The Words Matter Podcast with Oliver Thomson

Welcome to another episode of The Words Matters Podcast.

Many of you may be familiar with a recent paper I was proud to co-author titled: Avoiding nocebo and other undesirable effects in chiropractic, osteopathy and physiotherapy: An invitation to reflect – Journal of MSK Science and Practice.

We are very keen to engage the readership in this topic and are inviting readers and listeners of the podcast to critically reflect on the paper and submit questions and comments for a future podcast discussion. Your comments, questions can be submitted via the link here. 

On this Ask Me Anything I give my thoughts on the following questions:

• How to teach BPS model & clinical reasoning in academic settings?
• Should MSK practitioners do a degree in psychology?  
• How do you organise your evaluation & treatment within/between sessions?
• What do you wish knew when you started/you best advice to students?
• What are the best and worst papers you've read? (spoiler here and here are two of my favourites)
• Do you crack people’s necks? 
• How do you balance views as a constructionist/relativist stance with objectively implausible claims?
• What are your thoughts on reassurance and the recent discussion on Twitter? (here) 

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Welcome to another episode of The Words Matter Podcast.

Apologies for the slight delay in the episode, work and life events continue to get in the way of my passion for producing these conversations.

So it’s time for another Outsider episode (see prior Outsider episodes here, here, here and here), where I talk with clinicians that feel divorced from their profession and don’t identify with their professional label and the professionally assumed meaning of that label.

And on this episode I’m speaking with Eliud Sierra. Eliud is an evidence-based chiropractor who specialises in physical rehabilitation and chronic pain management through strength and conditioning focused treatments. Many of you may be familiar with him via Instagram, with his handle The_Rehab_Chiro – which amongst sharing evidence informed messaging also provides his critical and often humorous thoughts on chiropractic.

Eliud works in the U.S. within in a private clinic located in the city of Chicago . As an undergraduate student, Eliud attended the University of Iowa where we worked in the physical therapy department of the medical college, aiding in research regarding spinal cord injury patients.

After the University of Iowa, Eliud went on to attend Palmer College of Chiropractic where he got his doctor of chiropractic degree and founded the school’s first evidence-based club. In his professional career, Eliud has worked with a wide array of individuals ranging from elite athletes to post-surgical patients. 

So it was great to speak with Eliud, as you will hear we share a common experience of leaving via choice or through force a Facebook group of our respective professions and it fun to exchange the reasons and context around that.

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Welcome to another episode of The Words Matter Podcast.

I hope you’ve enjoyed the last couple of episodes exploring pseudoscientific claims and how to think about, and respond to them (here and here). And to give us all a break from the frustration, today I’m speaking with Dr Rebecca Olson about the role and value of sociology for practice.

Rebecca is an Associate Professor of Sociology, and Program Director of the Bachelor of Social Science at the University of Queensland. She’s Director of SocioHealthLab: a research collective that pursues social transformation in health and healthcare through theory- and justice-led applied socio-cultural research.

As a translational qualitative researcher, Rebecca  collaborates with health professionals, health professional educators and emotions scholars, bringing sociological insight to addressing complex healthcare challenges.

And Rebecca follows in the growing line of guests based at UQ including Karime Mescouto (Episode 39: Where’s does the power lie? A critical look at the biopsychosocial model), Jenny Setchell (Episode 50: The Qualitative Research Series - What’s left in the ruins? Post qualitative research) and more recently Nathalia Costa (Episode 68: The Clinical Reasoning Series – Navigating uncertainty).

