The magical phrase

[Barrett Dorko]

I continue to be fascinated by the concept of aphorism. Without question, James Geary’s book, The World in a Phrase is my favorite resource though there are others. I’m going to add them to this thread eventually.

Warning: TV show reference ahead.

I remember an episode of The West Wing. A political consultant played by the late Ron Silver says, “Those who have never been sailing competitively won’t understand my approach to political races.” He goes on to describe how a member of the crew will dislodge a piece of seaweed from the hull, thus eliminating the drag. “You don’t poke at it with a pole; you put the pole in the water in such a manner as to allow it to sweep back against the hull. This will remove the seaweed without adding to the drag in the process.”

He knew that every little thing was potentially important. This led to constant vigilance and a thoughtful approach to problem solving.

I feel the same way about getting our meme out there into the “real” world of the clinic – and I think a good aphorism or two will help us in this regard.

The following is paraphrased from Geary’s book.

Light and compact, aphorisms fit easily into the overhead compartment of our brains. They’re brief and concise. They’re meant for use during emergencies – they penetrate and thus with remarkable speed tell you everything you need to know.

Aphorisms are definitive. They assert rather than argue, proclaim rather than persuade, state rather than suggest. And though they demand assent through their declarative style, even the aphorist knows they aren’t 100% true.

Aphorists are far from harmless. They are troublemakers and iconoclasts, dogmatists whose majestic authority commands consent. They are revolutionaries.

Aphorisms have a personal quality that possess the power to both charm and enrage those who hear them. Different from proverbs which are worn and bereft of usefulness through repeated use, aphorisms challenge and shock us by demanding a response – either recognition or retort. They cast the audience into an active role, which is both their appeal and the reason they are so rare.

Like magic, an aphorism often achieves its impact through paradox and reversals of import. What the listener assumed would be the concluding phrase is turned on its head, and thus jolts the listener toward further thought. This is where the “enraged” part comes in.

Enough.

I’ve an aphorism to present here and I’m hoping to make it something our profession begins to hear once we’ve cleaned it up as need be.

Soon.

[Ken Jakalski]

Your insights on aphorism kind of reminds me of a Steve Martin line from Roxane:

"Oh, ho, ho, irony! Oh, no, no, we don't get that here. See, uh, people ski topless here while smoking dope, so irony's not really a, a high priority. We haven't had any irony here since about, uh, '83, when I was the only practitioner of it. And I stopped because I was tired of being stared at."

[Barrett Dorko]

I went out and got Geary’s other book and found this:

The best disguise is the one everyone else is wearing.

James Richardson

Our tendency to hide amongst others in the herd has a distinct survival value, and I understand that. But aphorists can't hide. I also think peer pressure in our profession makes middle school look like an artist’s colony and this explains the near absence of aphorisms in therapy.

Oh, there are a couple:

No pain, no gain – which is merely the Puritan ethic stated as a rhyme. Personally, I hate it.

Move it and move on – completely senseless.

Perhaps you know some more.

Here’s the new one I’ve promised:

When the primary complaint is pain, the treatment of pain should be primary.

Do you know anyone who might be enraged by this?

[Diane]

It's a good one. It's palindromic. Everyone will be enraged. Except those who will be engaged.

[John W]

I've said this in much less concise and aphoristic terms innumerable times to a variety of my colleagues and referral sources over the past few years. Now, I've got a handly little aphorism to use instead. :thumbs_up

I'm sure it will piss off many of them because I'm afraid they think they're already doing that and insinuating differently will be taken with offense.

[Frédéric]

I'm afraid they think they're already doing that and insinuating differently will be taken with offense.

I share the thought

[Barrett Dorko]

Well, if they're already doing this than there's no reason for anger. But if the aphorism bothers them, maybe it's because they know they aren't able to defend either their assessment or care.

I watch each day while therapists "deal" with primary complaints of pain by ignoring them, instantly concluding a mesodermal cause, telling the patient that it's "because they have been in bed too much" (?!!), asking when they last got a pain pill, asking if they want a hot pack, blah, blah, blah.

The aphorism forces those who hear it to examine their knowledge of the primary problem and their subsequent approach. Both are typically found lacking.

Now that I think about it, maybe anger is appropriate.

[Barrett Dorko]

Let's test the aphorism.

Print it out, post it where your colleagues will see it (adding my name is optional) and report on the response.

[Jon Newman]

...asking when they last got a pain pill...

I agree with your post Barrett, but I'd hate to see people stop asking the above if pain medication is part of the treatment of pain.

[Barrett Dorko]

I think that this is an appropriate question in context. But if it's the only one in response to a patient's complaint altered by position and/or use you've got to wonder why the therapist doesn't investigate further.

Of course, I'm sure you know all of that. My answer is for others following along here.

A better question: Has there been any change in the patient's request for pain meds in response to the therapy offered?

[Barrett Dorko]

The Punch Potential thread fits in here quite nicely, and I especially like the way Bas’ post #16 matches today’s Range of Motion blog post.