Podcast Episode #24 Maintaining Professionalism When Given The Benefit Of The Doubt

 

 

Jamie Johnston 0:12
You’re listening to the massage therapist Development Initiative. I’m Jamie Johnston. And I’m Eric Purves. This is a podcast by massage therapists for massage therapists. Our objective is to simplify how to be a more evidence-informed practitioner. Let’s dig into this episode.

Sometimes things in our profession change, sometimes for the better sometimes for the worse. And sometimes we’re not sure if it’s for the better or the worse.

This is one of those instances where I know that this is instituted with other colleges, but for our college in British Columbia, they have come out with a new standards of practice for us, where we don’t necessarily have to take a continuing education course for credit, but they have sort of laid the onus on us, and they’ve come up with career spanned competencies that we look at, for us to decide which direction we would like to take our own practice. That’s right.

Eric Purves 1:21
I think yeah, I think that’s that’s very, right. It’s, I have mixed feelings about this. And there’s a lot of goodness, but there’s also a lot of stuff that makes me concerned. And I think we should probably start off by saying our bias is that as people that earn a living, teaching Con Ed and providing educational opportunities to massage therapists, you know, we do get a lot of people that take courses just because they need the credits. Yeah. And they don’t necessarily really care what the course is, they may be aren’t that engaged with the material. I would say this is a minority of people. But this does, this does happen. And you always see and, you know, I’ve been doing this since 2015. And you always say no, then to cycle, you get a massive rush of people that are desperate for credits. And they just ended oftentimes, when you ask them, they’re just like, Well, this was available. And it was the closest one to me, is the closest one to me before we added online stuff. So people would, would do that. And so from a financial perspective, and from a business perspective, the old system was was good. But it also, I think you’d probably agree that it was not always you wouldn’t always get a full room of desire of people that really wanted to be there, that were really engaged. You’d have some people there’s like, I think the credits.

Jamie Johnston 2:40
Yeah. And that’s, I mean, even if I’m teaching a first aid course, it’s the same thing. It’s, you know, some, I mean, you try to make the class fun and make it so that people walk away going okay, that was fun class, but they’re the biggest reason they’re there is because the college just said, you have to take it. Yes. Right. So

Eric Purves 2:56
I mean, and it’s important for us to to have these, these, what they call this career span competencies, or what do they call it, they call it the professional practice Development Program, or the calling of the PDP, the practice development program, which looks very similar to Ontario strive program, where it’s basically more of a self reflective self directed learning plan, which you create yourself. And you basically have to follow these kind of 15 where they call them career span competencies, and we’ll talk about those I think individually here in a minute, the abyss, you have to follow those, and you have to basically create a learning plan that meets those competencies that are relevant to you, which I really like because I think if you as a clinician, and so as someone who still needs to take CS, even we teach them, we also have to take them ourselves, it can be very difficult to find stuff that is interesting or relevant to you, or that you want to take or that you want to take. So I think this actually is good. So good. The negative is from a business perspective, like it’s easy to sell courses when there’s minimum. CCS. Yeah. This is good, though, in the fact that it gives it gives our mentees the ability to choose and pick the kind of the direction they want to go based on their interests and based on where they are in their career. And based on the the populations they treat, or the environments they work in. That is good. And I’m not going to do that. I think that’s good. I’m very curious about how this is gonna be adopted by the profession.

Jamie Johnston 4:26
Yeah, it’s more like more in this case of a practitioner benefit, which is great. Right? Because this way, you get to decide where you want your career to go, which is we should we should all have that autonomy within our career to be able to to say, you know that I don’t want all that to say that we specialize in something but this is the things I want to focus on in my career. These are the directions that I want to go and they’re giving you the leeway to say good then go do that. Which is great. But the I think it’s important that are hopefully are going to talk a little later now, but it’ll bring it up. Now, it’s important for us to take into account that they’re giving you that leeway, and giving you the benefit of the doubt that you’re actually going to do it. So, we’ve seen, we’ve seen some debates, for lack of a better term in some of the Facebook groups where people are like, great, I don’t have to take CTCs. Now, that’s not what they’re saying. They’re, and by saying that, you’re actually almost like, kicking dirt in their face, because with them doing it this way, they’ve taken a step back. And when we’re giving you the benefit of the doubt, we’re giving you some some leeway for you to decide which direction you want to go. It doesn’t mean you don’t have to not take courses. You’re so they’re putting their faith in you that you’re going to be a professional and say, Okay, I’m going to keep up with this. And I’m going to make sure that I’m as highly educated as I can be in my career, in order to be of best benefit to my patients, which is the college’s job is to protect those patients. So they’re now giving you the benefit of the doubt that you’re going to do everything you can for the benefit of those people. Yes, yeah, and

Eric Purves 6:07
I think the only difference with this is, is you don’t have a minimum number of credits to take, you don’t have to go through the approval process, which I must admit like, right, it’s kind of annoying as the you have to submit all this paperwork and fill it all the stuff every time for a course. It’s it’s kind of a pain in the butt. So now people can pick and choose when they want, they don’t have to worry about going through that process. My worry. The worry, though I do have this as is the college was going towards a their evidence informed practice thing, which was good, which was moving in the right direction, even though stuff that wasn’t in this might be another podcast, if there wasn’t evidence based or evidence informed, was still getting pushed and being called Evidence Informed. And being approved. So I would say the approval process for that was probably not as stringent as it should have been. But they were moving in the right direction. Now they’re doing this and they’re saying we’re gonna we trust you to come up with stuff yourself. But without an approval process. How do you How is this ensuring that people are going to learn stuff that’s relevant? Yeah. Or learn stuff that is science based or evidence based or stuff that is defensible with current research? And that is where I get a little bit kind of concerns those being like, well, how is this going to be implemented? Or how are people going to adopt this into the practice? And I don’t know enough about Ontario’s program. It’s been around for longer.

Jamie Johnston 7:35
I think a few years, it hasn’t been around like a super long time, I don’t know, but

Eric Purves 7:39
maybe three or four years longer than like previously. And they used to have a minimum like a CDC requirement as well. And now they have more freedom. The freedom is good, because allows us to choose. But it does. I think the problem that results in is I think it can potentially allow more of the pseudoscience, more of the on defensible or non-evidence based stuff to flourish, because now that stuff doesn’t have to be approved. Yeah. So I’m kind of stuck in this this, I’m not really sure how to feel about it yet. Until I see it in action. Yeah. Yeah,

Jamie Johnston 8:17
I agree. And especially like, you know, when we look at the list of things, sorry, I’m just going to bring it up again, here. Of course, I mean, the the topics that they give, that we have to meet up to are great, you know, maintaining a safe work environment, maintaining comprehensive records, manage time and resources effectively treat others respectfully use evidence informed approach and your work interact effectively with other professionals like all great things that we should be focused on, within our continuing education, but not a lot of those are instances where there’s courses offered on them, which is probably why they’ve developed some of those courses that we have to take, which is fine. But when we look at some of the other ones, like functioning in a patient-centered manner, we should all be for patient-centered care. But to go back to the point that you were talking about, we see a lot of other comments and a lot of other terminology that’s used that isn’t patient-centered, that is still being pushed as a narrative that we should use with patients. So So there, there comes back to that concern about whether those things are going to be approved for people to take to take courses that aren’t patient-centred has absolutely