So on this episode we speak about:

• The distinction between sociology and social science, and where sociology sits in the landscape of intellectual enquiry.
• Rebecca introduces sociology as a research field and how she (and others) have engaged with it in relation to healthcare.
• We talk about medical sociology and the development of related methodologies such as grounded theory (see here and here) and ethnographic research (see episode 45 for more ethnography).
• The importance and value of sociological theory for practice – and we talk about how there is nothing like a good theory to offer a rich perspective and multiple lenses on clinical practice.
• And we also talk about what social theories are and where they come from.
• We distinguish between the natural world and the social world.
• We talk about the irony that while social factors and determinants of health seem to be important in understanding and predicting illness and recovery, yet sociological knowledge is does not feature strongly in healthcare education and practice.
• And finally we talk about what can we learn from sociological enquiry and how it can inform practice and policy.

So I really loved this conversation with Rebecca. As clinicians we seem to be very happy and comfortable with the other ‘ologies’ – such as biology, physiology and neurology so I hope that this conversation is a gateway to explore how sociology can support and guide clinical thinking and practice.

Find Rebecca on Twitter @RebeccaEOlson

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If you liked the podcast, you'll love The Words Matter online course and mentoring to develop your clinical expertise  - ideal for all MSK therapists.

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Welcome to another episode of The Words Matter Podcast.

It seems like the last episode with Dave Newell and Jack Chew was necessary; the feedback by and large was supportive, but clearly you cannot please everyone and for some people there is no argument, reason or evidence (let alone a podcast) that will ever initiate a reflection or reconsideration of their position and beliefs. 

So as promised, I’ve continued to explore these issues and today I’m speaking with Dr Carlo Martini about pseudoscience and pseudoscientific claims.

Carlo is an Associate Professor in Philosophy of Science at Vita-Salute San Raffaele University (Milan) and visiting fellow at the Center for Philosophy of Social Science at the University of Helsinki.

He has worked on the interface between science and policy, scientific expertise, and science communication. Carlo leads the work package "Behavioral Tools for Building Trust" in the H2020 Project "Policy, Expertise and Trust"

I spoke with Carlo last year in a two-part episode on expertise and experts; and many of the topics around pseudoscience that we discuss today have overlap with expertise and how we recognize and come to trust an expert – so it would be well worth listening or re-listening to those conversations which are episodes 53 and 54. 

So on this episode we talk about:

• The value-ladeness of the term ‘scientific’ and how the label can add value to a treatment, practice or person.
• We speak about the equalising effect the label ‘pseudoscience’ and how this seeks to remove any underserved benefit or misusing the label of ‘scientific’.
• We speak about the motives, incentives and intentions of those that might make or perpetuate pseudoscientific claims.
• We speak about how some practices and professions seem more susceptible than others to be informed by pseudoscience; but that pseudoscience can be found in across all disciplines from homeopathy, osteopathy, nutrition, medicine and even physics.
• We speak about the importance of peer-review and the openness of scientific community.
• And finally, we speak about the ethics and harms of pseudoscience and pseudoscientific claims.

So this was another great conversation with Carlo; his outsider position affords him a more dispassionate view of healthcare and his philosophical and sociological perspectives on pseudoscience was incredibly insightful.

Find Carlo on Twitter @martinicarlo

Support the podcast and contribute via Patreon here

If you liked the podcast, you'll love The Words Matter online course and mentoring to develop your clinical expertise  - ideal for all MSK therapists.

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Welcome to another episode of The Words Matter Podcast.

So it’s been a pretty action packed few weeks on social media; for those of you that have not been following there was a storm in a pericardial tea cup - for my thoughts on the saga visit my Instagram bio where there's an Instagram live video.

It was a rather unique experience, so the researcher in me wants to describe the situation, understand the antecedent conditions and get some purchase on the underlying beliefs and intentions when colleagues make implausible and sometimes bizarre claims and also reflect on our reaction to them and perhaps how we can engineer a more productive response.

As such, I’m going to follow this trail and in addition to this episode there are episodes planned with Carlo Martini (see our previous episodes on expertise and trust here and here) examining the phenomenon of pseudoscience; and also more Outsider episodes where guests relay their own experiences and outcomes of engaging with colleagues who hold such implausible beliefs and make such poorly evidenced claims which can only seem to map to the most distorted view of a biological reality.

