Cookbooks and aphorisms.

Aphorisms, those pithy statements presenting seemingly obvious truisms, are to meaningful discussions what McDonald's fare is to red food. Fast food has its time and place, but it is real food, the kind that takes time to prepare and time to eat, that provides us with the sustenance and nutrition we need for survival. Our love affair with the aphorism predates golden arches and 30-minute pizzas - just read your Bible or revisit Shakespeare. But recently, in our quest for tasty morsels of sound bites, we seem to have developed an eating disorder that keeps us from diferentiating the substantial from the insubstantial, especially if the latter is well packaged.

Our profession has more than its share of dubious aphorisms, expressions that appeal more to the ear than to the intellect, and too often the simplistic appeal of these statements leads us astray. The time has come to look at these nifty phrases and to determine whether, as Ross Perot, the king of aphorisms, might say, "That dog won't hunt." In future Editor's Notes, I will examine many aphorisms, but this month I want to examine a phrase that seems to appeal to our finest instincts.

In the aftermath of holiday gluttony, this may be a bad time to talk about cooking and cookbooks, but then again when are we in a better position to consider the necessity of the well-developed recipe, one that has stood the test of time? We have all heard the aphorism "Patients deserve more than cookbook therapy" or some variant on the phrase. The problem is that the phrase has more appeal than substance. During the season just passed, many a guest rewarded the effort of a host by asking for a recipe. The act acknowledged the success of the cook's implementation of the recipe. If the recipe was proffered, then it is up to the new chef to see if there can be successful implementation. But, often the cook will honestly say there is no recipe, and the ability to transfer a capability will be lost. The world will not be diminished or anyone seriously hampered by souffles or pies that will never be made, but the same is not true when we fail to have recipes for successful physical therapy.

Patients deserve cookbook therapy because that therapy can be the most effective, humane, and appropriate. Cookbooks contain recipes, and good cookbooks have recipes that have been tested time and. again. How can we argue against offering our patients tested protocols applied in a consistent manner? Oncologists have developed an effective armamentarium of recipes in their war on cancer, and few would eschew their efforts in favor of allowing artistic license from their physicians.

We need our own cookbooks. We need to develop recipes - good recipes - and then we need to test them. Finally, we need to determine when to use these recipes and how to use them best. We develop recipes by sharing our approaches through publication, and we refine and validate those recipes by conducting research. We should use recipes when we have evidence of their effectiveness, and we should apply them using the best scientific and humanistic principles possible. This means we may need to deviate from recipes when there is good cause, but not solely because we want to assert our need or desire as practitioners to be unique or independent. Some of the finest chefs in the world confess to the use of recipes, and they never seem to feel that their personal prerogative is denied or their artistry hampered.

If we decry recipes, we buy into a simplistic aphorism, one often accompanied by an appeal to maintain the "art of physical therapy." Appeals based on simplistic phrases help neither our patients nor our own professional standing. We show caring for patients, in part, not only by our interpersonal interactions, but also by our willingness to subjugate our egos in the pursuit of effective treatments. As this new year begins, let us embrace a willingness to search for and to use recipes that work and refrain from the need to forever engage in untested treatments. My suggestion would be more palatable if it were captured in a pithy statement - an aphorism always seems to give an idea greater meaning - but, then again, this is an idea that can survive based on its merit, and those are the best ideas.