Eric Purves 9:36
yeah, yeah. And I agree that there’s, you know, you look at this, the 15 CSE isn’t, you know, I don’t know if we can do one read them all. We don’t read them all. And we’ll read the ones that are the ones out that are probably most relevant. You said the first one here was function a patient-centered matter. Right, and that’s a good one. So working in the best interest of the patients and so their brief descriptor here is I won’t read the whole thing it says you ensure that patient one wellbeing is at the center of the decisions you make, and are aware of your obligations to safeguard young persons and vulnerable adults. Okay, that makes That’s seems very, that makes sense, right? That’s, that should be. That should be just a given right? You give each patient your complete attention and allow sufficient time to fully address their needs. You respect patient uniqueness, and take into account their views, preferences and concerns, which is great, right? So when people come in, they tell us what their issues and concerns are. And then we do our best to help them within our scope of practice. You actively involve patients in decision making and ensure that they’re fully informed about and consent to the services you provide. Which is great, because so people come in, we allow we give them information, we allow them to make decisions, based on on our own. But the problem isn’t, I think you and I’ve talked about this before, if we haven’t talked about the podcast, we definitely talked about almost every time when we teach is patients are fully informed about and consent to the services you provide. Yeah. And if you want to expand on that, because I know you, you have a great little spiel about this is that, but if we’re giving them information that’s not evidence based, that’s based on beliefs or historical ideas, but not based on current science, is that informed consent? Are we giving them proper information to allow them to make decisions about their health care?

Jamie Johnston 11:27
It’s not. Right. So as long as as long as we’re stuck to those, many of those old narratives that we’ve learned in schools that have since been proven wrong, if we’re still relying on that, I think a perfect example was, and I don’t know who the person was. So I’m not, you know, trying to put them out of them in any way. But when we went to the, the RMTBC conference couple years ago, that was based around cancer. And the person stood up and said that they had been a therapist for 25 years, and they were shocked that we were allowed to treat people with cancer. So in 25 years, this person had taken, I don’t know what for continuing education, but had not gotten past the fact that cancer wasn’t a contraindication anymore, at least, parts of cancer weren’t a contraindication anymore, I was baffled that it was okay to give somebody with cancer massage, when we know now that’s like one of the best things we can do to help. So for for whatever course, courses that person had taken in 25 years, had obviously not been given enough updated information to understand that. So I would make maybe a bad assumption that they’re probably still using techniques and narratives that were based 25 years before. And so if you’re doing that, you’re not getting informed consent from your patients, because you’re still telling them that you’re unwinding their fascia or your you know, altering their craniosacral rhythm or, or any of these other things that we learned that we know are true,

Eric Purves 13:09
increasing circulation, and therefore spreading cancer, putting too much load on the heart, that kind of stuff, which we know has no science behind it,

Jamie Johnston 13:20
that you’re increasing the risk of a diabetic reaction with a massage, right? Like there’s so many of those, right. So if you’re still using those outdated narratives, then you’re not getting informed consent from the patient, because none of those things are real. So that, again, it’s, you know, depending on what the course is people are going to be taking are, and the more that we talk about patient centered care, we see in many of these forms, people use a number of other I don’t want to say it’s a description, many other terminology, terminologies to try to represent the same thing. And one of the ones that I see that I that I never really understood was heart-centered care. And then I Googled it. And if you look at the definition of heart centered care, so I literally Googled heart centered definition. It says being heart-centered means that you are aware of what you desire in life, you know, your values, you know, how to take responsibility for yourself and your emotions. You make choices that honor your needs, values and beliefs. No point does that say anything about a patient and collaborating on what you’re doing with them? It’s every everything in there is you you’re you, you, you. So if you’re going in and saying that you’re providing heart centered care, it has nothing to do with the patient.

Eric Purves 14:42
It’s clinician centered. Yeah, yeah.

Jamie Johnston 14:45
Which is the exact opposite of what the college is requiring us.

Eric Purves 14:49
And that’s, that’s a term two that you know, I’ve seen floating around a bit and people grasp onto it because it sounds very holistic and very great, but I’m sure there are attempt is the intent is probably in the right place. But I agree with you that the if we are wanting to be a science based, mainstream musculoskeletal profession, that and we’ve said this before, we’ve said many times that we definitely have the capabilities of being leaders in the treatment of management of any musculoskeletal thing. For the most part, when we’re making up terms, or developing new terms about stuff, and trying to like, come up with their own acronyms or own explanations that have no scientific basis, that’s not serving our profession, or the public’s best interest. And we see that all the time, we have

Jamie Johnston 15:44
to keep in mind that the college’s responsibility is to protect the public’s best interest. Yes. And there goes back to their putting their faith in you that you’re going to do the right thing by them developing things this way. So, but then it also goes back to like, how closely is it going to be monitored as to what your what course you’re taking or what you’re doing? Well, we’ll see how that develops as this goes on. And hopefully, they do a good job of making it so that that therapists are taken to task for what they’re taking, what courses they’re taking.

Eric Purves 16:18
Yeah, and that’s the one thing that worries me too, is they say all these words, but they’re very vague. Nothing is really very specific. And so how is the college gonna? Like, what are the metrics for that? How’s the college going to get to know if someone is fulfilling out or not? When you don’t have? Like, here’s like, the person who is going to work in that patient centered manner. What’s that mean? Yeah, without the college, really providing specific definitions or without the schools teaching that specifically, it makes me think that’s, that’s up to so much interpretation, which is good that it shouldn’t necessarily be these hard and fast rules. But it also I think, can allow for a lot of a lot of like, really pushing boundaries of what that means, like you said, like heart centered. Yeah. You know, that’s, that’s not even a thing. Yeah.

Jamie Johnston 17:07
Yeah. At least provide a guideline of some sort. Yeah. Just a, this is what we expect. Yeah. And this isn’t going to be implemented until January. So those things could still come out. In the meantime.

Eric Purves 17:21
Yeah, the college did say that they are going to put out more kind of FAQs and more information about it. But this is this what we have to work off. So we’re just making judgments based on our initial reactions. Yeah, one of the other ones, too, which I think was worth talking about, because a lot of good stuff in here, right, maintain a safe work environment, maintain comprehensive records, personal wellness, you know, treat others respectfully, like, yeah, this just makes sense. So it’s like that shouldn’t even be on here almost, because that should just be

Jamie Johnston 17:51
given. That’s common sense. Common, it should

Eric Purves 17:53
be common sense, that should be like, and we all do that anyway. But some of this one here, which I thought was interesting. And it says, practice in a manner consistent with current developments in the profession. You take regular active steps to keep your knowledge and skills up to date. This includes reading professional literature, attending conferences, participating in courses and workshops, and consulting with colleagues. This one to me is one of the ones I like the most. Yeah. However, how this is interpreted and how this is applied in a practice or into someone’s Learning Plan. Could be the problem if someone is has embedded to a technique, or they might work in is embraces a technique, where they view themselves through a specific like acronym or through a specific just as the population of people I treat? And you maybe you have somebody, you’ve taken all of their levels of their courses. Is that Is that consistent with the current development in the profession? Not if they’re still teaching outdated things? Yeah. And so that’s where that’s where I think, okay, so what is current developments? And how do you know, or how’s the college going to decide what is the current development? I would I would read that and be like, what’s the current science say? So use the cancer example? Yeah, we can massage people that have cancer, whether they are currently undergoing cancer treatments, or whether they are palliative, or whether they fully recovered and they’ve got, you know, back whoring and surgery or neuropathy is after we can treat those people and we’re not going to increase the risk of harm, harming physical harm. However, using the cancer example, what if we start pathologizing? And so you’ve taken some, I don’t know, some courses on cancer now and oncology and those courses are taught with a non science in foreign non science based framework. Yep. And you’re treating people based on that framework. And that might not be in the person’s best interest. But that might be what you learned in the course you maybe thought an instructor was great, maybe thought the course was great. Maybe you had some great colleagues in there. But maybe the information wasn’t based on current science. But you were led to believe it was, but you were led to believe it was is that’s not that’s inconsistent with current developments in the profession.

