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Fierce Conversations
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Fierce Conversations - June 22, 2005 3:02:00 AM
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Barrett
Posts: 967
Joined: July 28, 1999
From: Cuyahoga Falls, Ohio
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Standing in front of a hundred or so therapists every other week for over a year now, I’ve concluded that the inertia of clinical practice-its stillness and unchanging nature-is the consequence of two powerful forces, one well known and obvious and the other equally powerful but hidden beneath the surface of clinical life. The first is the insurance industry’s grip upon testing, documentation and frequency of care that often stands in the way of all reason. I’d prefer that that force be discussed in another thread. The second; hidden from view but not unfamiliar to my students, is best introduced by the poet David Whyte in some lines from his book of prose “Crossing the Unknown Sea”:
“What we have to confront in the present workplace is the reluctance to engage in conversations that really invite the creative qualities hidden deep inside each human being. It is a reluctance born of the knowledge that by inviting creativity and passion, the organization must also make room for fear and failure.”
My new favorite book of all time is “Fierce Conversations” by Susan Scott. I found it while wandering through the public library here in Cuyahoga Falls. Scott, a business consultant, references David Whyte several times as well as many other eccentric and creative thinkers. She defines “fierce” as “robust, intense, strong, powerful, passionate, eager and unbridled” and distinguishes the conversations she advocates from confrontations or the pedantic, one-sided “versations” (“con” is Latin for “with”) that I find myself conducting continually as I teach.
Without going any further into this issue of clinical inertia-and perhaps you don’t even agree that such a thing exists-I’d like to see what others think about the idea that conversations about therapeutic practice can profoundly and rapidly change the way in which we think about, approach and handle our patients. I’m not talking about the careful examination of research data (something we can do while alone) but how a comment or a question from a colleague can alter us, as Scott says, “one fierce conversation at a time.”
_____________________________
Barrett L. Dorko P.T.
http://barrettdorko.com
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Re: Fierce Conversations - June 22, 2005 3:18:00 AM
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PTupdate.com
Posts: 1477
Joined: October 8, 2001
From: Pittsburgh, PA USA
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Barrett,
Unfortunately, this does not happen often...or at least often enough.
On a personal level, I do not associate with PT's, which makes it even harder. I'd love to sit at a table with a few other passionate clinicians, a pitcher of brew, and really argue and debate some topics.
I find that even when attending a course, nobody challenges what the person is teaching, even though quietly inside it might conflict with their beliefs or what they were taught....most sit there and wait for the next potty break. Once the break occurs, it seems most want to show their skills, and it does not appear to be an equal learning session, but rather "look what I know"
This website seems to be one of the few places where some discussion and argument does occur on a regular basis, and I like that.
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: Fierce Conversations - June 22, 2005 3:50:00 AM
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Jon Newman
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From: Amherst, WI
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I've often thought that a debate style continuing ed course would be extremely enlightening. The reason, I believe, that a debate style course needs to exist versus someone speaking up at a course is that in the latter case the passionate person is not truly given permission. That is, the presenter may say or encourage that type of conversation but the environment is not conducive too it. Specifically, the course is not a debate, it is a lecture and the audience and speaker carry implicit knowledge that this is the format. Deviating from this format may deprive others of what they want (whatever that is) and carries with it the possiblity of failure or embarassment of both parties so truly passionate conversation is unlikely.
On the topic of being changed by what a colleague asks or says...It happens to me all the time. And as John points out, it happens most frequently here.
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Fierce Conversations - June 22, 2005 5:25:00 AM
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JLS_PT_OCS
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From: USA
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Good point Jon about the implicit nature of the CEU courses.
I find that my personality fits well with fierce conversations, and I try to have these frequently with my colleagues. Unfortunately, this usually results in people kind of getting quiet, and I end up with the likely reputation (deserved I suppose) as being an opinionated windbag. Even when you invite commentary/criticism, I find most people tend to misread confidence as competence, and they do not challenge me. Which is why I like coming here, because I think everyone feels more comfortable when shielded by the computer screen. And I have learned a lot. Right now, I work with some sharp people who stand up really well, and have taught me a lot also.
Surprisingly, I still get people apologizing to me in the PM system if they disagree with me on a thread. This is very amusing to me, and obviously unnecessary (at least to me) as that's what I thought forums were for! I wonder if our culture has so completely ingrained the concept of submission to authority that we mistake strong opinions for signs of cultural power not to be contested. Has anyone(in any profession) a backbone anymore? I think the Political Correctness phenomenon has increased this current significantly.
I find my interpersonal relationships also benefitted from the freedom to have these Fierce Conversations, and I think my professional life would be better for it if it was more common, also.
I agree with John's idea about sitting around a table over a pitcher of brew... shall we say at Barrett's house this weekend? Who's in?
