The Words Matter Podcast with Oliver Thomson

Welcome to another episode of The Words Matter Podcast.

Today I’m speaking with Professor David Nicholls. David is a Professor in the School of Clinical Sciences at AUT University in Auckland, New Zealand. He is a physiotherapist, lecturer, researcher and writer, with a passion for critical thinking in and around the physical therapies.

David is the founder of the Critical Physiotherapy Network, an organisation that promotes the use of cultural studies, education, history, philosophy, sociology, and a range of other disciplines in the study of the profession’s past, present and future.

His research work focuses on the critical history of physiotherapy and considers how physiotherapy might need to adapt to the changing economy of health care in the 21st century.

He has published more than 35 peer-reviewed articles and 17 book chapters, many as first author. He is also very active on social media, writing more than 650 blogposts for criticalphysio.net in the last five years.

In 2017 he published the book ‘The End of Physiotherapy’ which is a critical history of physiotherapy, and is working on follow-up book called ‘Physiotherapy Othererwise’. He’s also just co-edited a book called ‘Mobilizing Knowledge in Physiotherapy: Critical Reflections on Foundations and Practices’.

His work on the professionalisation and socialisation of physiotherapy and crucially questioning where it’s come from and where It may be going (if going anywhere at all) resonates with my thinking about osteopathy and the social and historical circumstances which shaped its development and maintains its current practice.

In this episode we talk about:

• The role of qualitative research in helping to carve a new way of being as professionals and the revised values, identities and practices associated with this shift (including this paper by Elizabeth Adams St. Pierre on a 'post qualitative research' future).
• Building healthcare practice from the ground up with a new set of foundations and principles
• The tension which often finds its way into curricular when biomedical subjects sit alongside subjects social, psychological and humanistic topics.
• The person/body-as-machine and how this contrasts with a phenomenological view of the person of which he argues for.
• How critical theory has shaped much of his analysis and arguments of physiotherapy, such as the Impact of power on cultures, ideological-orientated enquiry (such as quantitative research), and the historical contexts within which actions takes place.
• The ‘physiotherapy paradox’
• The original questions asked by society and answered by physiotherapy and osteopathy, which catalysed the emergence and development of the respective professions.
• The social, political and economic structure which led to the development and subsequent maintenance of these professions.
• We then pose that if the original questions and needs of society have change then so should the shape, scope and purpose of professions.
• The post-professional era, which we may all be on the cusp of.

So this was a complete delight taking to David. His analysis of physiotherapy is forensic, yet the entire time he never once forgets the patient, and the front and centre role they deserve to play in both healthcare practice and purpose.

As you’ll notice when listening we wander (wade) thorough a range of related topics for over 90 minutes, and if wasn’t for the 11 hour time difference - with him needing to commence his day, and me needing to end it, we would have gone on.

Find Dave on Twitter @CriticalPhysio and @DaveNicholls3

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Welcome to another episode of The Words Matter Podcast.

So we are up to the fifth episode on this CauseHealth Series, in which I’m speaking with the authors of The CauseHealth book Causality, Complexity and Evidence for the Unique Patient.and that you can download for free or order a hard copy.

So in this episode I’m speaking for the final time with Dr Elena Rocca and Dr Rani Anjum about Chapter 5, which they co-wrote titled Complexity, Reductionism and the Biomedical Model (read Chapter 5 here)

The chapter is a comprehensive analysis of some pretty hefty topics, who’s depths are rarely appreciated in day-to-day discussions in healthcare practice or academia. How often do we use terms and concepts such as reductionism or biomedicalism, without really knowing the premises of these positions? Fortunately, Rani and Elena do a great job of laying out these positions clearly so we can all have a greater handle on these theses so as to be more deliberate when using them or dismantling them.

In this episode we talk about:

• What reductionism is in medicine and how this relates to the biomedical model.
• We ask what does it mean to be a reductionist ontologically and epistemologically?
• Biomedicalism is frequently represented or Straw-manned, so we attempt to steel-man reductionism and offer an argument for its strengths, merits and contribution to healthcare.
• The role of the biomedical role in the (over)medicalisation of people (eg burnout into depression).
• The biopsychosocial model, and how this acknowledges complexity in theory and practice but how the CauseHealth approach argues we need to move beyond the BPS model by starting with a change in ontology, and how we can learn from ecology to resist the fragmentation of complexity and preserve it in its wholeness.
• We once again talk about the importance of the patient's narrative and the causal story it can tell.
• Finally we talk about how our ontological bias with respect to causation influence our norms and practice.

