History is full of stories that teach timeless wisdom. Sometimes these stories provide a glimpse into the problem solving prowess of a genius that can remind us to imitate the same approach. One of my favorites is the below story of Charles Steinmetz’s interaction with Henry Ford.
Charles Proteus Steinmetz, the Wizard of Schenectady
(adapted from Smithsonian Magazine 8/16/2011)
He stood just four feet tall, his body contorted by a hump in his back and a crooked gait, and his stunted torso gave the illusion that his head, hands and feet were too big. But he was a giant among scientific thinkers, counting Albert Einstein, Nikola Tesla and Thomas Edison as friends. His contributions to mathematics and electrical engineering made him one of the most beloved and instantly recognizable men of his time. The German PhD engineer arrived to Ellis Island in 1888. In 1894 he began working at General Electric in Schenectady, NY. Using complex mathematical equations, Steinmetz developed ways to analyze values in alternating current circuits. His discoveries changed the way engineers thought about circuits and machines and made him the most recognized name in electricity for decades. He identified and explained, through a mathematical equation, the Law of Hysterisis, or Steinmetz’s Law. This Law described the phenomena governing power losses, leading to breakthroughs in both alternating- and direct-current electrical systems at a time when America was entering the golden age of electricity. Before long, the greatest scientific minds of the time were traveling to Schenectady to meet with the prolific “little giant”.
Life magazine printed an article on Steinmetz in 1965. A man named Jack B Scott responded to the article in the “letters page” of themagazine with his own story of Steinmetz. Scott wrote in to tell of his father’s encounter with the Wizard of Schenectady at Henry Ford’s River Rouge plant in Dearborn, Michigan. Scott writes,
“Ford, whose electrical engineers couldn’t solve some problems they were having with a gigantic generator, called Steinmetz in to the plant. Upon arriving, Steinmetz rejected all assistance and asked only for a notebook, pencil and cot. According to Scott, Steinmetz listened to the generator and scribbled computations on the notepad for two straight days and nights. On the second night, he asked for a ladder, climbed up the generator and made a chalk mark on its side. Then he told Ford’s skeptical engineers to remove a plate at the mark and replace sixteen windings from the field coil. They did, and the generator performed to perfection.”
Henry Ford was thrilled until he got an invoice from General Electric in the amount of $10,000. Ford acknowledged Steinmetz’s success but balked at the figure. He asked for an itemized bill.
Steinmetz, Scott wrote, responded personally to Ford’s request with the following:
Making chalk mark on generator $1.
Knowing where to make mark $9,999.
Ford paid the bill.
Steinmetz’s success and ability to find a positive outcome is genius, and is something to imitate. His approach is similar to our modern day neuroscience approach to patient care. His story communicates key lessons for current clinical success. It starts with understanding, and then focuses on two distinct methods that can lead to different starting points to solve a problem.
Complex problems require systematic understanding:
The genius of Steinmetz was found in his sophisticated understanding of how electric circuits and electricity functioned within a complex system. This knowledge allowed him to view problems through a different lens. Namely, he was able to process and make sense of information that others missed or considered unimportant. He was able to do this because of his mental model.
The core of a pain neuroscience approach is viewing a patient through a biopsychosocial lens. Gone are the days of only considering a biomedical model. It is necessary to understand how our biology, psychology, and physiology interact and are influenced by the surrounding environment to make pain an output. Beginning to consider the relationships between the neuro-endocrine and immune systems and how our nervous system processes injury, pain, disease, fear, threat, and emotions are at the heart of seeing the big picture. It is here that we, like Steinmetz, can appreciate complex problems and begin to provide helpful solutions.
Patient listening required:
Steinmetz understood the value of listening. He slowed down, took time, and did not try not to force an outcome. He was patient and observant. This was a pivotal part of achieving a positive solution. Ford’s engineers could hear what Steinmetz heard, but came to different conclusions.
We all know there is power in listening. But you can only “hear” when you have the correct context. Patients will tell you, like the generator “told” Steinmetz, what is needed to treat them successfully. Listening is the corner stone for understanding patient goals, picking the right words to instill hope, and for enhancing therapeutic alliance.
Limit Bias by making no assumptions:
Steinmetz presumably arrived at the Ford factory without prejudice or preconceived thought. He did not seek input from others, but instead wanted to form his own opinion by means of a thorough examination. He approached the problem with an open mind.
This is critical for all types of medical interventions, not just pain neuroscience. While a thorough review of a patient medical record is standard practice, arriving with a clean slate and open mind to the patient encounter is essential. Viewing each patient as full of possibilities increases the probability of success.
Arriving at better treatment starting points = Better outcomes:
Ford’s factory engineers had access to the same information as Steinmetz for solving the problem, but they missed it. This reminds me of the chasing down tissue problems when a patient has more of a pain problem. Starting at the tissues for a pain problem can lead to a similar outcome as Ford’s engineers. Knowing how to use the same information differently led to success for Steinmetz.
In the clinic we all get the same information, but understanding how to use the information makes all the difference. The combined results of taking a biopsychosocial view and listening without bias often result in considering alternative starting points for care. Instead of starting with stretching, strengthening, manual therapy, or modalities, you start with education for why things hurt, sleep hygiene, focusing on function goals, cardiovascular training. These alternate starting points often lead to different outcomes.
Taking a pain neuroscience approach in your therapy practice opens up possibilities. It is as simple, and as complex as that. It requires a deep understanding of the patient and their experiences that are often missed with traditional physical therapy practice. When patients receive this type of skilled care they may recognize the value of the service and, like Ford, pay up despite the cost.