becoming more human….

It all started, like everything nowadays, with a Twitter conversation. Like Columbus embarking on The Americas, entering the twittersphere was a strange experience full of new sights and sounds. An initial watching brief found the natives to be enthusiastic, prolific and very diverse. Thankfully the land is full of people passing through making new onlookers inconspicuous. After delving into their wonderful array of manuscripts and familiarising myself with their language, culture + emoticons I began to engage. First with the more approachable natives before the savages. The journey has been a fruitful one, taxing the mind, creating doubt from clarity and confronting ignorance.

This particular conversation went something like this:

@TaylorAlanJ: Pain artist  @lee_eugenie  asks …
“Clinicians are people too, aren’t they?”
#Physio   #ThatIsTheQuestion  ????
@neil_maltby:  maybe outside the clinic…. 😁
@lee_eugenie:   what are they inside the clinic then?
@neil_maltby: ha! Robots. Clinical reasoning machines. Some better than others at being human. 🎭
@neil_maltby:  sorry. Over cynical maybe. I know a lot of good therapists out there. (Maybe speaking more from personal history!)

Meanwhile another journey being made by healthcare professionals is into the territory of Evidence Based Practice (EBP). There is no doubt that EBP and research has added some much needed rigor to healthcare and has many uses including weeding out ineffective treatments, and improving the understanding (or lack thereof) of pathology and epidemiology. At first an irresistible voyage but recently doubts + questions are starting to be raised, all of which are essential for progress. Ongoing discussion about its nemesis causality (especially in complex disorders such as LBP, fibromyalgia, CFS), the law of diminishing returns, claims of over reliance on significance levels, homogeneous populations studied and poorly designed trials have blighted the EBP landscape. An excellent overview of the benefits of EBP by Kenny Venere can be found here.

It is concerning that in proclaiming Evidence Based Practice (EBP) we can be tempted into a whole new realm of Evidence Ish Practice (EIP). In this new country each native remains staunch to their instincts as they starve on a few choice manuscripts for sustanance. These are savage isles that see only empire and have not known peace nor reconciliation. Here everyday robots collect in herds to listen anew to their leaders mantra. Ideas are strictly forbidden and discussion nor questioning are permitted.

My worry is that a Sherlock Holmes phenomena strikes healthcare. Let me qualify this. At first I am wooed by this proposition, as an introvert who probably finds logic more natural than interaction. Sherlock is obviously gifted in logic and reasoning and I agree that becoming more robotic and machinistic may help quantitative data interpretation within the scientific process. But should this transfer into a clinical healthcare system? Could a robot replace us as healthcare practitioners? (Unfortunately in some cases this may be true!) Should we leave our emotions at the door?

Sherlock may be a master of multiple causality but also of pissing people off. This may be one of the reasons Arthur Conan Doyle scripted Dr Watson alongside Sherlock, someone with far more social skills. Thankfully I don’t see healthcare professionals being replaced by robots any time soon. That being said if we leave our humanity at the door then perhaps one day we will be usurped. To maintain balance it is important to recognise that emotion has the potential for harming our profession if our bias is left unchecked or it is used unwisely, but I think our healthcare patients are looking for connection. It may be the difference between the patient passively or actively engaging in their own healthcare.

So where does being more human help us (and our patient) on this healthcare journey? Well I want to start a series of blogs looking in detail at the subjective assessment. The part as a junior I rushed through as a formality to get to the nitty gritty of the objective assessment and treatment. It could be argued that technology or a robot could be more accurate with objective assessment (eg BP, RoM etc). The subjective is different. Its the main time we get to connect with the patient, understand them and their story, and form a therapeutic alliance. It’s fair to say my subjective assessment has become more important and probing over time and contextualises the objective assessment and treatment stages (and even continues through these stages). If we disengage from the subjective assessment we risk becoming robotic and disengaged from the patient, often missing vital information. With current research showing heterogeneity in clinical presentations and strong psychosocial factors with pain, pathology and recovery the subjective assessment should be a valued area of assessment.

Be more human. Be less robot.

Thanks for getting this far.


Further reading:

where humans beat robots (the last paragraph is particularly interesting)

this blog by @SpencerMuro about the importance of the subjective assessment

Featured content:

Miles et al (2008). Evidence-based healthcare, clinical knowledge and the rise of personalised medicine.

Venere (2015). In defence of evidence based practice.

Albarn (2014). Everyday Robots.

Elkins (2015). Business Insider UK

BBC (2015).

2 thoughts on “becoming more human….”

  1. Interesting and insightful……

    really comes down to Subjective as being the “Connection WITH the Patient”…. the Blog you reference still focuses on the Subjective being for Clinical reasoning…… If so, still better served by a Robot….

    Your line about emotion is the take home, because it hits the GOOD and the BAD in one sentence… and really the one thing Watson (robot) can not be is Empathetic!…. and its curious you nor Spencer mention this as a key to the Subjective…

    great thoughts…thanks

    Liked by 1 person

    1. Thanks Jerry! This is what I was after… some good solid critique. Love your thoughts and don’t want to dive too much into empathy as I may have future posts touching on this!

      I’d still hold a position that a human subjective would hold more contextual quality for clinical reasoning than a robot (depending obviously on the human!). Essentially a robot is slave to algorithm. This is great in concrete decision making that is known to be accurate. Will it ever get there? Who knows? My bias would be that I don’t think its possible to condense a subjective assessment or a human interaction into an algorithm (no matter how complex). Maybe I underestimate technology, despite my dad worked for IBM for years I wouldn’t call it a specialist subject of mine. (I might write a blog on this- thanks for the stimulation Jerry!)

      My point is that as a professional I way underestimated and spent too little on the subjective (for a variety of reasons). Your point that empathy is essential for a good subjective I think is essential in the mix. I too often disengaged or avoided my emotions, thinking I was doing the right thing- remaining objective. I now acknowledge that these are things to be harnessed for good.

      Once again thanks for taking the time on this Jerry. Much appreciated and you are certainly a good influence on me/us!


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