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  • #76
    Nice thoughtful post, milehigh.
    Diane
    www.dermoneuromodulation.com
    SensibleSolutionsPhysiotherapy
    HumanAntiGravitySuit blog
    Neurotonics PT Teamblog
    Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
    Canadian Physiotherapy Association Pain Science Division Facebook page
    @PainPhysiosCan
    WCPT PhysiotherapyPainNetwork on Facebook
    @WCPTPTPN
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    @dfjpt
    SomaSimple on Facebook
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    "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

    “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

    “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

    "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

    "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

    Comment


    • #77
      Originally posted by Milehigh View Post
      Stephanie, in regards to context, I was in no way taking words out of context. In the analysis of a logical string of arguments sometimes it is necessary to clearly state each argument so that it can be analyzed on its own. Agreed, not everything can be understood by reductionism. For the purpose of discussion sometimes it is necessary to state clearly which parts one agrees and disagrees with....
      Thank you for this Eric, your taking the time to further outline your thoughts on the matter are appreciated...and somehow, this posting conveys something inherently or fundamentally different to me as a reader than does you initial posting in this thread.

      I find your thoughts on "more vs less of who we already are" to be interesting, as I took it as not fundamentally become more of who we are (as you described), but rather if the advent of the internet with its unprecedented availability of information changes what a person values or provides a significant venue to develop a certain level of personal growth. My argument in that context would be that most people simply continue to seek on the internet information that they agree with or find appealing...thus "more of who we already are".

      I can also understand people coming onto the board for the first time and feeling frustrated by the way ideas are introduced, organized, and debated...but in my case, I think that is perfect, but I am a sample of one and am understanding not everyone wants to learn the way that I do now (this link and this link illustrate my own sampling well, I think)

      Originally posted by Milehigh View Post
      In regards to caring. I think we may as well sacrifice the fact that not everyone cares the same amount in anything or any profession. Everything exists on a continuum. For one I care about the environment but not to the same degree as the president of the Sierra club. Caring is a requisite, maximal amount of caring is not prerequisite to be a good PT. In physical therapy, I don’t notice a greater lack of caring than exists in any other profession or group of individuals. If you want to be the person that changes the culture then you probably need to care a little bit more than the next guy. However, if we spend our time lambasting therapists whom don’t care enough and not sufficient time trying to change parts of the culture of PT that affects outcomes of the individual PTs then we are not doing any good to the cause with which we care. This is a point and not an accusation at Barrett, the thread, SS, or any other individual.
      This doesn't seem right to me...the bolded in particular, but I will revisit this thought later in the day.

      Respectfully,
      Keith

      Interestingly, as an aside, I have found it curious that mods are always encouraging people to formally introduce themselves in the Welcome Forums, but I think I am beginning to understand now...
      Blog: Keith's Korner
      Twitter: @18mmPT

      Comment


      • #78
        Thanks Milehigh,

        I agree with Diane--thoughtful post.

        Originally posted by Milehigh View Post
        Jon, the more I think about the statement about the idea of growth of internet technology that “makes us more of who we already are”, the less I know what it means.
        I agree there is some room for interpretation here and only Barrett will be able to clarify what he meant. Your more simple interpretation is closer to my own. I think Keith captured part of it in his reply as it pertains to opportunities for information gathering (and confirmation bias) but you also exemplified the more important point (in my opinion) with your closing thoughts, "I intentionally exposed a bit more of me and my practice in response to the statements so that you may better understand my values and a bit of my philosophical underpinnings." I take the "making us more of who we already are" to be about opportunities to express ourselves in the manner we desire. Sometimes certain aspects of ourselves get expressed in a manner that wouldn't have been otherwise without the technology.

        Originally posted by Milehigh View Post
        Returning to the second statement re: information availability, I can appreciate the openness and the primordial soup of ideas here at SS. There is justification at keeping it a primordial soup at some level. However, the organization of the collective info here is difficult to process, difficult to learn from and difficult to understand from. There are great nuggets of information here but they are not designed for consumption. Thanks Jason for providing some links to focus some of my understanding of SS.
        Barrett once referred to this experience as "walking into the middle of a movie". A lot has happened already and it makes more sense if you started from the beginning. Discussion forums aren't the most convenient format for information retrieval and archiving. But then the most convenient formats aren't discussion forums. I suspect site improvement suggestions are welcome. I think the recent attempts from various members to centralize threads by theme is helpful and maybe the best one can do.