Jamie Johnston 20:20
Yeah. Yeah. It’s it’s almost too bad that there isn’t something in there that talks about critical thinking.

Eric Purves 20:29
That’s like, that’s untrue. I just, I was thinking that too. I read this, like, there’s nothing in here about engaging in logical fallacies or critical thinking or any

Jamie Johnston 20:36
of that stuff, you know, reading, like, yeah, being able to let’s just go back to the cancer example. That if you look at like the new clinical guidelines on, say, cancer care, and M escaping, yeah, there’s a paper out there on it. I’m sure I haven’t somewhere because I’m putting a horse together on that. And then being able to go, Okay, well, that’s the the creme de la creme. That’s that. Those are the papers I should look at. And then he will take a course that has a whole bunch of case studies that have been refuted by the clinical practice guidelines. Yes. But the person teaching the course presents all these papers and says no weapons based on research, because there’s there, we need to develop something to be able to, for therapists to critically look at that and go, Okay, this isn’t based on the best research. So maybe I should go home and look at some of that now and see if that refutes, what would what I just learned in this course.

Eric Purves 21:34
Yeah, and you do get a lot of that in our profession, not just pick our profession, but not just ask, but you do get a lot of that, where there’s these anecdotal stories that are that are being sold as hard science. And we look at the evidence based framework of like your, your clinical experience, your personal experience is part of that. And you don’t want to refute that. Because there, you know, you treat somebody and they get better. And you do that numerous times. And you see, because this one results, and that’s part of your evidence. Yeah. But the problem is, is the reasons for why they might get better might be very different from what you think. Absolutely. And maybe what you’re doing, and the stories that you’re putting on some of these people and these beliefs that you’re putting onto them might be harmful, because might take away their autonomy or their self efficacy. That is, I think we’re the why it’s important for us to be mindful of the difference between using anecdotal stories to validate why it is you’re doing what you’re doing versus the science because the science is there to inform those anecdotes. Exactly. I think I don’t know if that’s the right. If I said that. Right. That’s how I see it. Saying that, again, I think you’ve got out and why

Jamie Johnston 22:57
that anecdote worked. Yeah. And that comes in, that all comes back to the second point, and their thing is communicating effectively. Yes, right. So being able to take the current science and communicate that effectively to a patient so that these things aren’t happening. So that we aren’t just using this anecdotal evidence and saying, yes, it’s it’s because of XYZ when it’s actually because of ABC.

Eric Purves 23:23
Yeah. And that’s not pain. splaining? No, are not science playing. I think that’s sometimes when we think about effective communication, we were like, well, how do I explain pain to people? Or how do I explain this dysfunction? Or how do I explain this disease people? And we just kind of like vomit information, people. That’s not what it’s saying. So I think that’s part of effective communication is communicating a level that people want, as well as our own knowledge, like how well can we communicate? And how much and what how much information do they need? And how is it received? And I think they do say thing in here, too. You communicate clear and concise as possible and take steps to ensure that you are understood. That’s a really important piece. And surely you understood it, which comes down to asking them if they’ve understood or ask them to repeat it back to you. Yeah,

Jamie Johnston 24:09
there’s that old thing of like, Tell me Tell it back to me like you’re explaining it to a 10 year old. Yeah, exactly. So that they you get whether they absolutely understand what you were saying. Because if they, if they repeat it back, and it’s not at all what your intent was, then you need to change that communication and correct it before moving on with your treatment and all that and that’s all part of that consent thing as well. Yeah. Right. And I like like what they put in there is like even reading nonverbal cues, reading body language, things like that. So that you know, if you’re saying something to somebody, because I know there’s been plenty of times in my career where I’ve stuck my foot in my mouth and you see the person kind of looking at you and being able to read that patient and go, Okay, I need to take a step back here. Because I either said something wrong or said something they misunderstood and are not taking the way I intended. So there’s a little bit more behind that. But communicating effectively is obviously going to be an important part of what

Eric Purves 25:03
we do. Yeah. I think a lot of the stuff comes comes back to that effective communication.

Jamie Johnston 25:09
Yeah, yeah. Well, especially when we look at the, the clinical guidelines, and like the best approach for MSK care is always that reassurance, education. Right? Those two first things are all about communication. Yeah. And there’s a reason that the, the importance of those things are number one, and two, and then movement and actual manual therapy, or three and four, yeah, those, those things are more important. So one of the other ones that I like, that they put in is that you work within the limits of professional knowledge and skills, because that we go back to that story I told about the person at the conference and the cancer thing, but also, when we look at the brand new student that’s coming out. So let’s just say, a student, I graduated in December, we got out of school. So let’s just say that I graduated in December of 2022. And then all of a sudden, in 2023, I look at that, and I go, Oh, I don’t have to take CCS anymore,

then you should be very

limited as to what you can do with your patients. Yeah. Right. Like, if you’re making if you’re staying within that professional knowledge and skills. When I look back at what I know now compared to what I got out of school, it’s light years difference. And I’m not trying to say that I’m some smart person, it’s just that I’ve learned a lot in the last 10 years. And the way that I treat is different now the way I communicate is different now. So I think that’s a really important one because hopefully those students that are coming out brand new aren’t going, Oh, perfect. They’ve just told me I don’t know how to fix the season.

Eric Purves 26:45
you’d hope that students like you’re frustrated and so to school would want to to learn and I mean, I’ve been the I think we’re a little bit of a bias or a little bit of an echo chamber, or at least for me it’s been for myself is that a lot of the people that take my courses or sign up for my memberships or to take some of mine are new grads are relatively new grads that want to learn more, that have been exposed to stuff. I would say that you don’t get nearly as many of the 20 plus year veterans taking stuff. So I mean, I could just just be me, but that’s just my my anecdotal experiences. A lot of the younger and younger, they’re always young, but new to new therapists. Younger field. Yeah, usually younger than me. But, but new newer therapists are those people are younger than you and me. So yeah, it’s true. That’s true. Now, didn’t used to be that way, you know, are people that want to learn and a lot of them will take stuff, even though there’s no season rolls? Yeah. Because like, I want to learn this information. This is important to me. This is important to people I want to help. I want to I want to learn all the things. Yeah. So I hope that that becomes a kind of common thing. And I hope that when people are finishing school, like the educators or the schools now are kind of planting that seed to basically be like, you’re a lifelong learner. You don’t need to see seeds, but you still need to learn like it’s really important. Find a population or find an area of interest or find people you want to learn from and take their stuff, because that’s going to be valuable. Yeah. I like what you said a few minutes ago is that the If I think back to how I used to think and how I used to practice now, I used to treat people and how is communicate compared to you know, the last, you know, seven or eight years, like it’s embarrassing.

Jamie Johnston 28:33
I’ve often said I should go back and apologize to most of those people.