As always, I loved talking to Elena and Rani. Our discussion on complexity, biomedicalism and reductionism can help us become aware of our philosophical biases with respect to our practice, allowing us to analyse and reflect on them so we can begin to change them.

Find Elena and Rani on Twitter

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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.

In this episode I speak with Steven Vogel. Steven is Deputy Vice-Chancellor (Research) at the University College of Osteopathy and Editor in Chief of the International Journal of Osteopathic Medicine.

He has twice been a member of National Institute for Health and Clinical Excellence (NICE) Guideline Development Groups formulating NICE clinical guidelines for back pain and sciatica.

Steven led the large Clinical Risk Osteopathy and Management (CROaM) study which examined adverse events and outcomes related to osteopathic interventions.

His main research interests focus on back pain, clinicians’ beliefs and attitudes and more recently, reassurance, communication and consent, safety and manual therapy, patient reported outcomes, self-management rehabilitation strategies used in practice with people with low back pain, and the effects of cognitive and affective reassurance.

In this episode we talk about:

• What constitutive ethical and professionally agnostic musculoskeletal care (see Steve's paper here).
• The early research into psychology of LBP, of which he was a crucial part (see here here and here).
• The cyclical nature of current arguments (hands on/of/psycho/manipulation etc).
• The different levels (fizzy drink scale) of psychologically-informed practice, and the psychological processes involved in clinical practice.
• The challenges of developing these skills in clinicians, and the questions up for debate such as 'what does it mean to be BPS orientated' and 'what sorts of training bests develops those competencies'?
• The frequent situation where psychological interventions have high face validity, make sense to us an clinicians but show small effect sizes when clinically trialled.
• We talk about his seminal 2013 systematic review work on cognitive and affective reassurance.
• Signs of progress and lack of progress of for PIP
• The challenge of measuring BPS-ness and the empirical actions and observable behaviours associated with such a clinical orientation.

Steven is is perhaps the most measured, rational and composed individual I know. He remains totally zen even when being faced with some the highest intellectual dishonesty in the manual-physical-osteopathy spheres.

It was an absolute pleasure speaking with Steve about his seminal work as a pioneer of psychologically-informed musculoskeletal care, and reflect on how far we have come and how much further we have still to go.

Find Steven on Twitter @UCODVC_Research

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In this episode of The Words Matter Podcast, Dr Oliver Thomson speaks with Dr Ben Darlow. Ben is a clinician, teacher and researcher. He works clinically as a Musculoskeletal Physiotherapy Specialist based in private practice in Wellington, New Zealand.

His teaching and research are based in the Department of Primary Health Care and General Practice at the University of Otago. More about Ben's academic work. His research interests lie in the understanding and management of common musculoskeletal conditions like low back pain and osteoarthritis. here.

Many of you will be aware of Ben’s excellent research into back pain beliefs; both his qualitative work such as his papers “The enduring impact of what clinicians say to patients with LBP” (see here), and “Easy to harm and hard to heal, patients view about the back” (see here), plus the development of the back pain attitudes questionnaire otherwise known as the BACK-PAQ tool, which is now widely used by researchers across the globe in the study of back pain(see here). His work features heavily in the Words Matter online course on effective language and communication in the management of back pain (details here).

In this episode we talked about the nature, origins and importance of back pain beliefs. We dig down into the role of the clinician in co-structuring beliefs, narratives and frameworks with people experiencing back pain. We also explored the challenges and opportunities of providing diagnoses and explanations to people in pain.

I was really excited to speak to Ben, he was way up on the list of people I wanted to have on the show and his work has been hugely transformative for my own clinical work and I know influential for many MSK colleagues. Ben is a wealth of knowledge and able to relate his knowledge of the evidence to clinical practice in immensely engaging, passionate and accessible way. I bring You Dr Ben Darlow.

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