do I push myself to grow as a clinician? As a business owner? As a colleague?

4. Do I sufficiently understand shoulder injuries? Lumbar? Knee? Etc...

5. Have I recently challenged myself to learn something new?

6. How would I grade myself as a clinician? As a colleague? As a boss? As a teammate?

7. How do I envision myself as a coach or clinician in 5 years? 10 years?

8. To what can I hitherto attribute my success?

9. To what can I attribute my failures or dissatisfactions?

10. What improvements to my future career are within my control?

If you are not where you want to be, do not sulk or blame. Rather embrace how lucky you are to be one of those who understands that you are nowhere like enough of who you wish to become.

"We absolutely must leave room for doubt or there is no progress and no learning. There is no learning without having to pose a question. And a question requires doubt. People search for certainty. But there is no certainty." -RF


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