How the founder & CEO of Amazon can help you make better clinical decisions starting today.
Words by Craig Hankridge
Decisions, we make a ridiculous amount of them each and every day.
What to wear, what to eat, whether it's a green tea or double espresso kinda day, decisions are everywhere.
When it comes to your patients these decisions carry even more weight. People pay us to help guide them back to their goals. Conservative or surgical? Strength or mobility? Offloading vs loading? What makes them better or makes them worse?
When you think about it, it's a lot of responsibility. So how do we ensure we are making the right decision at the right time?
There is no fool-proof method but Jeff Bezos the Founder and CEO can help us out in how we frame our clinical decisions so we crush more of them, more often.
I'm sure you're familiar with doors, those things that allow us to walk through walls. Our decisions are more like them than you might realise at first. You see some decisions can be reversed, we can walk through the door, not like the outcome, turn around and walk back to where we started. Others however, once we are through we can't go back.
Two way doors (reversible decisions)
Imagine you have a patient who has a long history of ankle issues, repeated sprains, trauma and attempted treatment. Their pain is now at a stage that it is limiting their daily function and sporting performance. In your clinical decision making you have a series of two way decisions doors.
- Balance and proprioception training
- Clinical pilates
- Footwear and orthotics/bracing
- Corticosteroid injection
These are decisions that we can make with confidence and make rapidly. Why? Because if they don't work we can change our intervention. Yes, the patient has invested time and money, but they are not stuck in a clinical pilates class forever. On a percentage scale you can be significantly lower on your confidence/evidence level with two way decisions as there is always the ability to rethink the intervention.
One way door (not reversible)
For this same patient, we have options that may indeed help increase their activity and reduce their pain. In this case our one way door could entail:
- ankle arthroscope
- ankle fusion
- surgical repair of soft tissue structures in the region
Don't get me wrong, these options potentially may be the answer both us and the patient is seeking, HOWEVER, we have to ensure we have enough evidence to undertake such a decision as there is no turning back. In this case your confidence level for a one way decision has to be significantly higher and why we will often utilise extensive imaging, multiple opinions and exhaust conservative measures first.
1) Patients want to get better ASAP, so if you're looking at a two-way decision, go for it sooner rather than later and obtain feedback from the intervention as there is everything to gain!
2) If you're looking at a two-day decision you owe it to yourself and your patient to ramp up your level of evidence and certainty, nothing is ever guaranteed but it is worth taking your time as there isn't an 'undo' option.
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