Eric Purves 28:36
Yeah. And I am so surprised sometimes that people still came back. When, when when you but I guess it’s just a matter of people had this these expectations. And you provided that to them, and you thought you’re helping them. But I think a lot of times I was I wouldn’t say you’re always making them worse, but you weren’t always helping them. Yeah. Right. And I think that the it is hard to think that way. And you think even to when you’re starting to adapt and trying to be more what you call science based or evidence based. And you go through that process. I think you screw up even more because you’re trying to change that narrative. You’re trying to change how people think. And you’re you’re doing stuff and saying things which really unhelpful and probably quite harmful. Yeah. So I think there’s a learning process which we all have to go through. And I think anybody that feels that they know it all, or feels they don’t need to learn any more, I think is that’s a dangerous thing.

Jamie Johnston 29:30
You should probably leave the professionist Yeah, I

Eric Purves 29:33
mean, I always want to learn more because I never feel like I know enough. Yet. That’s that’s me. And I would hope that the majority of us that way, like Yeah, you know what, I would really like to learn more about ABC, whatever that whatever this field is, or this area is I want to learn more about, I don’t know, sensory neurophysiology or I want to learn more about you know, helping geriatric population of seniors I want to help more with athletics or I want to help more With chronic pain or whatever it is you choose you like, I think that people should just like, first. And then, and hopefully, hopefully, my hope would be with with this new stuff here with these new, like you for another cold career spanned competencies nothing in here talks about techniques. No. Right. It’s not about learning new techniques. It’s not about expanding your techniques. It’s not about the only assays they take technical knowledge and skills.

Jamie Johnston 30:35
Yeah, but at the bottom, but there’s nowhere in there that talks about technique.

Eric Purves 30:39
Yeah. Which is to me is sorry, that about the above.

Jamie Johnston 30:43
It says you apply your knowledge and technical skills, procedures, equipments, devices, techniques. But you’re you’re gathering skills, to gather information, assess, plan, land or deliver services. So even with that, they’re not saying that you go out and learn a whole bunch of new techniques, it’s that you gather everything that you know, and apply it.

Eric Purves 31:01
Yeah. Yeah, that’s right. Yeah, I read that again. And you either does say technique, but doesn’t talk about gaining new techniques. And so much of what we learned in our professional we’ve talked about this before is that people are looking to always get new techniques all the time, right, and collecting these these tools. And there’s, there’s a certain point where like, yeah, you want different ways of touching people. But I would say that, you know, majority of what we learn in terms of how to touch people, is we learned in school.

Jamie Johnston 31:29
Yeah, I probably learned everything I need to know about how to test people in the first three terms of school.

Eric Purves 31:33
Yeah. And it’s just a matter of refining that and kind of developing your own kind of.

Jamie Johnston 31:38
Yeah, the way you like to do it the way your patients like you to do it.

Eric Purves 31:42
Yeah, exactly. Exactly. One other one here, I thought was really good. Kind of next point was. And this is really what it comes down to now, we’ve talked with this before about evidence based versus evidence informed. I’m not as I initially liked the evidence informed approach or that evidence informed definition. But I’ve now kind of gone back to I think I prefer evidence based, just because that’s but same idea anyway, use an evidence blank approach in your work, right, as they say you make workplace decisions by integrating the best available evidence relating to the situation at hand, including research and credible published information, your own professional knowledge, including that of trusted colleagues, the patient perspective and the practice context. So if we’re using evidence to like, we really should be using evidence to inform our practice and combining what’s the research say, right, so usually, when we talk with the stuff, we teach the stuff, right, we usually talk about clinical practice guidelines, which are pretty special, specifically vague to be able to apply this information to people. But the thing that’s interesting with me that with this, though, is that if you said to most, I should say most if you said to many people was evidence based practice means you’re what’s evidence informed practice mean to you? You’re gonna not get it, you’re gonna get a lot of different answers. And I think the problem is, is that that terminology, or that phrase of evidence based or evidence informed, is not really well understood.

Jamie Johnston 33:21
Even within leaders in the profession, it’s not really well understood.

Eric Purves 33:25
Yeah, and I think I feel I mean, I don’t know, I feel like some of you, we say these things are pretty bold statements are kind of throwing people under the bus. But not anybody specifically. But you do see that all the time is like, so if something is evidence based, I mean, just based on the best available evidence for that. So let’s use cancer, because that seems to be the the one. So if you’re if you’re say your course, is evidence based, oncology, evidence based massage therapy for the oncology patient, there’s a core same for you. And how are you deciding what’s what? What information? Are you finding? It’s the evidence for that course. And you know, how to critique that evidence. Do you know how do you or do you know how to apply that? Is that evidence good or bad? Right? Is that are those case studies? Are these clinical practice guidelines? Are these just a single randomized controlled trial? is a systematic review with meta analyses? And then is there is there maybe some qualitative stuff there, but like, how do people feel that are being treated with cancer? How is how meaningful or important are these massage requirements for them? Like there’s a lot of different types of evidence that we could use?

Jamie Johnston 34:33
And are we applying it individually to each person who comes in because that’s going to change with each person?

Eric Purves 34:39
Exactly. So that always you know, this kind of this kind of stuff. I love it. I think it’s great. But my skeptical nature of where I’m, you know, I kind of don’t really believe in anything. Now, let’s Nilus nihilist nihilist nihilist doing bit of a nihilist sometimes is I think okay, this is great, but Is this information going to be? Is this going to be applied in it to courses or to workshops or to conferences? I don’t know.

Jamie Johnston 35:11
Or even it, even if it’s not a course workshop or conference, let’s just say it’s a therapist who has that interest and has maybe taken some and now is going, Okay, well, now I’m going to look at a bunch of the research on my own. Yeah. Are they going to apply it the same way? Right. Right. Maybe it’s not even from the course. Because Because part of this is, hey, you should be able to sit down and read a research paper and put in that, yes, I’ve done this. Are they going to? Is that individual going to look and go? Okay, how do I apply this to Bob, that comes in compared to Mary that comes in who are both dealing with cancer? Right? Right. different cancers, different expectations, different things all around that, right? So it can come down to that individual basis as well, just not the court, not just the cost basis. And that

Eric Purves 35:59
goes back to function, a patient centered manner, which was like the, one of the earlier earlier points, right. And that’s, and this is this thing is it’s interesting. So we talked about evidence informed evidence based stuff, and they say here, they say they say, including research and credible publishing information. Now, this is the problem. Right, as a profession. I was told recently that a lot that some of the schools have actually got rid of the research section of the court. Oh, I got the program. Like there’s no more research and statistics section. Wow. Because it’s time instructors. You can you don’t need to learn that stuff to pass your board exams.

Jamie Johnston 36:39
Well, then, how do you write your, your your, what did they call it? Not a case study

Eric Purves 36:45
here? You basically do a case study presentation. Yeah.

Jamie Johnston 36:49
How do you rate your case study if you don’t know how to look at research?