        Originally posted by Milehigh View Post
        Information alone is not enough.
        I agree. Information is necessary but insufficient.

        Originally posted by Milehigh View Post
        In regards to caring.
        I think the right questions here are "What is the therapist caring about?" and "What is the patient caring about?" and lastly "What ought to be cared about?"

        I liked your wish list. I'd like to see a core curriculum on pain become necessary for being an accredited PT program.

        I'd also like to see a semester devoted to narrative medicine and counseling practice.
        "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

        Comment


        • #79
          Eric, very thoughtful post. The time to organize thoughts and the effort and time to do so is often not done by many in this profession (and yes other professions as well). We are often more critical of our own profession, just like I am more critical of my children when they misbehave in public then I would be of someone else's.
          Kory Zimney, PT, DPT

          http://koryzimney.blogspot.com

          "Study principles not methods, a mind that can grasp principles will create its own methods." - Gill

          "All truths are easy to understand once they are discovered; the point is to discover them." - Galileo Galilei

          Comment


          • #80
            Originally posted by Milehigh View Post
            I think I have independently made some of the same observations but also reached different conclusions. These thoughts are for another time.
            I would really like for you to eloborate on this if you could.

            Great post Eric. Thank you for taking the time.

            Comment


            • #81
              Keith,

              You are probably right about the differences in tone between my posts. I thought of writing my second post as my first. But I figured I would post less and see what people had to say. Perhaps my ideas also evolve given more detailed reflection and the addition of feedback from the group.

              Originally posted by keithp View Post
              My argument in that context would be that most people simply continue to seek on the internet information that they agree with or find appealing...thus "more of who we already are".
              Agreed people use the internet to reinforce there construct bias. However, if that was what was intended by the statement then it should have read. The internet reinforces our own biases of our construct of reality. A great book that deals with this The Political Mind.


              Quickly re:caring. I will say, notice how I did not say a great therapist. I think we should divide what we think of as good and great expectations. We may want everyone and everything to be great by our own standards. But I think people rarely find life living up to every standard they have. Unless you abandon standards all together; another philosophical discussion.

              Maybe across the divide of substandard, to average to good, there is an appreciable difference in caring that needs to be addressed. I remain undecided about this and will need to think further. What is the state of the profession? Probably should be another post to elaborate on such a vast and constantly evolving concept. Suffice, I don't think it is substandard.

              Is caring alone what gets us over the hump. I still remains skeptical.

              Proud, re: My different conclusions. I think that will probably develop over time related to specific topics I see here on SS. I will think if anything explicit and concrete comes to mind.

              Look forward to hearing your response Keith,

              Eric
              --------------------------------------------------------------
              Body is imbued with mind, and mind is embodied.

              Comment


              • #82
                Therefore, neither does every therapist in this profession need to have a complete understanding of every philosophical paradigm and ability to site the latest and greatest RCT to be a good if not great therapist. Information alone is not enough.
                "Chance favors the prepared mind" (L. Pasteur). That's what I was thinking as I read this quote by Eric, and similarly Barrett's quote about the internet helping to make us more of who we really are.

                The internet- this vast trove of free thought, expression and information- puts both our weaknesses and strengths on display, and it's each individual's choice whether they'll participate and to what degree. Anything that has the power to do that can expose or highlight, as the case may be, our authentic selves. I think many, if not most PTs, lack the will or courage, to risk that.

                And I don't mean to suggest that this is a defect in character, but rather a consequence of top-down social engineering of human interaction- itself an insidious deprivation of our natural yearning to be free. The internet challenges that at its core.

