“ Intuition ” – and clinical reasoning

Intuition is one of two main modes of thinking, according to Daniel Kahneman. Intuition is fast, considers the whole rather than components of the whole, and intuition feels effortless. Intuition can also be wrong – but often isn’t (Gruppen, Woolliscroft &Wolf, 1988). We use intuition well when we’ve been exposed to many examples of the phenomenon under consideration – for example, if we’ve seen a lot of patients with similar health problems. We don’t use intuition well when we buy into biases or stereotypes. The alternative to intuition is slower thinking, that typically breaks the considerations into smaller pieces, often following a linear process where data (information) is collected and assembled. This kind of thinking is reasonably easy to investigate, whereas intuition is much more difficult to study (it’s fast, people can’t describe how they arrived at a conclusion, so it’s not amenable to self-report). Why worry about it? Well, intuition is the key strategy described by allied health, particularly physiotherapists, when considering whether a person needs further assessment for those pesky psychosocial factors (Man, Kumar, Jones &Edwards, 2019). What this means in practical terms is that a patient who doesn’t fit the stereotypical “risky yellow flags patient” may have to fail at conventional treatment before being directed towards a multidisciplinary, or biopsychosocial, approach....
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Assessment Chronic pain Clinical reasoning Occupational therapy Pain conditions Physiotherapy Professional topics Psychology intution Source Type: blogs

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Intuition is one of two main modes of thinking, according to Daniel Kahneman. Intuition is fast, considers the whole rather than components of the whole, and intuition feels effortless. Intuition can also be wrong – but often isn’t (Gruppen, Woolliscroft &Wolf, 1988). We use intuition well when we’ve been exposed to many examples of the phenomenon under consideration – for example, if we’ve seen a lot of patients with similar health problems. We don’t use intuition well when we buy into biases or stereotypes. The alternative to intuition is slower thinking, that typically break...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Assessment Chronic pain Clinical reasoning Occupational therapy Pain conditions Physiotherapy Professional topics Psychology intution Source Type: blogs
Once you begin to dip your toes into psychological therapies, it doesn’t take long before you begin to see TLAs all over the place. So today I’m going to post on two things: some of the TLAs, and why or how we might consider using these approaches in pain rehabilitation. The first one is CBT, or cognitive behavioural therapy. CBT grew out of two movements: behaviour therapy (Skinner and the pigeons, rats and all that behaviour modification stuff), and cognitive therapy (Ellis and Beck and the “cognitive triad” – more on this later). When the two approaches to therapy are combined, we have c...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: ACT - Acceptance & Commitment Therapy Clinical reasoning Cognitive behavioral therapy Coping strategies Interdisciplinary teams Occupational therapy Physiotherapy Professional topics Psychology Research Science in practice Source Type: blogs
Coping. Lots of meanings, lots of negative connotations, used widely by health professionals, rejected by others (why would you need coping skills if you can get rid of your pain?). I’ll bet one of the problems with coping is that we don’t really know what we’re defining. Is coping the result of dealing with something? Or is it the process of dealing with something? Or is it the range of strategies used when dealing with something? What if, after having dealt with the ‘something’ that shook our world, the world doesn’t go back to the way it was? What if ‘coping’ becomes a...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: 'Pacing' or Quota Assessment Chronic pain Clinical reasoning Coping Skills Coping strategies Motivation Research Science in practice activity patterns flexibility Occupational therapy physiotherapy values Source Type: blogs
This study provides some support for using single item questions to identify those who need more in-depth assessment, and those who don’t need this level of attention. I like that! The idea that we can triage those who probably don’t need the whole toolbox hurled at them is a great idea. Perhaps the New Zealand politicians, as they begin the downhill towards general elections at the end of the year, could be asked to thoughtfully consider rational distribution of healthcare, and a greater emphasis on targeted use of allied health and expensive surgery.   Deyo, R. A., &Mirza, S. K. (2016). Herniated Lum...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Assessment Back pain Chronic pain Coping strategies Interdisciplinary teams News Pain conditions Professional topics Research biopsychosocial disability healthcare rehabilitation self management treatment Source Type: blogs
