Laurie's Blogs.

There are many ways to achieve a desired effect.  In the complex realm of healthcare, where results matter, it's crucial to approach treatment planning with a blend of wisdom, open-mindedness, and a dedication to patient well-being. Yet, within the healthcare community, there exists a persistent challenge: dogmatism. This rigid adherence to certain beliefs, protocols, or ideologies can sometimes overshadow the core mission of medicine — to heal and alleviate suffering. In this discourse, we delve into the dangers of dogmatism in healthcare, the merits of pragmatism, and the role of idealism in a balanced approach to patient care.

On more than one occasion, I have been asked by veterinarians, “Do you oversee the therapists in your clinic to ensure they are doing things the way you want them to?”  I have always found this question shocking.  My answer has been (and continues to be), “No.  They are professionals and capable of making their own clinical judgement and treatment plan.  Every one of the therapists in my clinic could assess the same dog and come with a variety of treatment plans, and that’s okay!  There is always more than one way to achieve the desired outcome.”

Dogmatism, though often well-intentioned, can lead to tunnel vision in medical practice. Dogmatism refers to an adherence to ‘rules’.  When healthcare professionals become entrenched in specific treatment paradigms or ideologies, they may overlook alternative approaches that could better serve individual patients (i.e. Prescribing medications based solely on a textbook protocol or dismissing complementary therapies without consideration). Here, dogmatism can limit the spectrum of care available to patients.  Additionally, criticizing a treatment method without consideration as to whether it worked or not, or whether it was the best solution at the time, with the resources available, puts dogmatism over patient outcome.  (i.e. At my clinic, we never have two people in the UWT with a dog unless the dog is quadriplegic.  It’s not feasible, and our outcomes would suggest that it’s not necessary either.  Shoot me now, but that’s what we do!)

Moreover, dogmatic adherence to protocols can stifle innovation and progress in healthcare. Medical science is constantly evolving, with new research and discoveries challenging established norms. Yet, dogmatism can resist change, hindering the adoption of more effective treatments or diagnostic techniques.  One must also question whether or not the protocol or intervention used was ever researched or challenged, or whether it is simply a matter of “this is the way I was taught, and this is the only way I do it.”  If the way you do it works for you, then great!  If someone else has managed to do things differently (and it getting results), then isn’t that what matters more?

Conversely, pragmatism offers a refreshing perspective in the realm of healthcare. Pragmatism is all about being practical.  By embracing pragmatism, healthcare professionals prioritize patient outcomes above all else. This approach recognizes that every patient is unique, and treatment plans must be tailored to individual needs, preferences, and circumstances. Rather than rigidly adhering to one-size-fits-all solutions, pragmatic practitioners weigh the evidence, consider the patient's values and goals, and collaboratively develop a treatment plan that aligns with the patient's best interests.  One must also take into account the availability of equipment, personnel, resources, etc.   At the end of the day, did the job get done?  Was the goal achieved?

Or as any parent might relate to, ‘Did you survive the week, with everyone being fed and watered, and all appendages intact?’  If yes, then maybe you count that as a win!

Pragmatism also encourages flexibility and adaptability in the face of uncertainty. In medicine, not every case fits neatly into established guidelines or algorithms. Pragmatic healthcare professionals are willing to think outside the box, experiment with different approaches, and course-correct as needed based on real-time feedback. This nimble approach to patient care fosters resilience in the face of complexity and ambiguity.

However, it's essential to acknowledge the role of idealism in healthcare. Idealism, with its lofty aspirations and vision for a better world, inspires healthcare professionals to strive for excellence and pursue noble goals such as eradicating disease, alleviating suffering, or  making a dog walk again! Idealism motivates medical professionals to advocate for their patients, and uphold ethical standards in their practice.  As personal example.  I have a high degree of idealism when it comes to manual therapies in canine rehabilitation, and that rehab is only complete if manual therapy is part of the treatment plan.  I understand that not everyone has that skill set, but many dogs are still benefitting regardless from those providing “manual-therapy-less rehab”.

Yet, idealism must be balanced with realism. While lofty ideals provide a compass for our aspirations, they must be grounded in practicality. In the complex reality of healthcare delivery, idealistic visions may encounter logistical, financial, or ethical constraints that necessitate pragmatic solutions. Striking a balance between idealism and pragmatism allows healthcare professionals to strive for best-practice while navigating the practical realities of patient care.

To conclude, the dangers of dogmatism in healthcare are real and pervasive, undermining the core principles of patient-centered care and impeding medical progress. By embracing pragmatism, healthcare professionals can prioritize patient outcomes, foster innovation, navigate the complexities of modern healthcare delivery, and simple ‘do the best they can’. While idealism provides a compass for our aspirations, it must be tempered with pragmatism to ensure that we effectively meet the diverse needs of patients and acknowledge the constraints within an imperfect system.