Can an Ancient Adage Describe FOX’s Approach to Medical Complexity?
By Mark Sala, PT
Physical Therapist
“A Fox Knows Many Things, But a Hedgehog One Important Thing.”
–Archilochus (7th Century, B.C.)
What does this ancient Greek quote spark for you? I was immediately struck by how it aligns with what it means to be a FOX clinician. Through the years, the quote has been interpreted in different ways. To me, the main gist is that a fox possesses the natural ability to be flexible and adaptable when confronted with a challenge or task. It relies on imagination and creativity in order to achieve certain goals. Some scholars go further and say that a sense of humility is necessary to keep the fox grounded, knowing that there’s always more to learn. On the other hand, the hedgehog sticks to one overarching principle or strategy, perhaps in a more unyielding and rigid way; the inclination is to rely on or at least hope for, that one big vision that brings it all together.
So how do the differing definitions of Archilochus’s fox and hedgehog apply to the FOX clinician? When providing care to the geriatric population, is it more important to be as versatile as a fox or as unbending as a hedgehog?
The Older Adult: Increasing Variation and Medical Complexity
A varied skill set and the flexibility to meet unexpected challenges are invaluable when caring for individuals of any age. But this is especially relevant among the older population that FOX Rehabilitation works with. According to one geriatric axiom, we all get more variable with age—in physical traits, physical and cognitive performance, susceptibility to disease, and even our gait patterns. This is due not just to genetics but is also because every one of our clients is the unique product of a long life history—including their medical, personal, lifestyle, and work histories.
Clinicians working with older adults encounter such variety during our daily work. It’s not unusual to witness one octogenarian racing down the hall cane in hand, while another of the same age struggles with parallel bars or a walker. Unsurprisingly (I still get a little surprised though!), an X-ray revealing severe spinal arthritis can mean debilitating pain in one person, while showing mild to no symptoms in the next person. Again, human variation muddles the big picture.
With experience and lifelong learning, we also see that so many of our patients dealing with the same diagnosis—whether it’s Parkinson’s disease, a stroke, or knee osteoarthritis—can present so differently from each other. An exercise that was so successful with one person can be ineffective with another who shares the same diagnosis. Therefore, it wouldn’t be prudent to apply cookie-cutter approaches and treatments across the board.
And to add to the potential confusion, the accumulation of detrimental effects over time can result in greater risks of osteoarthritis, metabolic syndrome, cardiovascular disease, and cancer in our later years. Unfortunately for many of our patients, these afflictions can occur simultaneously. So, more comorbidities and multisystem involvement can compound the variability we already see among older adults. This medical complexity demands a rich knowledge base, sharp diagnostic skills, and an open mind to different or new evidence-based methods or treatments.
Therefore, the FOX clinician is like the fox, knowing many things—she has to know many things in order to be an effective and astute therapist.
Acquiring the Knowledge and Experience to Meet the Challenge
Many of us draw from a broad knowledge base, that starts with the foundation we absorbed in school and is layered with subsequent learning drawn from continuing education, graduate degrees, specializations, and certifications. Experience is invaluable as well—FOX clinicians have worked in pediatrics, acute hospital care, skilled nursing facilities, short-term rehabilitation, psychiatric departments, and sports orthopedic clinics. Our hard work and training in other spheres carry over in the form of practical knowledge and versatility.
Some of us have also been supervisors or directors in prior jobs, now assuming similar roles of leadership for FOX. Mentors, past and present, have always been precious resources for the professional. Fellow team members are there to lean on or turn to for shared knowledge regarding different strategies or techniques. Again, the FOX clinician knows many important things.
COVID-19: A New Clinical Challenge
As mentioned above, geriatric care involves medical complexity, which demands vigilant observations and assessments. Now the current COVID-19 pandemic brings novel challenges and concerns, especially since the elderly are being the hardest hit by this pandemic. Already on alert for any adverse reactions to medications, overloading exercises, etc., clinicians must also be watchful for the myriad signs of SARS-CoV-2 (e.g., dry cough, dyspnea, abnormal O2 saturation). In accordance with CDC guidelines, FOX has implemented precautionary measures, including PPE use and disinfection, as we strive to protect the patient, ourselves, and loved ones at home. Moreover, telehealth is a tool being explored and implemented in our private practice to help some patients keep healthy and ready to come back strong once we’re able to see each other in person.
Needless to say, it’s been a stressful period as we have to adapt to a seemingly endless cycle of changing news about this coronavirus. Adopting such new precautionary measures and strategies are part and parcel of being a flexible fox.
A Little Hedgehog?
Some may argue that therapists are also part hedgehog, embracing one all-encompassing principle that guides our everyday practice—that “one important thing.” The theme could be community, cause, or craft, which FOX has highlighted in the past. Whatever that thing is, it lights the fire within, providing the fuel that drives us. Maybe what’s actually unyielding is our dedication to serve and help others. This commitment can drive the clinician to seek further knowledge, adding to the tool belt that enhances our readiness for what may come. In that light, the hedgehog may represent the meaning behind our work (although I’m sure we’re not changing our brand any time soon—HEDGEFOX or FOXHOG doesn’t sound so great!).
The Clinically Excellent FOX
In the end, such an ancient quote can remind us of what we already strive for—to be clinically excellent therapists, providing effective care to our patients. Care that is based on our varied experiences and evidence-based practice drawn from multiple sources. This allows us to be as flexible as a fox and as driven as a hedgehog, which is much needed during these trying times.