Each time I encounter a post or comment by a clinician regarding an approach to rehab or an explanation for treatment effect or diagnosis, I wonder what experiences led them to their decision and perspective. I analyze this for all posts irrespective of accuracy and my own biases. Overall, the majority of thoughts appear to subscribe to contemporary scientific explanations. However, there is a significant faction within our field that does not. (Bear in mind this analysis acknowledges that there will be slight differences in approaches which can be substantiated by evidence. This is both expected and good for the profession.) Given that for the most part our education/training are similar from primary school through graduate school, access to scientific literature is fairly available to all and clinicians must stay current with CEUs, what are these deviations attributed to? What is the cause for the pseudoscience and in some cases anti-science pervasive within our profession?
However does this matter? Is there actually an ethical dilemma?
Clinical outcomes are important, as are experience and findings of research report typically represent the significant averages. There will always be individual variation and guidelines are meant to be just that, they are not intended to replace clinical decision making. In a sense summary findings of a meta-analysis or clinical practice guidelines should not be viewed as dogma and unalterably infallible. However, ascribing a treatment effect or diagnosis to something factually inaccurate and contrary to the contemporary understanding of physiology is not ideal. Especially considering that an explanation of observed responses to treatment should be disseminated to the patient throughout the course of care. If we are not providing patients and the community accurate explanations for what is occurring with treatment yet they still improve is that ethical is that justifiable?
Case example of many…..
A patient is referred to a clinic for chronic headaches and the clinician provides cranial sacral therapy which results in a positive outcome for the patient. The clinician attributes this beneficial effect from the cranial bones being misaligned and then subsequently being reduced with this treatment. Though the patient’s status improved, the explanation has no substantive evidence to support what was disseminated by the clinician. Is that ethical despite the good outcome? What would the best way to explain the response to this treatment?
Let’s hear your thoughts!