Micro vs Macro

John Fuller Beckwith9/16/2026

In lymphedema treatment, where and how can a passionate therapist make the most difference? Is it at the micro level, in your small clinic, one patient at a time, one interaction and one treatment at a time? Or is it at the macro level, by ascending the ranks within the profession to the larger organizations, joining or taking leadership of committees and by presenting at conferences? This is a fair question. As a new practitioner one can gaze with admiration at people who make a name for themselves by working for a larger organization, by getting their byline on important articles and research, by becoming a recognized ‘name.’ A new therapist may imagine it takes special talents and skills they think they don’t possess in order to ‘rise’ to the higher ranks in our field. I have been at all levels in our field and let me share with you, it’s not all that!

As a new therapist I gazed up at the known names in our field with admiration and respect. I wondered if I possessed some ability to contribute in that higher level. I put my toe in the water by trying to teach and by the generosity of Steve Norton was mentored into teaching. Receiving an invitation to a stakeholders meeting hosted by the NLN, I spoke up on some issues. Apparently, someone liked what I had to say. This led to an unsolicited invitation to join the LANA board. I was on the LANA board for two and a half years. There is a bit of a story there, but the point is I found myself hobnobbing at the macro level. And while clearly most all the folks who circulate at this level are earnest and caring and talented, the lesson I took from my experience is this: they are also just human. They are no better, no smarter and not better clinicians than any of the rest of us. They have opinions and views, but I realized so did everyone else out there. The lay therapist had as much insight as most of the folks at the ‘top.’ We expect people in those positions to take seriously their responsibility at the to support the work done at the micro level but the reality is they are fallible and do come up short at times.

Certainly, there are abilities individuals can have that lend themselves to public speaking or working on committees, doing research or even leading creative projects. We don’t all possess those sorts of talents. Those with the desire and ability can and should rightly apply those talents at the macro level. We don’t want to devalue skills that lend themselves to leadership or creativity. The question though, really is, where along this continuum of micro influence to macro influence is the real value.

I’d like to posit that the core value in our profession is impact made at the micro level. Making the most difference you can in the life of a single person suffering with lymphedema is where the rubber meets the road. And that means the true unicorns, the jewels in our profession are the clinicians who day to day, one patient at a time, give the full measure of their skill and knowledge to help those actually living with lymphedema. Those at the top, at the macro level, only matter to the extent that in their position they help the skilled clinician at the micro level provide optimal service to the patient. Their primary role is to support the best treatment. My patients commonly report that when seeing other lymphedema specialists they often felt overburdened because they essentially were pushed into self-treatment. There was a sense of, ‘Is this all there is?” and that their lymphedema was not really treatable. They pleaded with me not to make them bandage themselves. Yet when they see me for the first time they leave with a sense of hope they did not have before. When the therapy actually is effective in reducing their lymphedema (when it was not effective with the other CLTs) they don’t feel the lymphedema rules their life. This was a different outcome. It illustrates how those at the macro level should focus support for truly effective therapy and not just indiscriminately supporting all approaches. This is less about me personally and more about the difference that can be made in the trenches of lymphedema treatment. And this is the only difference that matters.

This discussion would be remiss if we don’t point out how the folks at the macro level in some circumstances have, over the years, dropped the ball. Which is to say there used to be a focus on gold standard treatment and training as seen in the original NLN position papers. That standard has greatly slipped as elucidated in other opinion pieces by this writer. LANA has not fulfilled its promise and in my considered opinion the LANA designation lacks distinction at this point. Macro has failed to support micro. LE&RN has developed into an influential organization and does provide leading edge webinars and research, but there is an over-focus on surgeons and surgery so as an organization they are remiss in that they put too little emphasis on CDT and the day-to-day struggle with lymphedema.

The point is this: let’s not devalue the one-on-one interactions with each patient, each day, each time. This is the core of lymphedema therapy and the place of most impact. Don’t be overly impressed with those at the macro level. Those folks are only of value if they can do something to support your work in the trenches. For therapists out there who might feel their place in our field is not that great, please know the opposite is true: your role is the most important role in the entire lymphedema community, more important than the surgeons, more important than the movers and shakers at the ‘higher’ levels. Your patient doesn’t care about your CV, they care only that you do your best for them. Continue to put your heart into each individual encounter, give each patient the full measure of comprehensive treatment and keep making that meaningful difference in each single person’s life. One at a time. This is the reason we do what we do.