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How employing the Fascial Distortion Model made me into a better listener

"Well, you're the doctor." says the patient, now silently staring into your eyes waiting expectantly for an answer.

I don't know how often I hear this said by patients. It's a statement of respect that we as doctors are the expert. It's a sign of trust that doctors know what's wrong with the patient and what to do to fix it. That's why they came--not to talk, but to be told by the doctor what is to be done.

Employing the Fascial Distortion Model (FDM), I've rediscovered what it means to listen to a patient. We are taught as medical students that, "if you listen to a patient long enough, they will tell you exactly what's wrong with them". But often it's too easy to cut off a patient by asking a barrage of questions that will help you complete your SOAP note.

Now, I'm learning how to coach patients to describe to me the minute details of their pain, to use their hands and words to explain to me where and how they hurt, and share a further history of what was going on when their pain started. All of these details help lead me to a diagnosis of fascial distortion and what kind of treatment I should use to address their pain. FDM posits that the body language people use to indicate their pain is mostly universal, so it's important that I give the patient adequate opportunity to do just that.

On the other hand, I'm also able to further identify with my patients and validate their experience of pain. It’s possible that some patients (and doctors) have the idea ingrained in their minds that it doesn't matter what we say or do, since we're all just going to take a pill or get a shot anyways. Some patients have learned not to talk about their pain beyond the bare minimum, explaining: "I can't complain, no one will listen anyways."

In contrast, I encourage patients to talk, because in the FDM, one of the key tenets is that the patient is the expert regarding their pain. As I listen to their stories, they are my greatest teachers. They help develop my clinical experience and pattern recognition when it comes to presentations of pain. No one knows pain more than the person experiencing it. What I love about FDM is that it is so patient driven and directed, and it gives us yet another reason to listen to what our patients have to say.

Yitzhak Lee, OMS-3

William Carey University College of Osteopathic Medicine

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