Saanichton Physical Therapy Blog

The inside track: Reflections of a Physiotherapist

The inside track:  Reflections of a Physiotherapist

The Sweet spot

It’s interesting how our thought processes change over time. Evidence based practice (EBP) has evolved over the years with debates and pendulum swings in how each entity interprets this concept. What we are really searching for is the sweet spot.

To me, the sweet spot equates to a bang on outcome affecting quality of life positively.

The evidence part of evidence based practice is the easiest part of it all. Clinicians don’t incorporate all the evidence out there into their practice… and not all the evidence out there fits the patient. Hopefully clinicians are able to recognize the evidence that fits the patient and incorporate that evidence into the treatment plan for that specific patient.

Lots of orange going on in that diagram. There should be – right? That is exactly where all the action takes place, right?

The complexity in evidence based practice is the simple fact that the sweet spot hinges on two people interacting, engaging and creating some result. The reason the sweet spot is so small is because the desired results do not easily or readily happen.

Let’s look at patients… what do patients bring to the table? What is in the yellow? I can assure you, it is more than perceptions. Patients have beliefs and expectations. They have preconceived notions. They have a particular amount of motivation dependent upon their level of commitment, their available time and potentially the influence of others in their lives. They do not have unlimited funds. Does the payer matter? They have a particular communication style and their own personalities. They may have chosen to receive services to appease someone else. Hopefully, they have targeted goals which can be measured objectively.

Clinicians bring more than their clinical expertise and opinion into the picture. Look at the amount of red! Hopefully, in light of the relevance of big data, hopefully more and more clinicians have practice based evidence at their fingertips. Clinicians have beliefs and expectations. Clinicians have a particular communication/interaction style. Clinicians have personality. Clinicians have varying levels of skill. Clinicians have varying levels of critical thinking abilities. Clinicians have various comfort levels revolving around delegation of care. Clinicians practice in various types of environments with all sorts of environmental ambiance and attitudes.

So we can clearly see that to have the best outcomes we have to hit the sweet spot. We would love to fix every patient forever in one visit!  That might be simple in theory, but harder to definitively put into practice. This of course can be extrapolated to many different professions. My partner is a teacher and there is a constant interaction between student, teacher and best practice. This concept reminds me of reading a book called ‘The Element’ by Sir Ken Robinson. He suggests that for people to truly achieve professional excellence they need to find something they are good at, but also enjoy doing- requiring integrity, intelligence and energy.  We need to want to be our best. I know our staff regularly reflect on how we can acheive excellent therapeutic results. We try to bring together all the components in the diagram by having several therapists with varying skill sets, by using up to date research and by trying to engage positively with patients. We will be integrating some changes shortly to really try to focus in on the orange zone (the interaction between patient and clinician).

At any time please feel free to tell us how you feel or how we can make the therapeutic experience better for you. We want to help and together we can make a difference.