One of the social events organized by our recreational therapist seems to be our patients’ favorite: tabletop games. Patients look forward to this activity, scheduled every Wednesday afternoon. For this, the therapist divides the patients into small groups based on their interests. Some play Scrabble. Some play Monopoly. Others prefer card games. The patients compete to win small prizes and trinkets.

Of all the tabletop games, the card games are the most difficult for me to understand. It seems as if there are too many rules and different card combinations you need to know to win.

One Wednesday afternoon, I brought a patient, Bill, into the activity room so he could participate. He had been looking forward to this afternoon’s activity all day. Bill requested the recreational therapist assign him to one of the tables for card games.

After an hour, I checked on how Bill was doing. Right next to him was a small pile of stuffed toys he had won. He told me he was cleaning house. As I helped him to drive his wheelchair back to his room, he said how he enjoyed the activity and then asked me whether I knew how to play cards. I said no, and explained it seems to be a bit complicated for me. He assured me it isn’t complicated and challenged me to learn to play cards. He said that in life, I should challenge myself to learn something I thought I couldn’t. I went home that day thinking about his words of wisdom.

The next weekend, I invited a few of my PT and PTA friends to my home, asking them to teach me some card games. As they began to teach me which card or card combinations make up a winning hand, I must admit it was really difficult for me to recall or recognize the patterns for winning card combinations.

At some point, though, things began to make sense. I concluded the rules of card games are similar to a comment posted by a TodayinPT Facebook follower. In response to my February 2016 blog, which focused on lack of treatment creativity among some PTs, the reader responded by saying “… evidence-based practice kills clinical creativity … especially here in Australia.” My conclusion led my friends to a spirited debate about whether evidence-based practice really is the winning hand over creativity in PT treatments, or whether clinical creativity incorporated an evidence-based practice. That’s why the latter appears to be novel and creative.

Our conversation grew into discussing how one can determine which type of research design provides stronger evidence: randomized controlled trials, single-subject design, etc.

Then, I asked the following questions: Do our patients really care if we are using creative treatment strategies, evidence-based practices, or both, to facilitate functional gains? What do our patients really care for the most?

I know they do not come to us asking whether we can use evidence-based practice to make them better nor do they demand we use creative strategies to help improve their functions. They leave it up to us to design an effective treatment plan because they believe we know the combinations that will make the winning hand for them.

Returning to our card games, I must confess I did not win any of them. However, when I return to work, I will be able to tell Bill I rose to his challenge of trying to learn something I thought I couldn’t.

I also know in managing patients: One card cannot do it alone; a combination of cards makes for a winning hand.