So I’m on a bit of a quest for the next few episodes at least to try understand how to approach (small t) truth claims which are used to describe what seems like an objective biological reality but come from seemingly completely different epistemologies and play by a different set of rules than that of biological reality.

How can we talk with colleagues that seem to hold significant differences in foundational aspects of healthcare and what it is to be a health professional such as the nature of evidence, logic, ethics and intellectually honest argumentation?

Just to declare and reflect on my own position; I am not a walking-talking positivist or strident empiricist; far from it - I most certainly do consider and embrace the plurality of truths which comes from the social construction of knowledge…as it relates to the social world; but for me I cannot see how a sense of relativism can extend to the natural world or the biology reality which brutally confronts us every second of our lives- whether we like it or not; literally with every breath we take and every time our left ventricle contracts.

I may be guilty here of epistemological blurring or straddling different paradigms - but clearly as with many of us, my position is evolving and it’s only through more critical self-reflection and more conversations that I might be able to iron out any wrinkles in my position or even change it completely.

So please subscribe to the podcast and consider supporting the show via Patreon; and as always a big thank you to those of you already doing one or both of those things.

So in this episode I’m speaking with Jack Chew and Prof. Dave Newell. Jack is an MSK Physio and broadcaster from the North of England and was the mind behind the phenomenal Physio Matters Podcast which was a huge inspiration for The Words Matter Podcast. He also leads the incredibly successful pan-professional MSK conference Therapy Live; as well as being  the director of MSK Reform. Jack keeps his hand in clinically at Chews Health HQ in South Manchester. And he’s recently been elected as a council member for the Chartered Society of Physiotherapy.

Dave holds positions of Professor of Integrated Musculoskeletal Healthcare and Director of Research at AECC University College also well Visiting Research Fellow at Faculty of Medicine, University of Southampton. He has spent the last 30 years teaching and generating research in chiropractic institutions internationally, holding the position of Research Director in two other chiropractic programs in the UK and Australia.

Dave has published extensively in areas relevant to musculoskeletal conditions in general and the chiropractic profession in particular. His contemporary areas of research interest lie in contextual factors in the therapeutic encounter, therapeutic alliance and the alignment of chiropractic profession with national health systems. Like Jack, Dave is a podcaster and is one of the hosts of icarechirocast, an international podcast discussion with leaders in the chiropractic profession. 

Dave and I spoke way back in August 2020 on episode 15 where we touched on the dogma and ideology which permeates through corners of our respective professions - so take a listen for further context around the topic. Another relevant episode is my recent talk with the philosophers of science Dr Elena Rocca and Dr Saúl Pérez-González about biological mechanisms and how we can judge the plausibility of such mechanistic claims - this was  episode 69 from March this year

So in this episode we speak about:

• The growing phenomenon of calling out the falsehoods make by professional colleagues on social media. We ask if this is effective and whether there's an obligation to do this and with whom does the obligation lie?
• We talk about what constitutes a nonsense claim and the gradations of bizarreness and implausibility.
• We ask what is the most productive way to respond to such seemingly ludicrous claims?
• We talk about to what extent can healthcare professionals hold and perpetuate such beliefs and the ethics and harms in holding or espousing such implausible beliefs.
• We discuss how some practitioners seem to embody and fall in love their such ideas; and the situation where some clinicians are unable or not prepared to separate their ideas from their professional selves and identity; making it almost impossible to 'play the ball and not the person'.

So this was such an enjoyable conversation; and only time will tell as to whether we achieved our mission of at least beginning to make sense of some of the truths and their plausibility in healthcare – I’m grateful to Jack and Dave for sharing their own valuable insights.

Find Jack @JackAChew and Dave @NewellDave on Twitter 

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Welcome to another episode of The Words Matter Podcast.

Sorry for the slight hiatus; COVID and general life caught up with me – but I’m pleased to be on top of them both and bring you the final episode of the clinical reasoning series.

