-----Original Message-----
From: kevin reese <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: Saturday, 4 September 1999 22:25
Subject: Re: FW: Clinical reasoning

Dear Sophie

I have been on my hols so catching this debate part of the way through. I
agree with Anna in that practice comes first and evidence/science follows. I
also agree with Ian in that the emphasis in all things being evidenced is
unrealistic. I am worred however about the idea of not thinking about
certain situations and going on to automatic pilot.

It is probably this rationale that gives the Chiropractors such a worrying
safety record. ie  I can perform thousands of cervical manipulations before
one goes wrong big style.

We must have the freedom to be intuitive. We must also be able to choose
from different schools, philosophies, intellectual approaches and techniques
and mix as we see fit. The thing we must never do is stop thinking. I can
think of numerous things that can look like a gastroc strain where the
approach you suggest would either be indffectual or dangerous.

I can only speak about my own practice and I never seem to have a routine
problem. Working predominantly with chronics, (over 6/52) if the solutions
were easy they would have gotten better without physio.

We may be meeting soon, so I hope this does not sound curt

Warm Regards Kevin Reese MCSP UK
-----Original Message-----
From: sophie dhenin <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: 01 September 1999 16:29
Subject: RE: FW: Clinical reasoning


>
>
>
>
>>Dear Simon
>>
>
>>  It is not a slight on our profession that we use
>>techniques we can completely justify but that we keep using them with
>>little or no thought.
>
>Maybe I'm being a bit picky about semantics......but I really don't have
any
>problem with using techniques with little thought if I've used them a
>hundred times before for similar musculoskeletal lesions when I know they
>work. I cannot believe that having made your diagnosis of say shin splints
>and having decided that one of several elements leading to this problem is
>tight gastrocs that you don't go right ahead and do some soft tissue work
>to the offending musculature and teach the patient to stretch. I do it
every
>week and don't think about it....
>OK that's a pretty basic example but let's face it, a lot of our work (or
>mine anyway) is fairly routine. I suppose I must adjust three or four L5/S1
>'s daily: again, having made my diagnosis I go right ahead and do it.
>Sophie
>
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