Eric Purves 36:52
And this is just totally anecdotal. This is what I heard was they just teach basics of that, in that when they doing that portion of the program? Yeah. I know. But But I think it’s the so if you’re not teaching, and this goes back to to, I mean, it goes back to what I did in my, in my graduate studies, was that when you’re not teaching people the basics of of science literacy, of research, interpretation and applications. Yeah, you’re not. And you don’t teach people about the Knowledge Translation From Research to Practice. Like when those basic fundamentals aren’t taught, they are never learned. Yeah. So there are colleges saying we need to be evidence informed. And our approach, we need to include research and credible publishing information. But when that information isn’t presented to people are taught to people in schools, they come up, how are they supposed to learn it? Are they gonna go take a course that teaches them how to read and interpret and understand the scientific paper? Not many. So when it feels to me when I read that, when I hear this, and I read this, I think, yes, this is great, we should be using an evidence for approach in our work. But what how do we know what’s evidence for evidence based, if we’re not taught, you don’t know what you don’t know, you don’t know what you don’t know. And you can obviously you can version A lot of us to learn it on our own. But that’s, that’s a self self regulating, self regulated thing. So I would almost like to see a 16th point was, which was like, learn how to do or how to understand research.

Jamie Johnston 38:24
But see that therein lies the problem, because like, just to expand on what you’re talking about, not only will people likely not come out and want to take the course, they won’t know that they should take the course, because they’ve never been taught it. And it goes back to I don’t know if we were talking about it on a podcast or where I was talking about it recently. But we’re, we’re primed from college, to believe that we should constantly take technique horses, because we’ve learned more technique courses in school than we do about therapeutic exercise or research or any of those things. So now, if the research component isn’t even there, but you’ve been taught five technique courses, you’re going to come out thinking the best thing I can do to help people is take more technique courses, right? Because that’s what’s been ingrained in you in school. So not only will people come out and possibly not want to, but they won’t think that they need to, because there’s never been any seed of importance placed on that. Yeah, that’s sad. Yeah, yeah. Because I remember when I did my case study, I got ripped apart. Because the research I used was terrible. Yeah. Which is good, because that showed me, Hey, you did a shit job on the research end of this, so you need to improve on that. Yeah. But now, how, how could they grade somebody on that if they’re not even teaching a research course?

Eric Purves 39:53
There’s big holes in all of this. Yeah, but the idea is good. So hopefully there will be a little more. Maybe we can do it. Hopefully there’ll be some more updates on information. Maybe we can do like a follow up podcast on it. Yeah, maybe they explain a bit more detail. Right? Yeah. Because it also so so if the next point, which I thought was, which was great, which is really relevant to all of this, which is practicing the self reflective manner, you regularly take time to consciously think about your practice, and to analyze your decisions and their impact, you obtain feedback from others, and you draw an external on external information to continuously improve your professional capacity and performance. This is very closely related to evidence informed evidence based practice, which is great to analyze your decisions and their impact. And it’s funny, like self reflection is something that they do not teach routinely in massage schools, at least far the conversations I’ve had with educators and schools and new grads, but it’s something that you see in all higher level university education. Okay, graduate studies, you know, masters, PhD studies, is that self reflective, so basically, how do you know what you know? And, and why do you do what you do? And why do you think the way you think, and why did you make that decision? Why did you say this thing? And really, it allows you to focus, you just stop and think about, and like your decision making? And, and when you stop and think about it sometimes. Like why I did this thing? I said this thing? Because I read it somewhere, and I thought it sounded relevant for this person. Maybe that’s why, or maybe it’s because you read a paper on it. Or maybe it’s because you’re like, I have no idea. This just felt like the right thing. But I think it’s really important for us to, to develop our Alexander professional capacity and performance by stopping and thinking and reflecting on our knowledge and why it is we make the decisions we do. Cool. I really liked that. Like that. One for me is one of my favorites from this and something that I would love it. This is me throwing this out there to the universe. I would love it if there was if that was something that they started teaching self reflection in massage school, I think it would drive students crazy, because they probably have no idea what you’re talking about how important it is. But I think it would be really, really important. I know I did it when we did in my graduate studies, like almost everything we did was we had to do these like self reflective journaling and stuff, which was super annoying at the time. But then once you kind of get into it, you’re you realize how important it is? Because you’re like, oh, that’s why I think that’s why I said this thing,

Jamie Johnston 42:38
but just started journaling this week.

Eric Purves 42:39
Oh, it’s really important. I feel it’s really important. And I know I’m not the only one because it seems to be a common theme. And

Jamie Johnston 42:50
but I think and this might be a really good way to wrap this podcast up. But if we look at the unless there was other points you wanted to make? No, this is this. This is this has been a good one. I think I think if we look at the end of that practice, in a self reflecting matter, what it says is you draw on external information to continually improve your professional capacity and performance. So that in itself, is shows us that it’s your responsibility to continually improve, not to look at this and go, Oh, we don’t have to take CSCs anymore. This is the onus is on you to continually improve and be a professional. Because when we look at the other healthcare professionals, especially if we look at doctors, nurses, OTs, physios, Cairo’s, like all these other ones, all of them, they may have the same idea where it’s a self paced thing. But they are required to take continuing education and our college is putting the responsibility on us to be a professional and to perform in a professional capacity by continuing to upgrade our knowledge and information that we use in our practice.

Eric Purves 44:02
Yeah, it’s very, it’s very, it’s very important. And I think if we want to maintain our credibility if we want to realize our true potential, and we follow these career span competencies, and individual arm T’s take it upon themselves to really take charge of what they learn and how they progresses as a profession. I think this is a very is a positive direction forward. And I think we said we start off the podcast with is from a business perspective, having the minimum C C’s was great. But as a profession, we do know that that doesn’t really help people. Yeah. Because people will just take stuff just for the sake of taking stuff. Whereas this is something that’s a little more probably be more time consuming. If you do it properly, because you have to create a plan and you have to engage and you have to reflect and you have to do all right All these things, too. And then you have to show how you have met these goals that you’ve chosen for yourself. And maybe that’s courses made it’s workshops, and it’s conferences, maybe that’s whatever, whatever. Yeah, I think it could be better. And I’m going to maintain a healthy level of optimism. But there’s going to be a definitely have a little a little bit of skepticism in there as well.

Jamie Johnston 45:23
Absolutely. And really, we should have skepticism with with everything that we do. So there’s nothing wrong with having that healthy level of skepticism. So I think until next time, thanks for listening, and we’ll see you on the next podcast. Thank you. We hope you enjoyed this podcast. These kinds of topics are what we are all about. If you’d like to learn more, go to our websites, themtdc.com or Ericpurvrs.com. If you know of any other therapists that could benefit from this, please tell them to subscribe

 

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Podcast Episode #23 Challenge Your Bias, But Still Remain Patient Centred

Jamie Johnston 0:12

You’re listening to the massage therapist Development Initiative. I’m Jamie Johnston. And I’m Eric Purves. This is a podcast by massage therapists for massage therapists. Our objective is to simplify how to be a more evidence informed practitioner, let’s dig into this episode.

Jamie Johnston 0:33

There are times when your beliefs get challenged. And there are times that you have to change the way that you do things.

I’ve been seeing, we’ve been seeing lots online lately, with people that are going back and forth between what the Noy group is saying and what other research papers are saying. And so we decided we would dig into some of this because as science should, we should always challenge our bias.

Eric Purves 1:37
Yes, and I agree that this, you know, I’ve been reading some of these guys, papers, and I’ve been reading some of their blogs for a while now, just because it provides a different thing than the normal echo chambers that we get stuck in. But it seems to me that

Jamie Johnston 1:00
So with that, we will look into a couple of papers that are both from Quintner and Wiseman. One called pain medicine and its models hindering or helping. And then the other one sort of just bringing the title up is pain is not a thing and how that error affects language and logic and pain medicine. So jumping into it, sorry, I’m going back and forth between notes here. I think the the biggest thing that I take from this is words matter, which we believe in anyway.

