"Evidence base"... This!
Just kidding. I now work under many rotating “Doctors of Physical Therapy,” two decades younger than me. They are frequently dismissing many physical therapy interventions as “not evidence based practice, “ or ineffective.
And they are correct about many previous interventions. Back in the 90’s, we frequently saw patients get hot packs, electrical stimulation, ultrasound, traction, massage, and sometimes very few exercises.
I don’t think these were effective, and most successful interventions now focus on movement and exercise.
Science
I grew up being very skeptical of most things. I was dismissive of many interventions. “That’s probably just a placebo…” Well in some cases, it might have been, but it was helping decrease this person’s pain. I was too cavalier and arrogant about dismissing something that was helping someone.
I can’t remember the exact details, but I regretted saying out loud that it was unlikely that something was helping pain. Was it better for me to be “right,” or would it be better to allow someone to have less pain, regardless of the circumstances?
Karma
I never used to consider someone’s working hands on experience. Karma has now dealt me a hand where I work under the same line of thinking I had many years ago. But I’ve done a little more math on the subject.
I’ve worked 29 years in the biz, x 40 hours/week, x 50 weeks/year = 58,000 hours direct patient time.
A Doctor of Physical Therapy with 3 years experience, 3x40x50 = 6000 hours direct patient time.
This doesn’t mean I’m right, by any means. It’s likely just an excuse for how academically lazy I was. These doctor PTs should be commended for how hard they had to work, to get where they are now.
And I continue to learn new things from every patient, every therapist, every day.
Those hours above represent nothing statistically relevant.
But I do have this running meter in my head of general impressions, that number in the hundreds. I have overall impressions of the effective rates for pain injections. Or, how many infections have I seen? How many problems have I seen after surgery? What’s the likelihood that this joint gets stuck? How long will recovery take? What happens if we push this case too far?
Bias
I’m now informed by the new generations that this line of thinking isn’t “experience”, it’s my “bias.” I am not being objective, and am skewed by experience, not helped by it.
That is possible. Although some of the studies that are cited have as little at 50 participants.
Conclusion
Am I wrong about all this? Probably. I’ve been wrong many times before, and have leaned much from those experiences also.
I’m also wrong about wanting to help people for too long. There are good arguments for better outcomes when you hold people accountable to their own plan of care.
Or, are the new crop just being lazy and making excuses…
We had those encyclopaedias!