Are You Thinking from the Inside Out… or the Outside In?
I recently came across a thought-provoking post by Izelle Labuschagne, where she challenged us to rethink how we approach problems. Are we reacting to external circumstances, or are we creating solutions from within? This concept resonates deeply in lymphoedema therapy.
As therapists, we often respond to what’s in front of us—patient symptoms, referrals, funding limitations, and evolving clinical guidelines. But what if, instead of just reacting, we shifted our perspective to focus on what we can create?
Harnessing Our Greatest Powers
Our ability to think critically, adapt, and innovate is what truly impacts patient outcomes. Two therapists can assess the same patient but, based on their perception and approach, see different paths forward. The difference? Their perspective.
A Shift in Clinical Thinking: A Case Example
Take the case of Margaret, a 67-year-old woman with secondary lymphoedema following breast cancer treatment. She had been prescribed compression garments but wasn’t wearing them consistently. During her review, she admitted that they were uncomfortable, difficult to put on, and embarrassing to wear in public.
This scenario highlights two distinct ways of thinking:
Outside-In Thinking (Reactive Approach)
“Margaret isn’t complying with her compression, which is why her swelling isn’t improving. I’ve explained the importance of wearing it daily, but she still struggles. Maybe she just doesn’t understand how crucial it is. I’ll reinforce the education and remind her of the risks if she doesn’t follow the plan.”
🔹 This approach focuses on the external issue—Margaret’s non-adherence—without addressing why she finds it difficult. The emphasis is on fixing behavior rather than understanding her perspective.
Inside-Out Thinking (Proactive Approach)
“Margaret wants to manage her swelling, but something is making compression difficult for her. Instead of assuming non-compliance, I need to understand her experience. What’s preventing her from wearing it? Are there alternative solutions that would work better for her?”
🔹 This mindset shifts the focus to problem-solving—finding a tailored approach that fits Margaret’s lifestyle. By exploring her barriers, the therapist may discover that softer fabric, adjustable wraps, or a donning aid could make all the difference.
The Key Takeaway? Change the Approach, Change the Outcome.
A reactive approach might have simply repeated the importance of compliance, emphasizing the risks of worsening swelling. But that hadn’t worked—Margaret still wasn’t wearing the garments.
By shifting to inside-out thinking, the challenge was reframed:
✔ Perception Shift: Instead of labeling Margaret as ‘non-compliant,’ we explored her perspective—what were her barriers?
✔ Collaboration, Not Just Education: Rather than just instructing her, we worked together to find a solution that suited her lifestyle.
✔ Practical Adjustments: We trialed alternative compression options, such as softer fabrics and adjustable wraps, making them easier to manage.
✔ Confidence Over Compliance: Instead of focusing solely on adherence, we empowered her with choices, helping her see compression as a tool for maintaining independence rather than a burden.
Encouraging Professional Growth Through Inside-Out Thinking
Adopting an inside-out approach in lymphoedema therapy requires more than just a mindset shift—it calls for ongoing learning, collaboration, and professional growth. Here are some ways to integrate this thinking into your practice:
1️⃣ Reflect on Your Approach
Take a moment to think about your own clinical practice. Ask yourself:
- Do I sometimes fall into reactive patterns when faced with patient challenges?
- How often do I take time to explore the patient’s perspective before recommending solutions?
- Where could I introduce a more creative, patient-centered approach?
Consider keeping a professional journal to document cases where a perspective shift helped improve patient outcomes. Over time, this reflection can help refine your clinical approach.
2️⃣ Seek Out Advanced Training
Expanding your skills enhances your ability to think beyond conventional approaches. Consider professional development opportunities such as:
✔ Workshops on Motivational Interviewing – Learn how to better understand patient resistance and encourage behavioral change.
✔ Advanced Lymphoedema Management Courses – Stay updated on emerging treatments and new garment technologies.
✔ Interdisciplinary Collaboration – Engage with occupational therapists, physiotherapists, and psychologists to broaden your perspective on patient care.
3️⃣ Case Discussions & Peer Learning
Inside-out thinking thrives when we learn from each other’s experiences. Engage in:
📌 Clinical supervision or peer mentoring – Discuss challenging cases and share solutions.
📌 Professional forums or LinkedIn groups – Exchange insights with therapists worldwide.
📌 Case study presentations – Challenge yourself to present a case study where changing your perspective led to a better patient outcome.
4️⃣ Challenge Yourself to See Solutions, Not Obstacles
Next time you feel ‘stuck’ with a patient case, pause and reframe the challenge:
🔹 Instead of “This patient won’t adhere to compression,” ask: What can I do to make compression work for them?
🔹 Instead of “They don’t have funding for treatment,” ask: Are there creative ways to improve their care with what’s available?
This shift not only improves patient outcomes but also keeps your professional growth dynamic and fulfilling.
The Inside-Out Difference
By thinking from the inside out, we weren’t just reacting to Margaret’s non-compliance—we were creating a new solution based on her needs. A few weeks later, she reported wearing her compression daily, feeling more comfortable, and noticing a significant improvement in her swelling.
The way we think determines how we act, and how we act influences patient outcomes. By approaching challenges with an inside-out mindset, we empower both ourselves and our patients to achieve better results.
👉 How do you apply inside-out thinking in your clinical practice? What professional development strategies have helped you approach lymphoedema care differently? Share your thoughts in the comments.