:)
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Fierce Conversations - June 22, 2005 5:37:00 AM
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Barrett
Posts: 967
Joined: July 28, 1999
From: Cuyahoga Falls, Ohio
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Jason,
Not surprised to see you here. I'm preparing a post to expand upon Scott's experience and writing and would certainly encourage anyone to get her book. I really need to start getting paid for this sort of promotion.
Whyte's book is reviewed on this site as well as "PC, M.D." and each specifically addresses your point.
I'll have to run your idea about the gathering this weekend by my wife-not that I'm not totally in charge or anything.
_____________________________
Barrett L. Dorko P.T.
http://barrettdorko.com
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Re: Fierce Conversations - June 22, 2005 6:41:00 AM
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Diane
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From: Vancouver, B.C., Canada
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Fierce Conversations: Love them, forum, private, public. I'm in. Chill the beer.
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Re: Fierce Conversations - June 22, 2005 7:13:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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Barrett-
Yeah, that book's on my reading list. I have to stop going to your book list, as my frequent reader card from the local bookstore will wear out soon, I am sure.
Don't worry about the money- I feel certain your promotion of the books is to help improve the reasoning and practice of other therapists, and as such your compensation is more...esoteric.
And maybe Diane can bring some good Canuck beer this weekend...
:)
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Fierce Conversations - June 22, 2005 7:27:00 AM
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SJBird55
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From: Michigan
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It all depends on the goals of a "fierce conversation." I do personally prefer debates that are challenging in nature - and debates that may not even really have an answer right now - but they do cause some thinking to occur.
Generally any time I've tried to have a clinical type of conversation with another therapist, especially when I'm questioning the rationale of some intervention, the therapist 9 times out of 10 can't give me a rationale and gets defensive. It's not worth the time and energy to get into any deep conversations with anyone you work with because the end result, in my experience, is that by questioning I've pissed them off because how dare an intervention be questioned. But... the same sort of conversation can occur with myself and physicians and there isn't a problem (I can question them just as they can question me and there is actually a stronger relationship created).
If there is a "fierce conversation" where there is bullying, arrogance, and more of a mandating tone, nothing will be accomplished on my end - that kind of atmosphere is a turn off.
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Re: Fierce Conversations - June 22, 2005 8:15:00 AM
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JLS_PT_OCS
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From: USA
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We use our peer review process to question each other and I think if you have found people who shut down and cannot offer you a rationale for a treatment or process than the problem may be with your coworkers and not with the concept of the conversation.
I have never worked with anyone who could not speak intelligently and at length about why they were doing what they were doing.
Perhaps integrating this sort of challenge is something we lose after school is over?
After all those oral exams, clinical rotations where you get roasted by your CI, etc...do our brains just turn to mush?
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Fierce Conversations - June 22, 2005 11:08:00 AM
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jbeneciuk
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From: Jacksonville, FL
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It's pretty sad that we can't even question another therapist regarding a given treatment rationale without having someone get very defensive, isn't that what makes this profession so interesting is that there is often not one correct answer for a given question...as Jason reminded me the other day, "we all have to be pretty tough skinned regarding this forum"...I tend to bring my questions to the forum and not in the workplace...I tend to stay out of trouble that way...
very relevant topic to the real world !!
JBeneciuk
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Re: Fierce Conversations - June 22, 2005 11:14:00 AM
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FLAOrthoPT
Posts: 1011
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From: West Palm Beach
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why not have the brews near the ocean here in so fla?
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Re: Fierce Conversations - June 22, 2005 11:54:00 AM
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srcase
Posts: 551
Joined: November 30, 2004
From: Michigan
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Wow, I have had these exact thoughts on my mind all week, as I was AGAIN reminded that I make other therapists look bad, and somehow that is my fault. I have always contended that no one can make you look bad except yourself. And further, if I treat others the way I would like to be treated, and they still get defensive, I cannot be held responsible for their reactions. But this kind of enlightenment seems to be lost among the multitudes of poilicies and procedural codes and workplace politics.
So, I am forced to dumb myself down at work, and try not to make anyone feel inadequate, and rely on you all to keep me challenged and honest!
And for that, the beer's on me :)
Sarah
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Re: Fierce Conversations - June 22, 2005 1:04:00 PM
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jbeneciuk
Posts: 112
Joined: November 26, 2004
From: Jacksonville, FL
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FLAOrtho PT: "I'm in" !!!
JBeneciuk
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Re: Fierce Conversations - June 22, 2005 1:11:00 PM
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nari
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From: Australia
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I think a fierce conversation as defined by Scott is difficult to do in the workplace because of the body language that occurs...on email that is invisible. Which is a good thing in some ways and not in others.
Like others who have posted above, I have had some fierce conversations in my more lively past, with an outcome, sensed but unspoken that I am thought of just weird..and a bit naughty for not following the Book of Physio Rules - whatever that may be.
