It is the Package

Gary Greenberg published an excellent piece in the New York Times magazine entitled “What if the Placebo Effect Isn’t a Trick”?

This well researched essay walks us through the history of the placebo effect, our current scientific understandings, and what effect these might have on western medicine. He describes the recent conference of the Society for Interdisciplinary Placebo Studies and how we now have an abundance of evidence that if people with chronic stress-related conditions receive a sugar pill from a provider in whom they have confidence, they will register the strongest placebo effects and will improve.  Time and again what are shown to strengthen patient’s response to “inert” substances is the mechanism by which they are delivered. Specifically, when the “intervention” is delivered by a warm, friendly, and trusted clinician who is paying close attention to the patient the results are amplified.

We are in a new era of physical therapy where we are moving away from the focus being on the “intervention” as the single type of exercise, manipulation, or pain education.  In this new era, we are embracing the Physical Therapist “package of care.”  Each step along the clients encounter with our services can have a positive or negative impact on their well-being.  The first friendly and caring voice they hear on the phone or the kind image on your website matters directly to their future outcome.  The ability to have all team members listening and caring with their whole-body matters. The ability to sit quietly and listen to our client’s story followed by asking the right question at the right time matters.  The highly skilled and elegant physical examination matters.  The skilled, gentle, and effortless manipulation of a body region matters. The least complex and most easily grasped and executed exercise program matters.  The gentle hand on a shoulder when the tears come matters.  The laughter, motivation, and the nudging of meaning back into one’s life matters.

Each of these attributes of the modern day effective physical therapist are important. It is indeed the package of care that we deliver that matters and we must strive to excel across all of these domains.

2 responses to “It is the Package

  1. P.G says:

    Very nicely written. It does matter!

  2. Paul Leverson says:

    Yes, and amen.

    Care for people can not ever be boiled down to the overly simplified results of a research study, average ranges, or “evidence based practice” as if those things provide all the answers to every question.

    The more we know, the more we need to listen..

    How do we measure “compassion”?
    What is the scale for the effectiveness of listening?
    Where would a person go to quantify appreciation? or…Hope?

    We are entirely fearfully and wonderfully made and will never know the end of it. If we’re not careful, we’ll devolve into “educated fools”, blinding ourselves to the simple wisdom of things we so appreciate when we see it in others.

    We are – by design – a social critter.
    We respond, immeasurably, to interaction, appreciation, affection, love.
    Hope is a powerful force in the nervous system. One we can not measure.

    Evidence…is only a place to start. Facts do not always lead to truth.
    Observe. Listen. Discern.

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