Above and beyond statistical evidence. Why stories matter for clinical decisions and shared decision making

Abstract

Physiotherapist Matthew Low is specialised in treating patients with musculoskeletal disabilities and uses dispositionalism as a framework in his clinical work. Low has developed and put into practice a clinical approach, following the dispositionalist theory, based on a ‘clinical alliance’ between patient and healthcare professional, who together try to make sense of the patient’s situation. This happens through the co-construction of a narrative, where the causal complexity of the patient’s experience is modelled using the dispositionalist vector model. In this chapter, Low translates into clinical reality several of the philosophical issues presented in Part I. First, he shows the necessity of considering the totality of causal evidence, including the qualitative and intrinsic propensities of the single patient at hand. Second, he demonstrates how patient narratives should be considered causal evidence and shows that evidence from population trials is just one piece of the puzzle for understanding causality in the single case. Low further reflects on the importance of moving past the biomedical and the bio-psychosocial models, that fail to honour the stories the patient tells or the full experience of persistent pain and how it affects (and is affected by) every aspect of one’s life. Taking the patients’ narrative seriously and working together with them on a long-term plan are essential tools when it comes to treating persistent pain.