Eric Purves 1:57
like, it took me a while to really understand what the heck they were talking about. Because it just seemed that they were just kind of basically critiquing everything that was quite common language are quite common beliefs or ideas or ways of practicing in pain care. And so I was like, Well, what do you got? What do you guys saying? And I think it really a lot of it comes down to is the words that yeah, the words that are being used and how things are being described, as well as it seems to be that the things that they that this group in these researchers are arguing against, is I think they’re arguing against how often, like kind of biopsychosocial models are used in practice. But not I don’t see it necessarily as a problem in the I don’t know, they use I prefer framework, they don’t really they’re not really as it’s I don’t think it’s a problem with the framework itself, as much as it is how it’s often communicated to people in pain in practice. That’s so that’s where I see the splitting hairs kind of thing.

Jamie Johnston 3:04
Wandering through, because I looked at as I was reading through it, I was kind of there was some of the challenges that they were making, which is great, because we should challenge things. But I was reading it and going well who’s saying that? Because some of the things didn’t. I’m like, those aren’t the things that I would say to a patient or those that’s not the way that I look at it. So that part of me was wondering like Who exactly are you challenging? Because there’s, there’s some of the things for sure that that are, for lack of a better term splitting hairs. But I, but I’m not sure who it is that’s communicating to patients in the way that they mentioned in some of these things,

Eric Purves 3:48
right. And the thing that I the takeaways I got from reading not just these papers, but some of the other stuff from them, a colleague Monica sent me probably a couple of dozen papers that they had sent her and then she forward them to me and I’ve read not all of them, but I’ve read through most majority of them. And I mean no I grew up and kind of mostly in that group who uses a specific language to communicate the complexity of pain, like they talked about pain being this protective response and pain can be a learned. thing, you know, and and I see the argument from this, this group hear about how that can be problematic. But what I do see from what noi has done, and mostly in their research is they seem to have taken this really complex neurophysiology and this human experience of pain, and they’ve tried to make it something more simplistic for clinicians to think or reason or use in practice. And so it’s shifted that movement away from this pathway, anatomical tissues structural problem explanation more towards a, your system, systemic sensitivity. You know, when there’s like brain and peripheral and spinal cord stuff happening, that’s like the one thing, right? And then they try and put it in a way that’s teachable and use can be used in practice. And I think there is probably some oversimplifications of the words that they use. And I, but I like what you say like I agree with what you say their jammies, I think the, it seems that your average clinician out there, if they are saying those words to people, that can be a problem. Oh, you’ve just learned your pain, oh, you’re just stressed out, you start blaming the psychosocial things, and just trying to discount completely the bio. So I know these guys are talking about the nociceptive apparatus and the nociceptive system, you know, and there’s always going to be an activation of that and every pain experience. And I don’t think that anybody is necessarily really arguing too hard against that. It’s pretty much like they’re saying like, yeah, there’s some type of activation in your system. That’s, and then and then you have a conscious awareness of that. And there’s other psychosocial stress, other things going on around you, which can influence that. Okay, I get that. But when we talked, when, when you’re talking to patients, clients, whatever, like, are you? Like, are you trying to explain away their pain? Because I don’t think that is what people are really doing anymore? And if they are, then I think it’s a misinterpretation of like, analyze teachings. Yeah.

Jamie Johnston 6:37
And I think like, just when you touched on it there, like, that’s one thing that I switched. The way that I explained it years ago, is that, you know, the psychosocial things can influence your pain, it’s not a causative thing. And I know in the one paper they talked about, like the mind body connection, and, and that they’re like, well, that, that my understanding of how I read it anyways, is that it’s it’s not what, what we should be saying to patients, but yeah, they’re also saying the biomedical model doesn’t work either. Yeah. So I get that. I mean, in the, in the one paper, they, you know, you go through and they make some good points, like, you know, they go well, I, when I look at what they’re saying, for words matter, like one of the statements was, when core concepts employed within a field are open, there’s potential for inaccurate or misleading uses of terms, which then can be amplified with the patient. And that talks about like pain, and it saying a stimulus in and of itself is not painful. By contrast, it’s the experience labeled pain that is painful. Yeah. Right. So it’s what the person’s going through is painful. Yeah, it’s not necessarily the stimulus. And then they break it down further with different objections and saying, you know, that it’s a noxious stimuli that causes the pain, that it’s a stimulus that as damaging, or threatens to damage normal tissues, which is the definition of a noxious stimuli that is capable act of activating merseysiders. Yeah, I don’t, I don’t think anyone that Noi group or or others are saying that that’s not true.

Eric Purves 8:15
Yeah, and this is where this is where it gets confusing, right? So what’s, what’s the argument? Their argument is, I think more about the well, they talk about the reification of pain. So pain being a thing. That’s that’s this, you know, this one papers called pain is not a thing, how that error affects language and logic and pain medicine. Well, pain isn’t a thing. I mean, pain is an experience of pain isn’t a tangible thing you can grab your hands on. But I failed to understand and maybe I just need to think about this, reflect on this a bit more, maybe I did just spend more time with this. But we use the term pain, because that’s an experience that people are aware, like, we all know, what pain is a pain for each of us is different. Yeah. And is anyone saying that? It’s not like, you know, and, and there is, there is lots of studies that show that, you know, there’s certain areas of the brain that are activated when someone’s experiencing pain. And then there’s lots of studies that I’ve seen that looked at like the transition from these kind of sensory nociceptive, dominant areas of the brain, and acute and then as things transition to a more persistent, there’s changes, those sensory areas go away, and there’s now activation in the limbic system and other areas of the brain, you know, and these i, and then, what I get from this group here is that they’re saying, Well, you know, you’re, you’re saying that people are thinking differently about their plant or pain or the pain is an output of the brain, you know, and that and they’re saying that that’s not true. And you think, Well, it’s, I get that argument, okay. It’s might not be true, but we do know that there is. If pain is a lived experience of somebody, then there’s going to be something happening in the brain and in the mind of that person. That could be sensitizing the overall system. Whether that’s a peripheral nociceptive or a central or cortical All thing that’s stimulating nociceptive activity? Does it? I don’t know, does it change? How we think does change how we communicate? Is it changing anything that is it something new. And I don’t think that it really is changing anything too much. Because a lot of the stuff that the kind of the last decade of pain information, there might be a little bit too much brain focus. But no one is saying that pain is not a lived experience of the person. I’ve never heard anybody be like, I’ve never I’ve never encountered anything like, Oh, you’re you’re just thinking your pain, you’re making your pain up, or your pain is an output of your brain. Yeah,

Jamie Johnston 10:38
and I know that. We’ve talked about it before where, you know, I’ve been communicating with a with a person, and probably use the long the wrong language where they went. So you’re saying it’s all in my head? And had to backpedal and go? No, no, no, no, no. So you know, if they’re making some very valid points, that the way we communicate with patients is very important. Because we don’t want people believing that it’s all in their head, but the brain is still going to be involved in whatever that pain experience is that the person is going through. And, you know, going through just looking at some of the stuff, they make the argument of the use of the suffix susceptive. They’re saying that that’s the property of a receptor, but it’s often tied to a stimulus. And this leads to an argument that the nociceptive stimulus is one that activates those receptors. But that’s what a noxious stimuli does. But that’s not a language that I would ever use with a patient. No. So I mean, important for us to have that knowledge. And I think one of the big things that they’re saying is, when we’re looking at research papers, this is the language that should be used. Yes. And I can’t disagree with him in that regard. But again, it’s not it’s not ever a way that I would communicate with a patient.

