As the Final Four approaches, it is fitting to relate some comments on a recent article I found on USA today. The floors are made of the highest quality wood and inspected to the highest standards. The article can be found here for full reading, but I wanted to comment on the quote below with main point underlined:
‘Stromberg tells of being approached by a company that offered a $1.5 million machine that could detect cracks as small as 1/32 of an inch.“I said our people can detect a crack down to 1/64th of an inch, easy,” Stromberg says. “Very little here is automated.”‘
Now putting on a research scrutiny hat, I know most are thinking ‘no way’, ‘I want to see evidence on that’, or ‘reliability to detect faults in wood has to be poor’. But, have you ever seen a master carpenter pick out a straight piece of wood or even mechanic correctly identify the size of a nut to choose correct tool by just looking at it or rolling around in their fingertips?
I think this is talent and really don’t argue with the person. It is done, and the reason, these people are professionals. They are the best at what they do.
Let’s relay this back to our profession. Palpation. It is scrutinized, down-played, and some even don’t do it as research says the reliability is poor. However, this is one of the staples of our examination. Let’s not throw this to the wolves yet. We are professionals and we can pick up differences.
My favorite part of the examination is palpating a patient’s cervical spine (try with your eyes closed so you can’t see the patient’s facial expressions) and be able to detect subtle differences. You can (and should) be able to tell them where their pain is before they tell you. You get the awe factor and you don’t need expensive tests/measures.
As the old men say, ‘this is not my first rodeo’. Trust your instincts, experience and continue palpation.
Now the next question is clinical utility. Is the difference in the soft tissue’s texture, tone and overall feel clinically meaningful? Well, that is a discussion for another day.