RE: Self-policing opportunity (Full Version)

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Sebastian Asselbergs -> RE: Self-policing opportunity (May 15, 2008 4:14:05 PM)

Rod, nice try.

Their religion may have an influence on the effects of whatever it is they are subjected to. It could influence outcomes, and thus could be interesting to study.
But at least THEN it would be a clear and up front variable of the study, not a bias of the researchers.
And that is a whole different issue.



TexasOrtho -> RE: Self-policing opportunity (May 15, 2008 7:15:01 PM)

Bas (Is that really short for Sebastian - I had no idea)

There is no may or could to it.  Spirituality most certainly is and always has been a variable in any study published on human beings regardless if it was openly acknowledged or not.  Religiosity and spiritual belief systems are such a fundamental part of our fabric that there is absolutely no way (outside of a nominal measure) it could be a "clear" or "up front variable".

Acknowledging religion and spirituality is one thing.  We all should have an understanding of how it may affect a specific patient's health and behaviors.  However, somehow weaving these issues into the standards by which we assess peer-reviewed research seems to be an obtuse exercise.  If you want to do it...good on ya.  I can just imagine better uses of your time.

By the way this article out of Duke University really jumped out at me during my Ovid search earier.  I have the pdf and it's a very interesting read.

Koenig HG. Religion, Spirituality, and Medicine: Research Findings and Implications for Clinical Practice. The Southern Medical Association. 2004.



Sebastian Asselbergs -> RE: Self-policing opportunity (May 15, 2008 9:45:52 PM)

Rod, I like the way you are so absolutely certain. A bit scary, but clear. And how do you know there is no may or could? Is that a rock solid belief? [;)]

I am NOT weaving these issues into research and standards - I am a bit (A BIT) concerned when they are so front and centre, that they may supercede professional standards of practice.
I just have to think about the doctor who practices family medicine in Ontario. He is registered in a Province where getting a birth control prescription is an established right. For teenagers 14 years and older too. He posted a notice that he would not do that because it clashed with his faith.
Here is an example of someone practising under a standard of practice and code of ethics - clear and well-taught AND repeated at receiving Licence to practice - but the good Dr. let his religious tenets supercede the standards.
He was finally slapped on the wrist, but is still trying to "talk" patients out of it.

Here we have a very strong separation of science and religion - you will be hard pressed to find any University with such religious connections as that Baptist one. I guess I am just too suspicious of the ability to balance the rights of the individuals with the overly public beliefs of the religious. (NOT all Christians)

The article you link to makes it abundantly clear that any religious focus (in medicine) is patient need driven - NOT practitioner or researcher.


PS: Yes, Bas is the dutch short form....



TexasOrtho -> RE: Self-policing opportunity (May 15, 2008 10:18:21 PM)

quote:

ORIGINAL: Sebastian Asselbergs

Rod, I like the way you are so absolutely certain. A bit scary, but clear. And how do you know there is no may or could? Is that a rock solid belief? [;)]


Rock hard baby. [;)] To a greater or lesser degree they certainly are. Seriously though. That "scares" you?  I'm starting to develop a mental image of you that I hope isn't accurate. ;)

quote:

I am NOT weaving these issues into research and standards - I am a bit (A BIT) concerned when they are so front and centre, that they may supercede professional standards of practice.

You make this statement as if someone is arguing the point.  Who the hell would make a statement to the contrary?  Are we welcoming studies that include such bias?  I'm looking forward to seeing where this has become a problem in our literature.
quote:


I just have to think about the doctor who practices family medicine in Ontario. He is registered in a Province where getting a birth control prescription is an established right. For teenagers 14 years and older too. He posted a notice that he would not do that because it clashed with his faith.
Here is an example of someone practising under a standard of practice and code of ethics - clear and well-taught AND repeated at receiving Licence to practice - but the good Dr. let his religious tenets supercede the standards.
He was finally slapped on the wrist, but is still trying to "talk" patients out of it.

Here we have a very strong separation of science and religion - you will be hard pressed to find any University with such religious connections as that Baptist one. I guess I am just too suspicious of the ability to balance the rights of the individuals with the overly public beliefs of the religious. (NOT all Christians)

I think you are right to be suspicous of maintaining this balance.  I also think those with strong faith beliefs should advocate for their side of the debate. Could these young ladies desperate for birth control pills (that's a really a right in Canada?) not find another doctor across the street willing to dish them out?  They most certainly can and do here...frequently.
quote:


The article you link to makes it abundantly clear that any religious focus (in medicine) is patient need driven - NOT practitioner or researcher.

Agreed, but these belief systems do not exist in a vacuum Bas.  Like it or not...your doctor has beliefs.  Whether they be strong, neutral, Christian, Muslim, atheist, agnostic, consistent or inconsistent with your world view...they do believe in something and these beliefs do provide some framework for their clinical decision-making process. 

The question is how much do you need to know about their beliefs before you will trust or distrust their clinical reasoning or research?  It is within your right as a patient to be distrustful, wary, or even paranoid about whether this balance is being met to your satisfaction.  Just keep in mind that providers are not automatons capable of making completely unbiased decisions regarding you or your family's health...

