white flags

[marcelk]

Hy all,

What do you think of "white flags" : namely the flag of the practitioner.
Caused by (variable degree of) Tunnel-vision of the practitioner.

Cheers Marcel

[Nick]

Marcel,

Could you please elaborate on what it is you are trying to say?

If it towards those of us who take a greater interest in neurobiology and attempt to integrate it into our clinical reasoning and practice, I think you are a bit mistaken. In fact, what it allows one to do is take a birds-eye view and consider a large number of variables while focussing on those that are most relevant to the particular pain presentation. This is different from holistic practice where so many variables are considered that just about anything can be thrown out as a solution - and yes, very much in line with the practitioner's personal bias and perceptual fantasy. Another argument in favor of science here!

Nick

[emad]

Hello Marcel ;
wlecome here .

I tried to search for white flags ,but failed to find an article ,hope one of other members find something .
I think you are speaking about the negative impact of non-professional practionner on the outcome of the management process.

best regards
emad

[Diane]

Hi Marcelk,
Welcome to SS.:)
Are you talking about the white flag of surrender? (As in, beats me, I can't understand what this is, I'm going to send you to see xyz)?

[marcelk]

I'd reckon you would not quite get my drift, (but I was wondering if any of you heard this word "b4"; sorry 4 that)

I'm a pt in the Netherlands (Europe), (the last 16 yrs, last yrs discovered & studied 'neurodynamics").

Traditionally a patient in the Netherlands needs to consult a physician before being referred to a pt.

This year politics decided that there is need for direct accesability to any pt.
So the local pt board came up with a 2 day course in wich one should be able to recgognize anything that's not within a pattern a patient is showing : identifying red flags (& yel./bl./black).

This is why I was curious if any of you ever heard of a "white flag", (not to comment something to/or about any of you).

The white flag stands for the white coat, (some of us wear/use), (not for surrender, i'am afraid); the white coat many pt's (globaly) use. (i.e. the doctor in his/hers white coat)

Example : pat. sees a pt, without refferal, he knows the pat. well, this time the pat. complains of serious neckpain but pat. is going on holliday within 2 days, so please can you help me he asks, pt meets the man at 18:00, after the last schedulled pat. that day. he put's the pat. in supine position places the cerv. spine in ext. & applies traction,..............

So what do you think about this (white flags)
Not only for yourself but on a big scale : Physiotherapist and role within the Community

Thanks Marcel

Ps tell you more on what happened with the man out the example

[nari]

Marcel

I'm still working out what you precisely mean by the white flag..does it mean that the PT is a figure of authority and therefore more trustworthy in the pt's eyes? I have never heard of a physio wearing a white coat...

If a pt came to me with severe neck pain, the last thing I would do is extend and traction the neck. Can't think of a reason to do that particularly risky manouevre. Ouch. What is pertinent is that you say the physio knows the patient well; meaning it might be safer to do that technique if there is history of exaggerated pain behaviour and it is known that there are no red flags, including a low risk of VA dissection....which we could never know for sure...
There are other options which would be better....

Can you list the flags and what they mean? Blue...black..?

Nari

[marcelk]

Hy Nari,

Well white coats or jackets (give it a name ) are commonly used by doctors
(lets say in a hospital environment) some PT's around here (the Netherlands)
use them too during work.
No I did not ment authority.

Blue : social & economical factors
Black : proffesion risk factors
White : hypothetical flag (non existing in clin.pract. (yet?),....)

knows the patient well : he knows him for lets say 5 yrs, pat. saw the PT many times, well as in knowing personally.

The "white flag" in this (real) example was that the PT thought to help this pat. without exam.! and do a thing in which he believed it should work, I don't know why cause I only heard the story last week.
The result of this technique on the patient was a fractured dens axis which resulted in a spinal cord lesion level C1-2, so this patient did not make it unfortunatly.

My only goal was to ask a general question on hypothesis of white flags.
I'm not a native english speaker so maybe there lies the confusion, (words).

You could say that (analogy) medical & other profesionals put on there glasses whilst performing there job & see there clients trough that.
Sometimes wthout knowing these glasses might be "clouded".

Hope i explained it enough
Cheers Marcel

[bernard]

Hi Marcel and welcome,

Are you saying that The "white coated" PT wasn't cautious because knowing well his patient, he tried a treatment which caused injury?

But in your example, your are saying that the PT just made a cervical extension and traction? Such example is weird and I do not think that traction neither extension are harmful!

[nari]

Marcel

Now I understand better, thanks.

PTs, on that score, are at risk of "white flag" management.
To perform any manouevre with the neck, let alone one with the risk of artery dissection or fracture without an evaluation is just asking for trouble.

I might call it a red flag, however. It was a hidden pathology that the PT should have determined, (not diagnosed), but suspected something was very wrong.

A case similar to yours, but with a better outcome:

40ish male, with history of myeloma, presented to hospital for management of the condition. He developed a painful neck and arm, constant 24/7 pain, with neurological signs in the arm. He wasn't the type to complain, so the specialist diagnosed thoracic outlet syndrome (that old furphy) and sent him to physio. The PT refused to touch him in any way because of the presenting signs, and sent him back. On XRay, the C5 vertebra had disintegrated almost totally due to myeloma. Off to the neurosurgeon who fixed him up pretty well.

One has to watch these doctors....and their off-the-cuff diagnoses.

Nari

[marcelk]

HY Bernard,

Yes the pt knew(!) the patient. And the injury resulted in death of the pat.
Cerv. ext. combined with traction give it a little rot. or lat. fl. is the recipe for a "hangmansfracture". (if there is something wrong in the C1-2 joint, in rare occasions it's known that for exampkle : with reumatism, the dens-C1 articulation can be fragile; red flag)

Cheers Marcel