Healthcare Advice: Why Do Different Therapists Offer Different Advice?

It can be frustrating to get different and sometimes conflicting advice from your various health care providers. Even when it comes to something that seems as simple as using heat vs ice, the responses you get may vary. Much of this variety comes down to a combination of the philosophical underpinnings of each discipline and what study the therapist has read most recently. Add to that the education and personal experience of the individual health care provider, and the variety of responses becomes even wider.

Western medicine takes great pride in considering itself to be based in scientific, evidence-based practice. This means that any decision or recommendation made by your doctor, nurse, physiotherapist, kinesiologist, and registered massage therapist should be based on current and up to date information and peer reviewed research. So why will you hear differing opinions even among these professionals? Some of that is due to the pure volume of research being conducted on a daily basis throughout the world, as well as the reality that in some cases there isn’t yet a consensus as to the more accurate answer. Take the ice question: in 2004 a peer reviewed systematic review found that there was minimal evidence to support the use of ice for injury management, and that further research would be required to offer a conclusive answer. Fast forward to 2022, and a current systematic review suggests that there may be value from a pain management perspective, but not from a healing perspective… oh, and further research is required to offer a conclusive answer.

This example offers an explanation of why you can’t simply get one single straightforward answer from all of your health care providers and advice will vary widely even among the purely western science based practitioners.

Now add into the question an entirely different philosophy of practice. Take Eastern medicine, in particular acupuncture: A practice based on centuries of learning, evidence, experience and study, the belief is that through acupuncture points a trained therapist can help regulate the “Qi” or life energy as it flows through the body. Using specific acupuncture points, the therapist aims to balance the yin (cool) and yang (warm) energies throughout your body. When it comes to a discussion on the use of heat or ice, an acupuncturist is going to be taking into consideration how a temperature fluctuation might impact your circulation, inflammation, and the overall ability of your system to regulate - not just the immediate area surrounding the ice or heat pack. They are aiming to help your body achieve balance. This means that if you are running warm (perhaps relatively more yang), or they see inflammation or flushing, the acupuncturist is unlikely to suggest using heat. In those cases you are more likely to be recommended cooling options to help your body find a neutral balance. Similarly, if you are pale and cold (relatively more yin), an acupuncturist is more likely to recommend heat to help your body warm up and return to equilibrium.

This is all basically to say it’s unlikely that you will get one consistent response from all of your health care professionals going forward. The more complicated the question, the wider the variety of answers you might expect. It’s always worth asking for a second opinion if you’re not sure of what you’re being told, and if your therapist can back up their advice with rationale, so much the better. If you are uncertain why you are getting disparate recommendations, asking for some background or what research they are basing their opinion on is always an option. You’re also more likely to get consistent opinions in a multidisciplinary clinic, because therapists who chose to work collaboratively under one roof are likely to have discussed common differences in opinion and background and come to a consensus.. Or at least they should be able to explain why their advice is different from their colleagues.

All the approaches to health care, including western medicine, provide an ever-evolving wealth of information for treating anything that might be bothering you - this means there may be more than one right answer for any individual and question. Beware of absolutes and guarantees, because the simple truth is that the more we learn, the more we recognize that there is to find out!