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That Grinds My Gears: Terminology

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  • CT That Grinds My Gears: Terminology

    I've been an active forum participant discussing things of professional importance to me since about 2005.
    I have learned a tremendous amount since then, been exposed to minds and ideas from all corners of the world, had my ideas and concepts challenged, and have grown in many ways.
    I've also been called names, been accused of incompetence, and threatened with a lawsuit over things I've said.

    In all that time, there are some recurring themes in clinical discussions that just drive me crazy. I've experienced them so many times, I'm just sick and tired of addressing them each time they come up. So I'll try to collect them all one by one, so I have a handy post to point people to when an issue I've dealt with before comes up.
    I'm going to call this the "That Grinds My Gears" series, after the famous Family Guy episode. Mostly because I need to remember to laugh about this stuff - or my blood pressure goes up.

    Here's my first entry. I hope you enjoy it.


    You know what really grinds my gears?
    When people complain of unfair treatment when I ask them to use accurate terminology.

    Often they phrase this as if I'm being excessively picky or unnecessarily pedantic about word choice such that I'm evading the issue. I couldn't disagree more.
    Words mean things. People who use inaccurate terminology to describe something are revealing they either haven't thought carefully about what they are saying or they have an incorrect understanding of the topic. In either case, its entirely appropriate for me to ask for clarification or point out inaccuracies as I see them.

    The famous physical therapist Geoff Maitland said "To speak or write in wrong terms means to think in wrong terms."
    He was exactly right.

    For far too long we have allowed a creeping anti-intellectualism in our therapy culture that encourages and celebrates strong and uninformed opinions and seeks to marginalize people who actually think and consider things carefully. I for one am sick of it, and I'm going to call it out when I see it.

    When people use inaccurate terms they reveal the depth of their misunderstanding. When that's pointed out, they often strike back and complain, accusing others of being pedantic. As things continue, they often reveal their true feelings of inadequacy by calling those who point these things out "elitist" or "arrogant". They sometimes use legal terms like "I didn't know you were going to make a federal case out of this" or words to that effect. Why would word use and good communication be any less important in medicine than in law?

    Maybe at dinner parties or among laypeople can some get away with imprecise language to describe pressing scientific issues. But I won't allow that when I have a scientific discussion with other practitioners. There are lots of people who won't challenge this sort of behavior. I won't be one of them.
    Get your facts straight and learn to read, think, and speak like a professional.
    Words mean things.
    Last edited by Jason Silvernail; 31-10-2010, 06:44 PM.
    Jason Silvernail DPT, DSc, FAAOMPT
    Board-Certified in Orthopedic Physical Therapy
    Fellowship-Trained in Orthopedic Manual Therapy

    Certified Strength and Conditioning Specialist


    The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

  • #2
    Excellent Jason!
    It makes my cogwheels screech as well. (See Tom Reeves' intro thread about my experience with MDs and language this weekend.)

    Since we need to take our patients' education VERY seriously (re: Mosely's work), it behooves us to simply use proper terms ALL the time. I have heard one MD say: "That's just semantics" at least twice this weekend, when I suggested that he could not say he was injecting the "pain generator", while another one said: "you know what I mean".

    When we use the proper terminology and words with each other and other professionals, we can only help understanding amongst us all.
    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

    Comment


    • #3
      Interesting start, I look forward to what follows.

      ANdy
      "Here is Edward Bear coming downstairs now, bump, bump, bump, on the back of his head behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there is another way, if only he could stop bumping for a moment and think of it." A.A. Milne

      Comment


      • #4
        I hope you enjoy it.
        Oh yea, I did.
        Barrett L. Dorko

        Comment


        • #5
          The Inspiration
          Jason Silvernail DPT, DSc, FAAOMPT
          Board-Certified in Orthopedic Physical Therapy
          Fellowship-Trained in Orthopedic Manual Therapy

          Certified Strength and Conditioning Specialist


          The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

          Comment


          • #6
            The next challenge is letting people know about your ground gears without looking like Peter Griffin.
            Rod Henderson, PT, ScD, OCS
            It is useless to attempt to reason a man out of a thing he was never reasoned into. — Jonathan Swift

            Comment


            • #7
              :thumbs_up:thumbs_up Jason! I like your verb.