As SJ says, a bullying "I'm-better-than-you,-get-off-your-perch" attitude is a turn-off. But if others simply think you are a bit weird but OK, then it's on - for me.
I like rattling the status quo, and have always done it, but am better behaved over the last few years - maybe the rattlers will surface this weekend!
Nari
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Re: Fierce Conversations - June 22, 2005 1:22:00 PM
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steve
Posts: 470
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From: Canada
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Barrett,
Great topic, although likely you are preaching to the choir when you are talking on this forum - we attend the forum because we like to discuss and think about ideas.
Steve
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Re: Fierce Conversations - June 22, 2005 2:29:00 PM
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SJBird55
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Joined: May 10, 2004
From: Michigan
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LOL nari... the sad thing is that from my experience most therapists do not like status quo rattled. Heaven forbid if I ever made waves or questioned something or offered a potential more efficient, cost-effective idea, because you know, it just isn't done that way. LOL
I'm of the philosophy that if 5 years from now my interventions and approaches are the same, I've got a problem. And, that same philosophy carries over into the business aspect - why keep running a business (and in my experience with hospitals) the same way, year after year? There's always a better way to do something, the problem is that either no one says anything or the controlers just don't let good ideas happen.
No, Jason, I don't think our brains turn to mush.. I just think that overall in our particular field in the civilian world, there are very low expectations for us to meet. If it doesn't take more than breathing and showing up to the clinic to meet those expectations, well, over time there is no motivation to necessarily think too much (because it really isn't expected). So technically, there is a mast majority of our profession going along in a rut and probably going to stay that way until something rocks the boat to mandate a change. Sad, huh?
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Re: Fierce Conversations - June 22, 2005 2:33:00 PM
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JSPT
Posts: 284
Joined: April 19, 2005
From: Michigan
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The ego can be an ugly thing. I haven't seen that word in this thread yet, but that's what this conversation boils down. Of the 15 PT's I work with, I can think of 1 whom would not take a question regarding a treatment technique as a personal assault.
Unfortunate for me, becuase when I am questioned by patients and other clinicians, I remind myself why I a choosing a certain method. I think it makes me a better clinician, so I have taken to flat-out telling co-workers to question me if they see something unusual. This is why having a student can be nice sometimes.
_____________________________
JS
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Re: Fierce Conversations - June 22, 2005 2:51:00 PM
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Synergy
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From: Texas
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I agree with Steve. Those of us who frequent this forum do so for a reason...not to just engage in friendly banter and get help/ideas for treatments, but also to put each other to the test so to speak. I know I've had my cage rattled a few times but it's constructive and it builds character and can help make you a better clinician. If anything, this place improves critical thinking skills.
Bring it on! :)
_____________________________
Chris Adams, PT, MPT
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Re: Fierce Conversations - June 22, 2005 3:11:00 PM
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Barrett
Posts: 967
Joined: July 28, 1999
From: Cuyahoga Falls, Ohio
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A number of things in Scott’s book intrigue me and I wouldn’t presume to put forth her many ideas, formulas for success with conversation or personal experiences here, but I can paraphrase those that struck me and will become underlined once Amazon delivers my own copy.
She begins by insisting we have the courage to “interrogate reality,” which is itself something that changes without warning or announcement. Then she points out that unless we ourselves are “real” in the sense that our emotion regarding the issue at hand is evident nothing will change. In other words, no mindless nodding while you wait for the other person to shut up. Scott suggests we use silence as a way of allowing our sense of what’s been said to sink in and lead us to the next stage. There are seven total principles in the book but these are the ones that struck me.
Last week a woman who is in charge of physical therapy services for a large pain clinic attended my course. I asked her what she was expected to do in this capacity. “I’m supposed to relieve their pain,” she said. “How do you go about that?” I asked. “Conditioning” was her total answer. I said nothing for perhaps ten seconds, and then, quietly; “Is that helping?” She looked at me quite relaxed, smiled, shook her head slightly and said, “No.”
Now, I run into this issue at nearly every course and though it is commonly agreed that connecting fitness to pain is, to put it mildly, problematic, I don’t usually sense that the conflict is so clearly defined and that some sort of movement toward an alteration in care might begin to take place. I’d have to give credit to the “fierceness” both the therapist and I were willing to invite into this brief exchange.
_____________________________
Barrett L. Dorko P.T.
http://barrettdorko.com
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Re: Fierce Conversations - June 22, 2005 3:17:00 PM
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nari
Posts: 1568
Joined: November 14, 2003
From: Australia
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Barrett
I think you will find that the multilogues for the weekend will be conversations, and not versations!
One reason, amongst the obvious, is the safety net of email, lack of visual contact and so on.
The visual rejection of ego is much harder to take.
Nari
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