                So, I don't think most of my colleagues are lazy or lack the will to learn new information, I think they're just plain scared. Fear with its partner ego are what invariably intercede between stagnating and growing. Why prepare when there's only an increased chance-not a guarantee- of a successful outcome? It's eminantly less threatening to just plod through the day doing what you've gotten used to doing, which also happens to be in compliance with the rules from "on high".
                John Ware, PT
                Fellow of the American Academy of Orthopedic Manual Physical Therapists
                "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
                “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
                be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

                Comment


                • #83
                  John,
                  As they say "you can't grow in your comfort zone."
                  Deb

                  Comment


                  • #84
                    Earlier in this thread, I wrote:

                    ...I would argue that to be a health professional who remains willfully ignorant of current concepts related to the care of their patients and is unwilling to adapt their own learning methods to provide better care for those patients needs to have their capacity for "caring" brought into question.
                    In response, Eric wrote:

                    Caring is a requisite, maximal amount of caring is not prerequisite to be a good PT. In physical therapy, I don’t notice a greater lack of caring than exists in any other profession or group of individuals.
                    I was thinking about "caring" most of the day today, trying to wrap my mind around if I have been mischaracterizing what it means to actually "care", and how it relates to PTs in particular...I wouldn't disagree that I don't notice a greater lack of caring than exists in any other profession or group of individuals, and I got a little ambitious with the bold highlighter this morning.

                    So I looked up some definitions to help me sort things out. Caring is defined by The American Heritage Dictionary as:

                    Feeling and exhibiting concern and empathy for others
                    If we look at Collins English Dictionary, it defines caring as:

                    Feeling or showing care and compassion
                    while defining care as:

                    1. To be concerned or interested
                    2. To provide needed assistance or watchful supervision
                    I suppose that to me, there is a distinct difference between 1) To be concerned or interested and 2) To provide needed assistance or watchful supervision. The latter requires action while the former does not. When I think of "caring" and PT, I have traditionally thought that it was necessary to be both concerned (exhibit interest/empathy) and provide needed assistance. In as much, I would agree that to "care" (empathy) is a requisite in providing care (needed assistance) as a PT.

                    What I have difficulty with is the inconsistency in ANY therapist (the good or bad) who is working as a clinician charged with providing needed assistance and is oblivious to their own lack of effectiveness and refuses to seek out new/additional/pertinent information to provide beneficial care to their patient. The responsibility of the provision of "needed assistance" by a PT is not to simply "do anything". Instead, it is to do "something" with the intent of addressing the manifestation of that "thing" in the patient with which the PT empathizes with (i.e. Pain, inability to live independently, etc), based on the best information available to the clinician. The internet has altered forever what information is now become available to the clinician in question.

                    And that is where, to me, things get a bit dodgy...can the clinician who doesn't seek out information on the internet really be as empathetic as they think they are (or claim to be) if their outcomes are less than desirable? What do they really "care" about? Is the patient's response to treatment truly at the forefront of their decision making model? Do clinicians mistake sympathy for empathy? Would this allow the clinician to dissociate from their patients in such a way that a lack of desirable outcomes is not taken as a personal affront to everything they have learned about their own practice? There seems to be a fundamental incompatibility between being empathetic while simultaneously not seeking out a means by which professional growth is attainable. Maybe John is right when he says, "Fear with its partner ego are what invariably intercede between stagnating and growing."

                    The thing that is disturbing to me is the logical consequence of a scenario whereby a clinician's lack of motivations for professional growth are a direct reflection on their abilities to empathize with their patients, which I believe we all agree is (as Eric notes) a requisite to becoming a PT. Again, I believe this calls into question the capacity for such a clinician to care at all and makes me wonder how many PTs do not possess the requisite skills required to perform the job they are hired/licensed/trusted to do.

                    I suppose I go to bed tonight with more questions than answers (as is usually the case), but I appreciate the opportunity for a dialogue such as this and hope that this posting will still make sense in the morning.

                    Respectfully,
                    Keith
                    Last edited by Keith; 17-08-2011, 04:59 AM. Reason: red: forgot to come back to my original point, sorry
                    Blog: Keith's Korner
                    Twitter: @18mmPT

                    Comment


                    • #85
                      Good questions, Keith and any logical answers could be loaded ones.