The series really has been incredible – to have 10 episodes totalling over 10 hours of long-form discussion with guests that have such a depth of expertise and insight into their respective domains of clinical reasoning is just wonderful – I very much hope and think, that this series will form an invaluable resource for clinicians and students just like the CauseHealth and Qualitative research series. So please enjoy and share.

So as promised, in this episode I’m speaking with consultant physiotherapist Matthew Low. Matthew is a good friend and regular guest on the podcast (listen here, here, here and here). His ability reflect and think deeply about the experience of clinical practice and to use evidence and theory to get some sort purchase on a clinical reality is a joy to engage with and listen to. Matt and I meander through some of the implications from the series. Our conversation is wide ranging, and we cover:

• How ‘clinical reasoning’ as a term fails to capture the technicolour and socially interactive process of sense-making.
• We talk about The Cynefin framework as a way of aiding clinical decision-making.
• The challenge and awkwardness of diagnosis construction in MSK practice.
• What it means to embrace uncertainty, and from who’s perspective.
• We speak about ethics-based practice and also the primacy of thinking narratively.

So thanks again to all my guests, listeners and Patreon supporters.

Support the podcast and contribute via Patreon here.

If you liked the podcast, you'll love The Words Matter online course and mentoring to develop your clinical expertise  - ideal for all MSK therapists.

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Welcome to another episode of the Words Matter Podcast.

So we are at the penultimate episode of the clinical reasoning series and I hope you’ve enjoyed it and much as I have. In the final episode I’ll be chatting with Matthew Low where we will be reflecting on the series as a whole and tying up any loose ends in regards to what this all means for clinical practice.

Matt is a good friend of the podcast and he’s been on several times taking about evidence-based practice (listen here), person-centred care (listen here) and causal dispositionalism (listen here and here). He has impressive combination of clinical experience and expertise combined with a vice like grip on theory and evidence for practice. 

And a big thank you to you all for supporting the podcast and series - needless to say, your support makes the show possible. Support the podcast via Patreon here.

I’ve received quite a few questions and comments as a result of the series, so I thought I dedicate some time in responding to some of them in clinical reasoning-themed ask me anything. The questions I’ve received are wide ranging, so I’ve tried to choose a good spread and will seek cover as much ground as time and energy allow. So in this episode I cover:

• How my view of clinical reasoning has shifted.
• My research on clinical reasoning in osteopathy (see here).
• Our assumptions when seeking to understand why a person is suffering and how we might help them.
• Whether I think that the different musculoskeletal professions such as physiotherapy, osteopathy, and chiropractic clinically reason differently. 
• How theory can shroud and inform the focus of our cognitive processes involved in clinical reasoning.
• The nature of expertise in relation to clinical reasoning.
• My suggestions for developing your clinical reasoning.

Thanks to all for listening, sharing and supporting The Words Matter Podcast and a huge thank you for all the guests that have shared their own reasoning and thinking so wonderfully.

Support the podcast and contribute via Patreon here

If you liked the podcast, you'll love The Words Matter online course and mentoring to develop your clinical expertise  - ideal for all MSK therapists.

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Welcome to another episode of The Words Matter Podcast.

We have reached the final few episodes of the clinical reasoning series; and I hope you have enjoyed the journey up to this point. This series and the podcast more broadly is made possible by all the Patreon support, and ever a huge thank you for those supporting the show and to those listening and sharing the podcast with your friends, colleagues and students. 

On this episode I’m speaking with Dr Elena Rocca and Dr Saúl Pérez-González about how evidence of biological mechanisms can support our clinical reasoning.

Elena is an associate professor at Oslo Metropolitan University, and specializes in issues related to responsible knowledge-based decision-making with focus on risk and safety of medicines, both from a practical, methodological and philosophical perspective. Her work is interdisciplinary between scientific evidence, practice, policy and philosophy. Elena's research includes causality assessment in drug safety, clinical reasoning, analysis of expert disagreement. Elena is part of The CauseHealth team and we spoke several times on the CauseHealth Series on probability, medical uniqueness, causal dispensationalism and philosophy for practice.

