I treat a number of patients who have difficult diagnoses or have not succeeded with previous treatments. It can be, at times, stressful and difficult. All of us at one time or another have had a difficult case. Maybe there were a ton of comorbidities complicating the presentation. Maybe the presentation was complicated by multiple impairments. Whatever the cause, we all encounter these cases and the only way to be consistently successful is habit.
What do I mean by habit?
One of my favorite books, The Power of Habit by Charles Duhigg, discusses how our automatic brain works.¹ It’s on a completely different wavelength and processing pattern than when we have to think and make a decision. In the book, Duhigg talks about Tony Dungy, Super Bowl winning coach with the Indianapolis Colts. Duhigg discusses Dungy’s methods of training his players to react. He repeats the same thing over and over until it becomes a habit so when the players are on the field, they react instead of think. When it is the end of the game and the pressure is on, those who are thinking feel the stress. Those who are reacting just do…..and they do just like they have 1,000 times before. Here’s the key. Because they have run that specific play until they perfected all the patterns, when something goes wrong, they know it and can adapt. They snap out of the pattern and are able to adlib.
Treating patients is exactly the same. Great clinicians follow a system and recognize patterns they have seen thousands of times. The key for the complicated patients is that the clinician is able to see where the patterns don’t fit and where they do!
I co-founded an education company, The Association of Clinical Excellence, where everything we do revolves around 2 simple principles. The principles help us to establish and reinforce patterns. The first of these is our Treatment Philosophy and at the heart of the Treatment Philosophy is a simple, test, treat, retest method. It allows us to recognize patterns in our practice and because we are constantly reassessing, we can quickly recognize when an outlier exists. Best of all, we can quickly change because of it.
If I am treating a patient for a gluteal tendinopathy and notice that their lumbar screen turns up (+) or screen the hip joint and see pathologic findings, I know I need to shift gears. I put tendon loading progressions² on hold and determine whether an intervention at the hip or lumbar spine can change a patient’s pain or impairment. If it can, then the tendon loading is likely still important, but I need to address the other issues to drive the patient outcomes we are all looking for!
This method of treating allows us to establish methods for quick decision making based on both the literature and our personal experiences. It also allows us to follow habits, but also snap out of the habit to allow us to treat the individual patient’s variance.
- Duhig C. The power of habit: Why we do what we do in life and business. Random House. 2012.
- Grimaldi A, Fearon A. Gluteal Tendinopathy: Integrating Pathomechanics and Cliinical Features in Its Management. J Orthop Sports Phys Ther. 2015;45(11):910-922.