Eric Purves 11:55
Yeah. Well, and this is goes to a lot of the stuff that we have in research and in our, in our world of pain, and rehab, and movement and all that stuff, is that there’s really cool information. Yeah, but how much of it is really clinically relevant? You know, so based on, you know, like, this is some of the some of the stuff we talk about in our courses, and we teach and, you know, we communicate with others about it. But in terms of like, how relevant is that to us clinically? Is this providing new? Not really, I mean, I would say maybe I’m, I am maybe a little bit more aware of being less brain centric, but still, you’re still like neuro immune centric with this information, because that information coming from the nociceptive activity is being received within the system. And then that is that awareness of that. And meaning of that is, comes from the person and their experience. So I, it’s good, I think it’s good to get out of the echo chamber and think it’s good to challenge stuff, but it’s just I still don’t see it hasn’t changed, how I would do a lot. But I want it to like, I would love to read this and be like, I’m open book, what do I do differently? What do I do better? What do I get throw away? What do I adapt? Very slight, very slight.

Jamie Johnston 13:13
And, you know, as we look through like, does it just because I made a whole bunch of notes on this, when they’re talking about like pain sensitivity, insensitivity hypersensitivity and pain threshold, things like that, because you know, we we’ve all had those, those people on the table, that I’ve got a high pain threshold, you can dig your elbow into me, and I like that. So one of the points that they they made is, is the threshold, the quality of the stimulus or the quality of the response. So if the person has a low threshold, which means the person’s which actually means a person’s ability to tolerate the experience, they’re saying we should use descriptions like pain inducing stimulus and intensity, with more specific terms that refer to the type of stimulus which would be like mechanical, thermal, thermal or chemical. But again, that’s that probably has less to do with us digging our elbow into them more to do with how they’re experiencing pain in the outside world. And what what things are inducing pain for them or creating pain for them? Yeah, yeah.

Eric Purves 14:12
And this goes, this goes back to what we talked about all the time, is in is, there’s not a right or wrong, like a person has a high or low or insensitive to touch. What’s the right touch for that person as us as massage or manual therapists? Well, the one and the person likes the one that they can tolerate. So it doesn’t matter what their level of sensitivity is, or is it maybe just it like it just as a clinician, if you understand that there’s these different sensitivities and everyone’s going to respond differently and there’s a world around this person, there’s a person who’s experienced that might be sensitizing their system. Then all we need to really understand from this is that you always are adapting your your touch or your treatments or your you know, interventions and strategies to what fits best for that person. That day, just to help the person have a better lived experience.

Jamie Johnston 15:04
And then always, yeah, like you said, that comes back to their experience. So whether the painful experience that they’re having when they’re not with you, that’s their experience and the experience they’re having while they’re on the table with you, is their experience. So that’s where that communication aspect comes in. Of does this feel good to you? Is this a good experience for you? Those kinds of things when we’re doing manual therapy with somebody always comes back to that patient centered care. Yeah, what experience is important for them? What is it valued? experience to them was a meaningful experience for that person on the table? Yeah. Easy. It’s interesting, though, because some of the things that we’ve talked about so many times like pain catastrophizing, they they make the point that is catastrophizing, a part of the pain experience or a reflection upon the experience. And is this purpose to serve the experiencer or the observer? So if we’re talking if we think as the observer that somebody is catastrophizing? Is that more important to us? Or is it more important to the person? Person? Yeah, yeah. But it’s something that we should try to take into account. But it doesn’t also doesn’t necessarily mean we’re going to look at them and be like you’re catastrophizing right now. No, right. Yeah.

Eric Purves 16:27
And that’s a really, I mean, yeah, that’s a really important distinction, because we like that kind of moves. Like we want to move away from that operator. perspective, or we’re putting our judgment or beliefs onto the person, which would be so if we said, oh, you’re catastrophizing, that’s us putting judgment onto onto the person. It can provide us insight into thinking well, yeah. So say you’re doing the pain catastrophizing scale, and it says they have a high score on that. What it’s how is that going to that is actually can be useful information for us, because it lets us know, as a clinician, this person is suffering from their pain, and how they how they feel about how they’re experiencing their pain. But it doesn’t tell us what their level of pain is. It just tells us how it’s impacting them. So I don’t again, I don’t see how that really, you know, unless you told somebody you’re catastrophizing. Yeah. Which you wouldn’t that which

Jamie Johnston 17:39
could have a massive impact on somebody? Yeah.

Eric Purves 17:41
Then it’s just we have to be mindful of using our words, for sure. Yeah.

Jamie Johnston 17:45
Yeah. Yeah. Which leads us into also, the comments that they make on kinesio phobia or fear avoidance, they make the kind of make the same point that is that a judgement of the observer or judgment of the person who’s experiencing it. Just reading here for it says it doesn’t deny the importance in challenging challenge of interpreting the behavior of a person experiencing pain. So they suggest that we explore the person’s cognitive appraisal of their own predicament in their words. So listen to them, and whatever they tell you is what they’re going through. Yes, so comes back to that patient center character.

Eric Purves 18:25
Yeah. And that’s what we’ve I mean, that we’ve learned that before from you know, having interviews with people like like Keith Meldrum, who it’s, you know, talking about the, you know, the lived experience, the dog was every year at San Diego Pain Center, they always have the pet or the almost not always, but many years, they have that panel of people their lived experience. And that’s always emphasized as being the most important thing, like you can know all your stuff about pain, you can know all your treatments and all the things to say and do and not do. But what what matters most is really trying to be in that safe space for that person for their lived experience, and not taking that away from them or not trying to replace that with your own views.

Jamie Johnston 19:09
Yeah. And so I like how they put some of those things in there that you know, is it the role of the observer, or the role of the person who’s going through it? And there’s definitely going to be some instances where it’s our responsibility as the observer to recognize that something might be going on. But it also doesn’t mean that we have to communicate that specifically to the person in front of us.

Eric Purves 19:33
Not unless we get their permission now, unless they want to know, which is person centered again. Yeah.

Jamie Johnston 19:40
So it’s, I know this very interesting because I’ve seen this big, these big debates and arguments online. And the Yeah, I mean, the the people make some great points in these papers, but I think in the long run, we’re all saying the same thing.

Eric Purves 19:58
Yeah, and It is, you know, I know in this this this pain medicine and it’s models paper, which is a bit old now I think it’s 2010 or eight or something, it’s a while ago, it’s really an argument against the linear process of bio cycle socialism. Right and that is true that you know, in the bio psychosocial when you first encountered as a clinician, you’re often looking to be like, is this bio is a psycho is a social and you’re looking to explain pain via one of those domains. And it becomes and so they’re like, oh, no, the bio psychosocial is more inclusive, whereas traditional biomedical if the Descartes Cartesian model was very linear, so that whole was explained. And Biomedicine is very linear. But biopsychosocial is just as linear. You’re just looking to find something new to caught to blame. And I’m thinking, well, maybe it may be that some people are applying it. But that’s not how I don’t think how it’s supposed to be implied. I’ve never understood it to be applied that way. It’s more like holistic, like whole with a W like looking at the overall person, their experience, and how is the world and the person how is everything around this person is shaping their experience? That’s how I see biopsychosocial. I don’t see it as this linear process, but maybe how it’s taught or maybe how the people understand it is different. And maybe, you know, if I think back to my early days, maybe I thought it was different, too. But I know you can. It’s hard to remember we used to think not yesterday. Yeah, where am I?