Saúl is a Post-doctoral research fellow at the Center for Logic, Language, and Cognition in the Department of Philosophy and Educational Sciences at the University of Turin. Italy. He has a background in philosophy, with a PhD in Philosophy and MA in Contemporary Philosophical Thought. He is currently Working on/Member of the PRIN research project “From Models to Decisions” Funded by the Italian Ministry of University and Research.

Saúl has held Visiting researcher positions at Centre for Humanities Engaging Science and Society - Durham University the Centre for Philosophy of Social Science - University of Helsinki.

In this episode we talk around a paper that Saul and Elena wrote together titled 'Evidence of Biological Mechanisms and Health Predictions: An Insight into Clinical Reasoning' published in the journal Perspectives in Biology and Medicine.

So on this episode we speak about: 

• What is meant by the term ‘mechanisms’ and what constitutes of them.
• How evidence of mechanisms is typically portrayed and valued in the epistemological and methodological hierarchies of evidence-based medicine.
• How evidence of mechanisms can be useful to our clinical reasoning by helping us make predictions around safety and efficacy of treatment interventions for individual patients.
• The potential the dangers of relying on mechanistic knowledge in replacement of knowledge about effectiveness (such as knowledge generated from clinical trial).
• How evidence of mechanisms can take any form of study design; from lab-based animal studies to understand biological mechanisms at play to qualitative studies to understand the mechanisms involved in the processes of the social world.
• How evidence of mechanisms is generally more decisive for discarding inadequate interventions than for identifying suitable ones.

This was yet another enlightening conversation and quite distinct from the previous episodes on the series. As such, it adds to rounding and deepening the view of clinical reasoning that this series seeks to offer.

Find Elena and Saúl on Twitter 

@ElenaRoccaPD

@SaulPerGon

Support the podcast and contribute via Patreon here

If you liked the podcast, you'll love The Words Matter online course and mentoring to develop your clinical expertise  - ideal for all MSK therapists.

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Welcome to another episode of The Words Matter Podcast.

So we are up to the 8th episode of the Clinical Reasoning Series and on today I’m speaking with Dr Nathalia Costa about clinical uncertainty. Nathalia is a Brazilian physiotherapist who completed PhD studies in Australia used mixed-methods to investigate the nature of low back pain flares (see here). This PhD work was won the Lumbar Spine Research Prize awarded by the Society for Study of the Lumbar Spine in 2021 (see Nathalia's other research here).

Nathalia is currently working as a Postdoctoral Research Fellow at the Universities of Queensland (UQ) and Sydney (USyd) investigating how both clinicians and people with low back pain navigate uncertainty during clinical encounters. And as such we speak about her work investigating uncertainty and talk around a paper, she and her colleagues published this year titled 'Uncertainty in low back pain care – insights from an ethnographic study', published in the journal Disability and Rehabilitation (see paper here) and a previous podcast on ethnography here with Dr Fiona Webster here).

So on this episode we speak about:

• What uncertainty is and allude to the different ways and taxonomies used to describe it.
• Different sources of uncertainty and use the ambiguous nature of low back pain as an exemplar.
• The ways that we as clinicians might neglect uncertainty or attend to it.
• How we often seek to reduce uncertainty through the use of clinical reasoning or the application of evidence for examples through clinical guidelines.
• We talk about how an intolerance to uncertainty may prompt binary thinking and cause us to retreat to the comfort of the biomedical model and biomedical thinking.
• Occasions when we really do want to be certain as we can possibly be, and that there may be some ethical and therapeutic merit in communicating this to our patients.
• How uncertainty with low back pain is imbued with emotions – on both patient and clinician’s part.
• How clinicians may emphasise uncertainty to patients, intentionally or unintentionally and the resulting impact that this might have on the balance of power within the relationship
• And we reflect on ways that clinicians better navigate uncertainty.