                      I think of caring as applicable to the interactor model for a PT, rather than the interventional/operator model, where the PT's ego can dominate.
                      Empathy is part of the interactor model, whereas sympathy can be anywhere on the spectrum and is generally unwarranted.

                      If therapists fail to update to current understanding of pain and function, then they are not serving the best interests of patients, or themselves. Theoretically, most PTs would agree with this, but they may not recognise that their knowledge is not up to date.

                      Nari

                      Comment


                      • #86
                        This is a beautiful thread.....wow. Thank you all for your thoughts.

                        I am really enjoying the blossoming discussion on the deeper definitions of caring and what that really means....

                        :thumbs_up:thumbs_up:thumbs_up:thumbs_up
                        Stephanie A. Mikoliczak, DPT
                        sigpic
                        And the day came when the risk to remain tight in a bud was more painful than the risk it took to blossom. - Anaïs Nin

                        Comment


                        • #87
                          Great posts Keith and nari.
                          I especially like this nutshell paragraph:

                          If therapists fail to update to current understanding of pain and function, then they are not serving the best interests of patients, or themselves. Theoretically, most PTs would agree with this, but they may not recognise that their knowledge is not up to date.
                          That is bang-on, nari!
                          We don't see things as they are, we see things as WE are - Anais Nin

                          I suppose it's easier to believe something than it is to understand it.
                          Cmdr. Chris Hadfield on rise of poor / pseudo science

                          Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

                          We don't need a body to feel a body. Ronald Melzack

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                          • #88
                            Hey Eric!

                            I'm a high school coach and not a PT, which means, as one therapist once said to me: I'm that group responsible for sending kid to PT. As a result, I always look for things on SomsSimple that can help improve my awareness of how the brain reacts to the stresses I'm applying to muscles, joints, and tendons during training.

                            I really liked this passage:

                            To be a good therapist in my mind one needs to be armed with good habits, good reasoning skills, and good sensitivity to a great many different systems in the body, have good techniques and have a good ability of judging the progress of their work.
                            I can substitue "coach" for "therapist" pretty easily. If there's one thing that's changed for me over the past thirty-seven years, it's been a greater focus on trying to asess what things change mechanically as kids run faster. This is not just to determine how succesful what I've "done" has been, but to determine if what I've been doing is indeed contributing to faster running. For me, it's judging not only the progess of my work, but the work itself.

                            Coaches are always good at making up crap based on what we think athletes need to do to get stronger and faster. But the reality that most of us don't like to admit is that a fair amount of high school kids will improve regardless of what we do...simply because they are naturally getting bigger and stronger. The "problem" with natural growth and talent is that it reinforces for us that our "crap works."--the end justifies the means. As Dan Brown once said of Mary Decker: "I could coach her all wrong and she'd still go out and run a 4:20 1500."

                            And when we think our crap works, we're not always interested when good science tells us that's not how it works.

                            In the coaching community, I've found that the "how" is not the always the focus. Results and outcomes speak for themselves.

                            As a colleague once said to me, "Coaches like you who like to get into the science of training are usually those who ain't winning."

                            Comment


                            • #89
                              MoveForwardPT? Really??

                              Does this guy care about his LBP patients?

                              [YT]iVyVnbESt1s[/YT]

                              I think he thinks he does, but he clearly doesn't have a handle on current pain theory. How can one truly care with the purposefulness and compassion that Keith just described above while lacking fundamental knowledge to achieve the goal (i.e. reduced LBP, improved pain free mobility) and to understand what it is the patient is experiencing?

                              Not possible. The gap is too large, the chasm is too wide.
                              John Ware, PT
                              Fellow of the American Academy of Orthopedic Manual Physical Therapists
                              "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
                              “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
                              be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

                              Comment


                              • #90
                                BTW, was anyone else distracted by all the bustling going on in the background of that video? Does anyone think that a patient in pain might be affected by all that noise and activity? Is this compassion, empathy and understanding for a patient in pain?

                                As a career-long member of the APTA, this video is an embarrassment to me.
                                John Ware, PT
                                Fellow of the American Academy of Orthopedic Manual Physical Therapists
                                "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
                                “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
                                be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

                                Comment

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