It was a few years ago. A patient came to my center with a rather complex health problem. These were non-specific pain that did not respond to clear anatomical patterns. In addition, there were associated psychosocial factors, which made the case even more uncertain. I tried to do my best, but my technical resources and my knowledge in those years were insufficient. He did not know how to manage this type of chronic problems, very possibly linked to cortical changes and a central sensitization process. As much as I tried to calm and lessen the symptoms. Nothing worked as I expected. Clinical techniques and healthy habits were not enough to achieve a significant change in symptoms. I felt absolutely committed to my patient but was not reaching a satisfactory result. It was a few months of accompanying with the hope that next week will arrive with a smile and an improvement that will give us hope. Finally, I proposed to stop therapy and recommend another direction. She agreed.
A few weeks later, many cases, children and adults derived from this patient began to arrive. They came confident and assured of my professionalism, by my surprising prescriber. How was it possible? That patient was referring me so many people now. What made her trust me if she hadn’t been able to solve her problem? So, I called her to thank for her confidence and of course, I asked about that promotion of my work. She told me: “I went to many professionals before I came to you, who tried to help me with my symptoms, but with you I really felt accompanied. You understood how I felt, and our sessions were a calm and safe place. Indeed, you guided me and thanks to the steps I took, my life is better now”.
When healthcare professionals think of clinical reasoning, one-word pops into their minds: “diagnosis.” To know what happens to propose the correct treatment. This is called diagnostic reasoning. This type of reasoning comes from an empirical-analytical research paradigm. To be clear, it is a mental process to arrive at a dual “yes” or “no” conclusion. You have a disc injury, or you don’t. You have a congenital torticollis, or you don’t. You have a genetic syndrome, or you don’t. Diagnostic reasoning is fundamental in pediatric physiotherapy as in the rest of the health sciences and medicine. However, diagnosis in physical therapy is conceptually very different from the diagnosis in medicine, and confusing them only leads to problems between professions.
In the 1990s, health science professionals started to be more interested in patients’ experiences of pain or disability. They realized that they wanted to know the person as they knew their illness. This was essential because in clinical practice the physiotherapist notes many variables of which some are out of the clinician’s control. In the case of pediatric physiotherapy, environmental aspects such as time of television or sleep, school, relationships in family, among others. Hence the concept of narrative reasoning arose. A reasoning where the truth is not dual correct or incorrect, but depends on the meaning and context of the person. The objective is to know the unique experience of the patient and her family. Enter the experience of it, beliefs, feelings and behaviors in health. Have you found cases where your recommendations, advice and exercises were not done until you discovered a condition that was blocking everything? That conditioning factor is sometimes a belief … how am I going to put my baby on his stomach if she can die? How am I going to do this exercise to my baby if she cries? Or the influence of the environment … bulling, social pressure, broken families.
Entering the patient’s experience as an essential aspect of the therapeutic process improves adherence to treatments and functional outcomes. Probably because people feel more motivated when they are accompanied and understood in their own reality. Analyze your experience as a patient or as a parent of a patient in your personal history. Remember where and when you felt cared for and accompanied, and where and when you were not.
What I would highlight as the main idea is that feeling well accompanied is not something that depends solely on how nice or friendly the person who attends me is. That is important, but we are talking about something that is beyond individual personality. It is something that is part of a care built on a global health model, on care values, on service planning, on specific communication techniques that can be learned and trained on a way to specify the objectives of therapy but mainly about a way of understanding health care.
Look at this video to know more about clinical reasoninghttps://www.youtube.com/watch?v=DQg-XNkHTsI
The clinical reasoning that takes care of patient and family, which is collaborative, interactive and psychosocial is a fundamental axis of the PIMT concept. Is this not how it should be in the global pediatric physiotherapy and physiotherapy in general? All pediatric physiotherapy training should include this type of approach. Two training paths ensure this objective and make a difference within the PIMT concept. The course “therapeutic intervention in PIMT” (see the program here in Spanish) and the course “clinical reasoning in pediatric physiotherapy” (see the program here in Spanish).
These trainings are for you if:
• You want to be successful in communicating with patients and families.
• You want your patients and families to follow your recommendations and adhere to your treatment
• You feel that you can do something more for child development through the education of families and society
• You feel that you need tools to communicate better and to positively influence the health behaviors of families.
• Do you really believe that pediatric physiotherapy needs not only technique but also heart
Sign up for any of these trainings here and make a difference. Do you believe in a pediatric physical therapy with heart?
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