So this was another brilliant conversation. Uncertainty, whether we like it or not surrounds and often defines our clinical work and is the omnipresent elephant in the clinical room and lives of our patients. Nathalia’s work provides some crucial insights into the slippery and uncomfortable nature of clinical uncertainty which can allow us to reflect on how it make us and our patients feel and consider how we react in the face of it.

As always, I have linked Nathalia's paper in the show notes, but please look out for a follow up paper which adopts a theory-driven post-qualitative approach to explore clinicians’ experiences navigating uncertainty when working with patients with low back pain (see podcasts here on post-qualitative research here and here).

Find Nathalia on Twitter @nathaliaccosta1

Support the podcast and contribute via Patreon here

If you liked the podcast, you'll love The Words Matter online course and mentoring to develop your clinical expertise  - ideal for all MSK therapists.

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Find Nathalia on Twitter @nathaliaccosta1

Welcome to another episode of The Words Matter Podcast.

If you're enjoying the Clinical Reasoning Series and the podcast more generally, please consider supporting the show via Patreon. You can pledge as little as a pound or a couple of dollars per episode. Your support really makes a difference and helps ensure the quality and regularity of the episodes.

Following on my previous episodes in the series with Bjørn Hofmann (here and here) where we spoke about the ethics of disease and the moral obligations that flowed from being given a disease label - on this episode we are going to speak more explicitly about clinicians' thinking directed towards ethical problems and the resulting moral judgments they should endeavour to make and the processes which delivers them to those judgments.

And so today I’m speaking with Professor Clare Delany. Clare is a Professor in Clinical Education at the University of Melbourne, Department of Medical Education, and a Clinical Ethicist at the Royal Children’s Hospital Children’s Bioethics Centre and Peter MacCallum Cancer Centre in Melbourne. She also chairs the University of Melbourne Central Human Research Ethics Committee.  Clare’s health professional background is in physiotherapy. 

For the past 15 years, Clare’s research and professional work has focused on a combination of clinical education and clinical ethics. Her research interests  include applied health ethics, paediatric bioethics, clinical reasoning, and critical reflection and she has authored more than 100 publications in peer-reviewed journals covering these areas of applied clinical ethics and clinical education.

Clare has co-edited the books ‘Learning and Teaching in Clinical Contexts: A Practical Guide’ and ‘When Doctors and Parents Disagree: Ethics, Paediatrics and the Zone of Parental Discretion.’

So on this episode we speak about:

• What ethics is in the context of healthcare practice including the ethical principles of autonomy, non-maleficence, beneficence and justice
• About the interaction and occasional tension between evidence-based practice and ethics-based practice and how ethics can help settle clashes between research evidence, patient values and clinician judgement and experience.
• What ethical reasoning is and the processes involved In making moral judgements.
• How it feels to identify an ethical problem which is often intuitive or as Clare describes an ‘ikiness’.
• Ethical reasoning when the consequences or stakes are high.
• Communicating risk to patients prior to treatment.
• Some case examples including patients requesting seemingly ineffective treatments or treatments which the clinician may feel is potentially harmful or not in the patients best interest.
• How the ethical principles should apply to all healthcare settings, whether public or private but in reality there are differences on how these principles are interpreted and applied in these respective settings.
• And finally we speak about how ethical reasoning motivates us to be aware of our own assumptions and of the assumptions and values of others which enriches our clinical work and also the therapeutic bond with our patients.

So, this was such a wonderful conversation with Clare. She beautifully highlighted the foundational nature yet often prickliness of the ethical dilemmas we all face in practice and shares some extremely useful reasoning strategies to identify, manage and resolve the inevitable ethical moments in our clinical practice.

Support the podcast and contribute via Patreon here.

If you liked the podcast, you'll love The Words Matter online course and mentoring to develop your clinical expertise  - ideal for all MSK therapists.

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