…science is more than a body of knowledge, it’s a way of thinking.
If we are not able to ask sceptical questions, to interrogate those who tell us that something is true, to be sceptical of those in authority then we are up for grabs for the next charlatan, political or religious, who comes ambling along.“
As therapists, if we do not adopt the Clinical Scientist way of thinking, with it’s inherent scepticism, are we at risk of being up for grabs by the next therapy charlatan?
Are we not referring to clinical reasoning here? The corner stone of any interaction with the patient! This clinical reasoning has to include the solid scientific act of ongoing attempts to prove oneself “Wrong”. Only when we fail are we reasonably certain that we might be right, in the company of current knowledge. Hence the necessity to attempt to stay abreast of present day thinking……for that let’s be thankful to NOI and this site…..
I’m not sure that clinical reasoning goes deep enough – based on what I was taught and what I have observed. The core stabiliser, the dry needler, the McKenzie practitioner, the joint mobiliser/manipulator will all argue they have a robust clinical reasoning system behind their approach, but how many will stop and question the “science” (dogma?) that underlies their reasoning in the clinic? I know from my own experience that the cognitive dissonance that can occur when trying to prove oneself wrong is unpleasant at best, painful at worst!
To paraphrase, when the only thing you have is a pilates reformer/needle/3 diagnostic boxes/thumbs then everything looks like a(n) instability/trigger point/dysfunction-derangement/stiff joint…
Against this, I’ve heard many a therapist argue that they have “many tools in their tool box” (if the needles fail then I’ll give them some Pilates)- as if clinical reasoning is no more than selecting the right size spanner, rather than a deep questioning and interrogation of the gurus, their theories and their methods.
In many ways I fear that the Sagan’s warning is too late for a lot of physiotherapy/ists – charlatan might be too strong a word (or not, in some instances) but in my more pessimistic moments it seems that many physiotherapist have been and continue to be up for grabs by the next “in” thing in therapy.
Of course there are many positives too, and perhaps ironically it is through current technological advances (blogs, Twitter, Face Book, “connectedness”) that change is being driven.
For me, Clinical reasoning is all we have to offer….. It is the Context…..the Content varies from practitioner to practitioner. Sadly only the practitioner can take on the responsibility to “Widen his or her Horizons” and step out of their comfort zone ….if we are not prepared to get better at answering the three basic questions of:-
What is wrong here, what has to change and how do we bring about that change about, then we shouldn’t be in the business of caring. Sadly many practitioners skip the first two questions and default to their favorite techniques …….