              In french we say : «avoir le verbe haut» meaning one whose having the hability to speak with great intensity in a powerfull manner and with meaning.
              Last edited by Frédéric; 01-11-2010, 05:30 AM.
              Frédéric Wellens, pht
              «We often refuse to accept an idea merely because the tone of voice in which it has been expressed is unsympathetic to us.»
              «
              Those who cannot understand how to put their thoughts on ice should not enter into the heat of debate.
              »
              Friedrich Nietzsche
              www.physioaxis.ca
              chroniquesdedouleur blog

              Comment


              • #8
                "You know what I mean!"

                People often say this when I make a correction or attempt to clarify what it is they mean.
                Often it's saying the word "pain" when they mean "nociception".

                No, I don't know what you mean!
                When I see something so obviously wrong, I can think of three possibilities:
                1. They know the proper term and made a mistake.
                2. They don't know the proper term and are operating on incorrect information
                3. They know the proper term and are putting the incorrect one in its place deliberately.

                My overwhelming experience over many years is that the most likely possibility is #2. Either way, communicating well requires that I not assume things. Asking you what you mean and offering a correction if needed is part of a good discussion.
                I don't know what you mean. Words mean things.
                Jason Silvernail DPT, DSc, FAAOMPT
                Board-Certified in Orthopedic Physical Therapy
                Fellowship-Trained in Orthopedic Manual Therapy

                Certified Strength and Conditioning Specialist


                The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

                Comment


                • #9
                  I know what you mean.

                  I just sat through (for the last two days, taking extensive notes) a 48 minute lecture by the father of central sensitization himself, who still calls everything "pain" (although he does plunk nociceptive as a adjective/descriptor in front of the word "pain" when he's talking about nociception, most of the time). It doesn't help when the two are still being confused or at least left confusing by useage, by people who actually DO know what they DO mean.

                  Where does that leave the rest of us? Thinking fondly of Moseley, at least in my case. Apparently (according to Moseley himself, at IASP in August) it is Donald Price who was the original voice protesting that the two terms be separated/deconflated to make clearer the subterranean archeology of mechanism interpretation beneath their discrete meanings.
                  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
                  Neuroscience and Pain Science for Manual PTs Facebook page

                  @dfjpt
                  SomaSimple on Facebook
                  @somasimple

                  "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


                  • #10
                    Good stuff, especially that last phrase from Diane:

                    ...subterranean archeology of mechanism interpretation...
                    When people say, 'You know what I mean" it's usually because they don't know what they mean.
                    Barrett L. Dorko

                    Comment


                    • #11
                      A few years back at Supertraining I was called to task for misspelling "gait" as "gate." I never thought that was being pedantic or picky. If you're sloppy, you're sloppy.

                      Comment


                      • #12
                        Originally posted by Barrett Dorko View Post

                        When people say, 'You know what I mean" it's usually because they don't know what they mean.
                        Exactly!
                        Jason Silvernail DPT, DSc, FAAOMPT
                        Board-Certified in Orthopedic Physical Therapy
                        Fellowship-Trained in Orthopedic Manual Therapy

                        Certified Strength and Conditioning Specialist


                        The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

                        Comment


                        • #13
                          On a similar note:
                          Some time ago I responded to a query in the New Scientist back page. My response was never published. In the current issue (13 Nov) the query is reprinted:
                          Painful thoughts:
                          I understand that there are no pain receptors in the brain, so people undergoing brain surgery can be alert, with anaesthetic administered only locally to the scalp. If this is so, how do we experience the pain of headaches and mihraines, especially those that seem to come from a specific point inside the head and which throb and radiate from that point?
                          The reply, from the editor of Spinal Cord and a retired neurologist:
                          The functional elements of the brain are indeed mostly insensitive to pain. However, a variety of structures in the brain can generate pain signals, including blood vessels, the dura mater, the cranial nerves and the upper cervical roots. All of these are well endowed with pain receptors.
                          In addition, lesions and tumours in the brain and spinal cord may cause pain that appears to originate inside the head.
                          Eh????

                          Nari

                          Comment


                          • #14
                            Nari, are you going to try again?
                            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
                            Neuroscience and Pain Science for Manual PTs Facebook page

                            @dfjpt
                            SomaSimple on Facebook
                            @somasimple

                            "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


                            • #15
                              I thought of that, but I can't see any chance of challenging a (retired) neurologist or that the person making a perfectly reasonable enquiry would "believe" me over an -ologist.

                              I did include in my response references to Melzack and Moseley re the origin of pain. Perhaps he/she followed that up. or not.

                              Nari

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