The Pain Catastrophising Scale is one of the more popular measures used in pain assessment. It’s popular because catastrophising (thinking the worst) has been identified as an especially important risk factor for slow recovery from pain (Abbott, Tyni-Lenne &Hedlund, 2010), for reporting high levels of pain intensity (Langley, 2011), and for ongoing disability (Elfving, Andersoon &Grooten, 2007). I could have cited hundreds more references to support these claims, BTW. The problem is, once the PCS is administered and scored: what then? What difference does it make in how we go about helping a person think a li...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Assessment Back pain Clinical reasoning Coping Skills Coping strategies Education Low back pain Pain conditions biopsychosocial Chronic pain Occupational therapy pain management rehabilitation Therapeutic approaches Source Type: blogs
In my last post I wrote about the Pain Catastrophising Scale and a little about what the results might mean. I discussed the overall score suggesting a general tendency to “think the worst”, with the three subscales of magnifying or over-estimating the risk; ruminating or brooding on the experience; and helplessness or feeling overwhelmed and that there’s nothing to be done.  At the end of the post I briefly talked about how difficult it is to find a clinical reasoning model in physiotherapy or occupational therapy where this construct is integrated – making it difficult for us to know what to ...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Assessment Chronic pain Clinical reasoning Low back pain Occupational therapy Physiotherapy biopsychosocial pain management Psychology Therapeutic approaches treatment Source Type: blogs
Courtesy of many influences in pain management practice, you’d have to have been hiding under a rock or maybe be some sort of dinosaur not to have noticed the increasing emphasis on using questionnaires to measure factors such as pain catastrophising, depression or avoidance. The problem is I’m not sure we’ve all been certain about what to do with the results. It’s not uncommon for me to hear people saying “Oh but once I see psychosocial factors there, I just refer on”, or “they’re useful when the person’s not responding to my treatment, but otherwise…”, &l...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Assessment Chronic pain Clinical reasoning Coping strategies Occupational therapy Physiotherapy Psychology Science in practice biopsychosocial goal-setting healthcare pain management Therapeutic approaches treatment Source Type: blogs
Humans vary in how comfortable we are with uncertainty or ambiguity: Tolerance of ambiguity is a construct discussed in cognitive and experimental research literature, and refers to the willingness to prefer black and white situations, where “there is an aversive reaction to ambiguous situations because the lack of information makes it difficult to assess risk and correctly make a decision. These situations are perceived as a threat and source of discomfort. Reactions to the perceived threat are stress, avoidance, delay, suppression, or denial” (Furnham &Marks, 2013, p. 718).  Tolerance to uncertainty ...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Assessment Clinical reasoning Coping strategies Pain Pain conditions Professional topics acceptance ambiguity healthcare pain management Research Therapeutic approaches treatment uncertainty Source Type: blogs
Bless all the physiotherapists in the world, they keep us doing exercises. And exercises are good because they get us doing the things we want to do in our daily lives. But how does it work?  This is not an exposition on exercise physiology – I’m not au fait enough with physiology to do that and there are many other people out there with vast amounts of knowledge giving us the benefit of their wisdom who have written at length about exercise and why it’s important. Instead I want to talk about some observations – and maybe pose some critical questions too. For many years I’ve worked in a ...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: 'Pacing' or Quota Assessment Chronic pain Clinical reasoning Coping Skills Coping strategies Low back pain Occupational therapy Pain conditions Physiotherapy Psychology Science in practice pain management Research Source Type: blogs
Bless all the physiotherapists in the world, they keep us doing exercises. And exercises are good because they get us doing the things we want to do in our daily lives. But how does it work?  This is not an exposition on exercise physiology – I’m not au fait enough with physiology to do that and there are many other people out there with vast amounts of knowledge giving us the benefit of their wisdom who have written at length about exercise and why it’s important. Instead I want to talk about some observations – and maybe pose some critical questions too. For many years I’ve worked in a ...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: 'Pacing' or Quota Assessment Chronic pain Clinical reasoning Coping Skills Coping strategies Low back pain Occupational therapy Pain conditions Physiotherapy Psychology Science in practice pain management Research Source Type: blogs
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