Walking To The Edge Of Thinking

Hey, I know you. You are a rational, logical person. You have followed a series of methodical, logical steps in your clinical decision-making. Your thought processes have brought you to the edge of the proverbial cliff in your thinking.

You glance over the edge. It's a big jump, a bit of a leap of faith if you will, to make the next step.

There is one logical step to make to move forward. But what happens when you walk to the edge? Do you take the step forward and follow your clinical reasoning through to its next logical progression? Or do you step back from the edge?

Welcome to one of the biggest challenges in clinical reasoning - and life in general.

We witness this phenomenon in many facets of life. As you might imagine, the clinical world provides many prime examples of it. We don't have to go much further than to use palpation as an example. Let's follow the step-wise progression in logic ...

... The scientific research indicates that it has poor inter-rater reliability. Check.

... Statistically speaking, this poor inter-rater reliability makes it, by definition, of low and/or questionable validity. Check.

... This makes it have limited utility as a diagnostic tool. Check.

... Meanwhile, I claim to utilize evidence in my clinical practice. Check.

You have walked to the edge in a step-wise fashion. Now what?

The next logical step would be to discard its use, correct? You have evidence, logic, and a sound progression of thinking all in your favor.

But what happens?

Clinicians step back from the edge - and keep on using it. And teaching it. And claiming it will require years of expertise to attain the skills necessary for it. We continue to spend reams of time teaching it in entry-level education and beyond.

Meanwhile, as Led Zeppelin once noted, "The Song Remains The Same".

See what I mean?

The big problem with walking to the edge isn't the walk itself. It isn't the logical progression of thinking. It is what you do when you get there that is critical. Making that next step in your thinking oftentimes provokes a feeling of fear or uncertainty or even despair. If I continue to step forward, I will find myself at a place where I may not know just what to do. But on the other hand, my thinking tells me I sure can't stay where I was.

Conundrum, indeed.

Rand once stated that

"To arrive at a contradiction is to confess an error in one’s thinking; to maintain a contradiction is to abdicate one’s mind and to evict oneself from the realm of reality”. (Rand)

I couldn't agree more.

It is in moments like this - those in which we challenge our beliefs and comfort zones - that we have the potential to experience transformational growth and attain great epiphanies. Or, we can step back from the edge and maintain comfort, stagnancy, and the dreaded contradiction for reasons of fear or uncertainty.

Which do you prefer?

Photo credits: Oneras

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• Clinically Complex, Or Just Poor Clinical Reasoning?
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• Clinical Reasoning: When Beliefs Trump Evidence