I Like to be Right, Is That So Wrong? | Modern Manual Therapy Blog

I Like to be Right, Is That So Wrong?


I like to be right. Who doesn’t? But sometimes, I like it a little too much. Both my wife and my mother have pointed out certain (probably too many) situations where this slight character flaw has been more to my detriment than to my advantage. I have lost patients in the past and justified it due to the fact that I was right about their condition, treatment approach, etc. So does being right matter? I still think yes…and no. But as with most situations, it depends. I like being right in the sense that I want to be able to explain to patients/customers what I think is going on with their situation. That should be the minimal expectation as healthcare providers–and far too many of us fall tragically short of that goal. We should be able to answer the customer’s questions/concerns to the best of our knowledge. However, there is a fine line and we can’t be be afraid to say “I don’t know.”
The truth is good and ignorance sucks–Todd Hargrove
So why do I bring this up? Because deep within the recesses of my psyche, I have a constant battle going on–the desire to be right against the desire to meet the patient’s needs. In the past, my desire to be right has won out more often. But these days I’m trying to level the playing field. The following scenario is an illustration of that. I believe we learn more from failure than we do from success. Failures and shortcoming are what keep me up at night or wake me up early in the morning.
An intelligent person learns from their mistakes. A wise person learns from someone else’s mistakes
I have a patient in their 70’s that I was treating for left sided neck pain. He would occasionally report having intermittent left lateral arm pain. His wife, (at least ten years younger and with other somatic modifications), is also being treated at our clinic post-op rotator cuff repair. She is convinced that his arm symptoms are indicative of a cuff problem as well. I have tested his shoulder several times. With active movements in multiple directions and with resisted testing of the cuff, I have been UNABLE to reproduce any of his arm symptoms. However, after treating his neck with a combination of manual therapy and exercise, IF he happens to have arm symptoms on that day, they have been completely alleviated.
I have also explained to him that the likelihood of partial thickness rotator cuff tears increases with age and that is completely normal. I also predicted that an MRI would most likely show something, simply due to the fact that in the general population over the age of 70, the incidence cuff tears in individuals WITHOUT pain is as high as 70-80%, and it is also completely normal. Therefore, no outright conclusions can be made based on that diagnostic finding.
Nevertheless, my patient ended up seeing a shoulder specialist several weeks after we have wrapped up the episode of care for his cervical spine. He went ahead and had an MRI done (likely due to the influence of his wife), and it indeed showed partial thickness tearing in the cuff. He explained that the shoulder specialist (who, in fact, is probably the best shoulder surgeon in the city), pointed everything out on the MRI to explain what was going on, and then proceeded to give him a cortisone injection in the shoulder.
I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail–Abraham Maslow
So, long story kind of short, he will be returning to therapy now for his “shoulder.” This patient and I have established a good relationship over the past few months. We connected over our family history: as a German Jew, his family escaped Nazi Germany during the war when he was a young child, as did my father and grandparents. And as much as I thought I gained his trust when it came to my assessment of his situation, both from our multiple discussions and with clinical testing, it still was no match for the influence of the combination of his wife and the orthopedist.
I know I’m not alone in this predicament. This is the uphill battle we face daily as physical therapists. I highlight this because in regards to this case, I am most certainly correct about his condition. I will take my position on my rightness in this situation with me to the grave. And it DOES…NOT…MATTER. The patient/customer believes what they believe. Since I clearly wasn’t already able to do it, I’m not going to convince him otherwise now. This is where the concepts of customer wants and needs tends to diverge.
Will this affect my treatment? I will likely incorporate some exercises for rotator cuff strength/endurance into his program. But at the same time, I also don’t want to give too much credence to a diagnosis and belief system that I consider to be incorrect and possibly unfair to the patient. Todd Hargrove highlights my feelings:
Maybe in the short term there is no harm, but false beliefs have a mischievous way of eventually causing problems in the long term
I believe I have the patient’s best interests in mind, but who knows better–me or him? At what point do I honor his beliefs and provide the care that he thinks he wants, although it may not actually be what he needs?  Can it be both? If I stick to my guns, I run the risk of losing credibility with my patient and perhaps the referring physician. Something to reflect on.
As always, thanks for reading. Comments and discussion welcome.

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

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