First Principle Thinking and Clinical Practice

In the middle of a hectic day, my assistant walks in to inform there is a new TMJ consult, referred by a fellow ENT. Generally the office would insist on a prior appointment, especially for TMJ and sleep consults, as they take almost 40-45 mins in the first consultation. But Rachna, this new patient, was accompanied by a small child and a husband; we understood it would be difficult to get her back. She was taken in soon.

As I always do, my history taking is not like a conventional interrogation in a Doctor's office. It's more like new friends or collaborators getting to know one another for the first time — who you are, where do you stay, sometimes what brings you to Goa, who are in the family, occupation, etc. Generally patients wonder why I am doing this small talk, as they are used to heading directly to the dental chair as soon as they enter a Dentist's office.

While this whole small talk is going on I am curiously watching the relative ease (or lack of it) with which they answer my questions, body language, eye contact, face shape, forward neck position, while waiting to hear from me.

Coming back to Rachna, I could see a small lower jaw, gummy smile, short neck etc, but I could also see a relatively nervous human being wondering what's happening to her, why are Doctors not able to give her a concrete answer for her ailment (mainly myogenous in this case), why is she being referred from one place to another (I was her third Doctor).

As she sat on the Dental Chair, and I examined her as per my TMJ examination protocol, I was quite clear that her joints were functioning well but her muscles were in deep stress, since a while. My next question was, are you under any emotional or psychological stress since a few months — the answer to which I already knew, since her body was telling me the truth. I still had to hear it from her, as a formality of anamnesis.

And there it was, a flood of tears coming from her eyes, as if the whole stress of so many months which was pent up like a dam lost control and found its way into the outer world. Of course, I did not tell her to stop crying or to be strong. I just let her vent out everything, all toxicity of repressed emotions — because it's only then can real healing start.

First Principle Thinking, as we know, is an ancient philosophy first popularized by Aristotle and in modern times revived by Elon Musk and High Performance Coach Dr Michael Gervais. It is a method to break down complex ideas to their most basic undeniable truths. I find this approach very useful in TMJ, Sleep and Breathing Disorders practice, or any other clinical condition where I feel the condition that I am witnessing may have roots coming from various origins. And unless we figure that out, or develop awareness of it through trusting partnership with our clients and patients, whatever we do, the best of surgical medical care, will fall short of long term relief.