Inference is a fascinating word. It has dual meanings that can describe both the process of thinking and the conclusions from thinking. Inference is associated with the intellectual ability to reason, think, and solve problems. Vocabulary.com defines it as:
“conclusions drawn from supporting evidence and reasoning”.
Our lives are full of inferences where logical deductions are made based on premises assumed to be true. Individual inferences can range from logical to illogical because they are influenced by experiences, beliefs, reasoning ability, abstract thought, and expectations. Though inferences often contain fallacy and bias, we use them daily to help navigate life. Here and here are some fun examples of inferences.
There is a good chance that every new patient arriving in the clinic has made inferences about why pain is present. The logic of these inferences, whether true or false, strongly influences deeper beliefs about the pain or limited function. Understanding what patients believe about their pain is of emerging interest to many therapists (here). Considering that what a patient believes is likely related to his/her inferences, it becomes necessary to bridge any disconnect that exists between a patient’s inference of the problem and your post-evaluation inference of the problem.
Physical Therapists are really good at making logical inferences about why a patient hurts or has limited function through evaluation. The initial evaluation process encourages clinical reasoning to methodically review facts, examine, synthesize details, and make judgements that can be translated into meaningful information. The cumulative evidence of the evaluation helps infer the logical source of the problem and becomes the foundation for developing the plan of care, goals, and treatment.
Here is the key message of the blog. Although we possess logical inference for a patient’s problem at the conclusion of an evaluation, we often disregard the importance of candidly communicating it with the patient.
By failing to influence and challenge the patient’s thinking process of why he/she hurts we leave a giant opening for poor outcomes. Instead, being confident in our post-evaluation conclusions, we begin treatment. This communication neglect leaves space for a patient’s pre-existing, often illogical, or poorly constructed inferences to fester. The therapist to patient inference gap must be bridged.
I have missed out on building a bridge for inference more times than I care to admit. A simple example of missing goes something like this: I share my thoughts about a case with a frustrated patient after four sessions of therapy. These are thoughts I had at the initial evaluation but did not share them openly. The patient then says something like, “well I would not be this frustrated if I had known that”.
The logical and sequential presentation of your post-evaluation inference, ultimately allows a patient to see the same information differently. Shifting a patient’s inference, from illogical to logical, may increase the probability of the patient achieving a different conclusion for the cause pain.
Intentionally taking the time to slow down and clearly communicate evidence helps a patient shape a new interpretation and perspective of a problem. It speaks to creating prognosis and expectations, but goes much deeper into shifting how and what is thought about the problem.
Pain pioneer Louis Gifford had it right a long time ago, as he created a bridges for inference, by helping patients answer these four questions:
- What is wrong with me?
- How long will it take to get better?
- What can I (the patient) do for it?
- What can you (the therapist) do for it?
Take time to consistently answer these questions with compassion and you will be building bridges all day long. The better we get at this, the smoother it all seems to go. (My inference!)