PubMed Won’t Treat Your Patient

I’m back in my hometown near Green Bay, WI this week, working out of my parents’ basement while my daughter gets some time with her grandparents before school starts.

One of the perks of being my own boss is that, for the most part, I can work from anywhere. This week, “anywhere” happens to be my parents’ basement, which includes homemade cookies in the middle of the day.

Since we were back in town, I took my daughter to Lambeau Field. For those of you who live under a rock or don’t care about sports, Lambeau Field is home of the Green Bay Packers, the greatest sports team on the planet.

We didn’t go to a game. We just visited the stadium, went through the pro shop, and watched her get excited and beg me to buy every Packers item they were selling. It filled my heart, and tested my self-control, because I wanted to buy everything too.

I’ve been to Machu Picchu, and it took my breath away. I’ve been to Lambeau a million times, and it still takes my breath away every time I see it. I’m still not sure why Lambeau isn’t one of the Seven Wonders of the World.

Anyway, football season is here, and early season football means a lot of players are learning playbooks. New players, new coaches, new systems, new terminology. The playbook gives the team structure and a plan.

But the playbook doesn’t play the game.

Once the ball is snapped, things change. The defense shifts. Someone misses a block. The quarterback has to call an audible. The play breaks down, and now the players have to adjust in real time.

That’s usually what separates the players you remember from the ones you don’t.

And I think we forget that in healthcare sometimes.

We talk so much about research studies and peer-reviewed evidence that I think some clinicians start outsourcing their brains to it.

Now, before anyone starts sharpening their pitchforks, I want to be clear. I’m not anti-research. I’m not anti-evidence-based practice. Published evidence is necessary for our profession. It should guide us, challenge us, and keep us from making decisions based only on habit, ego, or laziness.

But research studies and published evidence are still the playbook.

They’re not the game.

A research study can give us principles, direction, and useful information. But it can’t fully recreate a real treatment session with a real person.

Think about working with the limb loss patient population and all the complexities that come with that rehab process. The person in front of you isn’t a test subject isolated in a lab. They’re dealing with psychosocial adjustments, pain, socket fit issues, alignment issues, medication effects, motivation, family stress, financial stress, fear, uncertainty about the future, and plenty of other things that don’t fit neatly into a controlled study.

All of that changes how they respond to treatment.

So yes, ask what the literature says. But don’t stop thinking there, because the research isn’t going to give you the answer for every patient in every situation.

When your patient is sitting in front of you, they’re not waiting for you to recite a study. They’re trusting you and your expertise to help them achieve their goals.

That requires evidence, but it also requires clinical judgment, critical thinking, rapport, the ability to read the room, and the willingness to adjust when the play you called doesn’t work the way it looked on paper.

That’s the art of our profession.

And sometimes something works because you’ve done it over and over again. You’ve tried it, adjusted it, watched how patients respond, and seen it help enough times to know it works.

There may not be a perfect peer-reviewed study that outlines exactly what you did, why you did it, and why it worked for that specific patient on that specific day.

Sometimes it works because it works.

Research studies should inform your practice.

They should not replace your brain.