Jamie Johnston 21:28
Yeah. However, and we can, I think we can go off on a little bit of a discussion about this, as well as at the end of one of the papers I there’s a statement that they made that I absolutely loved. Because I think it’s applicable to so many more things in our profession than just this one topic. They said one of the more powerful therapeutic tools available to the clinical pain practitioner, irrespective of their background discipline, is to present a clear and honest explanation that is as close to accurate as possible in the current state of knowledge. Yeah, I think that is beautiful. And I think that we, we have to take that and almost apply it for lack of a better term globally to what we do. And for those that are that are out there saying, I don’t need to look at research because I know what I do works. Ones that are still using old narratives of how their technique works. This right there, it if that doesn’t tell you that you need to change. I don’t know what else could because we have a responsibility as healthcare practitioners, to give as honest an explanation of what’s going on with the person in front of us as we can with the most updated current state of knowledge.

Eric Purves 22:47
100% And we have an ethical obligation to do that as healthcare providers, right, we should have, you know, as you learn new information, even if you look at our, like our competency documents and stuff that they have here in BC, the you’re supposed to use research and incorporate into your practice regularly. And as as you learn, you’re supposed to be able to adapt your knowledge based on your current on, on adapt your practice based on your current knowledge. And the and as we learn more if we learn stuff that contradicts or challenges what we used to know or what we used to do, then we have to, we have to change, you have an ethical obligation to change and people come to seek our care deserve that.

Jamie Johnston 23:30
And which is the exact reason why we wanted to discuss these two papers. Yeah, is in the hopes that it will either challenge or make us change. And it probably has to a degree but probably not to the degree that I thought it was going to.

Eric Purves 23:46
Yeah, and I think so too. I agree with that as well. I was trying to really my reading through these things before really trying to really trying to challenge my bias. And but as I read through this, I’m thinking No, that’s kind of what I already that’s kind of what we already say and what we already do. And and it’s good to question the stuff obviously, like we said before, it’s good to not just sit in an echo chamber but the one issue I have with these guys writings is that they don’t really they don’t really give you any further information about like here’s things moving forward. You’re fine you can fix that. Yeah, it’s very philosophical and very like well this other way is not right. But I would like to see them come up with like an idea or like a like a Knowledge Translation plan or something moving forward that says this is how this information could change your practice or could could be applied to your practice. I would love to see that because when you when it’s just challenging and saying like, this is this is wrong bla bla bla but without a que What do you replace it with? Then then it becomes harder to to incorporate into your to your practice. I think the message is gonna get lost. I think that’s why In like the, you know, RC world that we live in, is that when you’re teaching stuff, you have to find something else to replace it with. And I know, early in my career trying to just give people information hoping they would change. They don’t change, you just try and give them some information and be like, and this is how we try and use this in practice. This is how it shapes what we say and what we do and how we think. But with the absence of like, what do we do with this information? I think he gets lost in a lot of people. I think that’s probably part of the problem, at least from my anecdotal observations of this, how this stuff works in social media, when people are arguing about it. It’s like, Yes, so what do you tell me then?

Jamie Johnston 25:41
Yeah, yeah, I agree. But I would say one thing, looking at it is my impression was that they were saying this is how, like, these are the terms that should be used in research, these are the team terms that should be used in papers. So perhaps, if, if that’s the approach is if they’re saying, well, from now on, when a research paper is done, this is the term that should be used, then gradually that would start to change, perhaps how we’re communicating with a with a patient or with the person in front of us. Yeah. But that was that was just my impression of what they were trying to say.

Eric Purves 26:15
Yeah, and that’s, and that’s, I think that’s a really valid point. Because we, I think one of our first podcast we did was about like, words, the power of beliefs and stuff. So yeah, if there’s better ways of kind of communicating the similar ideas or similar or same things, then, of course, let’s change it now become the new normal.

Jamie Johnston 26:32
Yeah. Yeah. But I, but I still don’t think it would change how I communicate with the person in front of me, because I would never look at a person and use words like noxious stimuli. And, and those kinds of things. No, unless, like you said before, unless they asked and wanted to get really educated on this stuff. You know, but I see the value of using it properly and research.

Eric Purves 26:57
Yeah. Yeah. And maybe that’s maybe that’s where this stuff will be beneficial. Moving forward, is maybe there will be some changes in how the researchers are doing the things. Yeah. Rather than clinicians and I mean, we look at all this stuff through a clinicians lens, not through a researcher lens. Yeah, I mean, these guys are, you know, Quiner and Cohen are retired. And Assaf is I think he works at a university in Israel. So yeah, yeah. Israel, I

Jamie Johnston 27:26
think witness Australia.

Eric Purves 27:28
Yes. I think Cohen is too. But anyway, yeah. So there’s, but it’s interesting, because I would like we get so caught up in the details about things like these like minutiae of the neurophysiology and the language and stuff. But I would, I can be very bold. I’m gonna say if you took this information to a psychologist who treats people in pain, terms like, yeah, who cares? It’s always with the lived experience. It doesn’t matter what this other stuff.

Jamie Johnston 27:58
Yeah, if you were talking to like a millennial, well, yeah, you would probably look at this and like, okay,

Eric Purves 28:04
yeah, they’re like you, they’re gonna say, Well, why are people arguing with this? Like, doesn’t matter, like, what matters most is the person is experienced? And how can we help shape that experience? And through their, obviously through the psychological interventions or ways? You know, this? So I think this, this stuff here is very, very, there’s a lot of people out there that treat people that help people hurt. Yep. This information, I would say would be specific to maybe more physiotherapy or medicine. But I would say, I would say a lot of these guys criticism, a lot of it comes towards the physiotherapy professions, because that is going to allow us directed towards NY and mostly is stuff and Butler stuff. So psychologists and other people are, who cares?

Jamie Johnston 28:51
What we do, because then that’s why we looked at the papers. Yeah, exactly.

Eric Purves 28:54
I think I mean, I think it’s interesting. It’s,

Jamie Johnston 28:57
yeah, so I think the I think we can look at the overall message of this specific podcast is that we can come to agreement that it’s the person’s experience, that’s going to be the most important thing for us to take into account. And just communicate well with your patients. And there are certain times where we need to be the observer and just listen to what it is they’re saying to us. Yeah. Which is

Eric Purves 29:22
good quality. person-centred Care. Yeah. And we don’t need to impart our beliefs on to people without their permission or without their wanting to.

Jamie Johnston 29:33
Unless, unless they ask, unless they ask. Yeah, and, you know, and, of course, the other thing is to always be open to challenging your bias and looking at new things and, and seeing how you can improve as therapists. Brilliant, perfect. That one actually went a lot quicker than I thought it was going to. Because it took me a long time to go through those papers. But yeah, I think that’s a that’s a good way to wrap it up and thanks for listening, everybody. We’ll see you next time. We hope you enjoyed this podcast. These kinds of topics are what we’re all about. If you’d like to learn more, go to our websites,

Eric Purves 30:12
themtdc.com or Ericpurves.com. If you know of any other therapists that could benefit from this, please tell them to subscribe.

 

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