Termnology and pts

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Hi

Firstly, it's good to see my good friend Phil Clayton on the site. Enjoyed your postings Phil.

Kevin introduced the changing of terminlogy within podiatric circles for a need for clarity. Taking this slightly outside the profession I am wondering how people explore the issue of explaining a possible biomechanical foot problem with their patients.

Specifically, do people explain things to pt in terms of alignment or misalignent?

Personally, now, I find myself doing this less and less and have adptoped a way I am comfortable with.

BTW had a problem spelling biomechanical today. At least twice it came out as "biomaniacal". Hmm, maybe that explains a lot.

Ian

 

I try to avoid terms like misalignment as I believe it pathologizes what we are slowly redefining as "normal". I have always been fond of phrases like 'the architecture of your foot'. It gives a sense of both structure and function, and lets the owner of the foot at least believe what they have is a unique and wonderful designer piece. To this I add notions of movement - some accomodative, some excessive, and so on. Through this I can portray the dynamic nature of foot function and mechanical therapy.

I have always worried about 'misalignment' in the way that people talk about chiropractic "I had to have my back/neck/whatever put back in because it went out". It sounds too fixed - like there is only one correct way to be aligned. It hearkens back to the days of arch supports, where the foot had to be shoved back into an acceptable position.

maniacally yours (but well medicated)

Felicity

ps. I don't mean to imply that chiropractic is in any way dodgy, it is the way people talk about it that worries me

 

The clinician has a wealth of knowledge of anatomical and functional terms that are vital to accurately communicate with other clinicians regarding a patient's specific pathology. However, these same terms are usually foreign to the layperson. Therefore, this difference in understanding between the medical community and the public creates the need for the clinician to develop two sets of vocabularies when communicating with these two very separate groups of individuals.

This ability to communicate effortlessly with both clinicians and the public is a talent that is quite natural for some clinicians and very difficult for others. However, I have noticed that most clinicians will become better at this "change of gears" in communication as long as they perceive a need for its importance throughout their careers.

I sometimes use the concept of deformities, sometimes use the concept of normal vs abnormal function, sometimes use the concepts of force, and I may even use more sophisticated physics and engineering terminology for my patients, depending on their level of anatomical and mechanical knowledge. Probably the best way to communicate many of these ideas is to have a wall chart in each treatment room that illustrates the anatomy of the foot, a picture of a pronated and supinated foot, and pictures of common pathologies. Then the clinician needs to simply talk the patient through their pathology using pictures.

The adage "a picture is worth a thousand words" is certainly applicable here in that an understanding of their pathology is tranferred to the patient with a minimum of time and effort on the clinician's part. I recently purchased these wall charts over three years ago for each of my treatment rooms when I opened my new office and have found them very valuable in communicating with patients regarding their pathology and the mechanics behind their pathology. I also work with an orthopedic surgeon in the office and he has similar wall charts in the rooms on knee, hip and shoulder pathology which many of my patients are quite fascinated with.

Never underestimate the power of good illustrations when communicating complex topics to either clinicians or the public. When I am writing a paper, book chapter or newsletter, about half of my time goes into writing the article and the other half of the time goes into "drawing" the illustrations on the computer. I strongly feel that good illustrations are a very necessary and important part of allowing an optimal transfer of my knowledge to the reader when discussing complex biomechanical topics.