I saw a Muslim urologist a few years ago for a hernia repair and err...transmission check.  I was fairly confident that he and I would see many many things differently in our world view.  However, I still permitted the gentleman to make important decisions about my health care.  Why?  Because what he does five times a day has nothing do with why his finger was in my yoo-hoo.  [:)] 



Jon Newman -> RE: Self-policing opportunity (May 15, 2008 10:38:33 PM)

Rod, I don't have access to the full text of the article you're citing.  How does the author define spirituality?  Whether spirituality (whatever that is) is important or not would depend upon the question you're trying to answer and the prior probablility that spirituality will influence the outcome of interest.

Bas offered up an example of religion affecting the working end of the practice stick versus how religious belief might influence the types of things that get to be researched in the first place.  For an example of the latter, consider this piece (<--click on the phrase "this piece" to link to the article) by Steven Pinker.  If, at this high level of power and influence, health care research is hindered by faith why is it so hard to think that such decisions don't occur at lower levels of research decision making and official/authoratative discussions of theory in PT? 

Crevidence, I definately have a taste for refined sugars anyway.  Thanks for the video recommendation.  I'm listening to it now.



Sebastian Asselbergs -> RE: Self-policing opportunity (May 15, 2008 11:21:39 PM)

"Could these young ladies desperate for birth control pills (that's a really a right in Canada?) not find another doctor across the street willing to dish them out? They most certainly can and do here...frequently. "

Not easy here. Shortage of doctors. But That is not the point - the point is that the population and the doctors have an agreed-upon set of standards that define practice and control ethics - monitored by the College of Surgeons and Physicians.

" Like it or not...your doctor has beliefs. Whether they be strong, neutral, Christian, Muslim, atheist, agnostic, consistent or inconsistent with your world view...they do believe in something and these beliefs do provide some framework for their clinical decision-making process."

No argument. However, they SHOULD NOT do more than provide a framework - when they become too much front-and-centre - they could influence actual practice decisions to the point I alluded to in my example.

"The question is how much do you need to know about their beliefs before you will trust or distrust their clinical reasoning or research?"

Well, if I have to see a doctor who has his religion publicly displayed in his office, or when I see his waiting room materials belonging to a specific religious group, or when his research or publications have religious quotes...I say: Bye Bye. Won' t trust his complete adherence to the code of ethics as I understand it.


As far as you are concerned, if the specialist with his index finger roto-rooting was saying: ""Whatever you do, do your work heartily, as for the Lord rather than for men,
Colossians 3:23, NASB" , you wouldn't mind would you......

Jon, very interesting and scary article. And very apropos to this thread.



TexasOrtho -> RE: Self-policing opportunity (May 16, 2008 7:45:16 AM)

Jon just finished the article.  It took a lot for me to make it though an article from the "New Republic", a fairly leftist publication.  While there were a few complete inaccuracies regarding Catholic church, I found it an interesting and thoughtful article.  I will say that the clear bias in the author's tone throughout the piece made it difficult to distil some of his more salient points.  Although I appreciate the transparency of such an editorial, you always read them with the notion that this is one persons interpretation.

Bas.  If not knowing your provider's spiritual belief system helps you sleep better, than more power to you.  Just because the doctor's beliefs aren't spoken during an exam, doesn't make them any less relevant to that physician...they are still there.  Although I can see where health care and religous beliefs are sometimes (albeit very very VERY rarely) incongruous with our oath as providers, these are rare cicumstances that are given too much weight in this particular discussion among physical therapists.

I'll stick to my statement that theology or atheism is an undercurrent of our interactions regardless of how transparent.  The fact that some folks find this "worrisome" or "scary" is silly to me, but ultimately has to be worked out by the ones with this misguided anxiety.  Ironically, I bet a historical study of the Hippocratic oath would reveal some theological underpinnings as well.  I hope this doesn't scare you. [:D] Keep in mind I respect your opinion Bas, but respectfully disagree.



Sebastian Asselbergs -> RE: Self-policing opportunity (May 16, 2008 8:03:32 AM)

Rod, thanks for that. I absolutely agree that this conflict - potential conflict - is likely rare. Maybe even VERY rare. And I would like it to remain that way.
This discussion was not a "high alert" on my part, hence the frequent "may". "could"  and "potential".

And yes, I am more comfortable with medical professionals who do not loudly proclaim their religious beliefs in their place of practice. Whatever that belief may be. After all, I am there to look after ME, not to satisfy their needs. 
It has nothing to do with not knowing their beliefs - it has everything to do with HOW important their beliefs appear to be in relation to their practice.

It is a grey area - and I will likely continue to respectfully disagree with you on this one. (with me being a recovering catholic and all [;)] )



Jon Newman -> RE: Self-policing opportunity (May 16, 2008 8:13:48 AM)

quote:

Jon just finished the article.  It took a lot for me to make it though an article from the "New Republic", a fairly leftist publication.
 

Sacrifice is what's all about Rod.  Good for you.

quote:

While there were a few complete inaccuracies regarding Catholic church, I found it an interesting and thoughtful article.


I'm interested in accuracy.  What were the inaccuracies (because I don't know enough to know what they are)?

quote:

I will say that the clear bias in the author's tone throughout the piece made it difficult to distil some of his more salient points.  Although I appreciate the transparency of such an editorial, you always read them with the notion that this is one persons interpretation.


What was the author's bias?  He clearly had a point he was arguing but I'm unsure of the bias aspect that you note. 

Here is some more commentary on the article from the Neurocritic

The indignity of ice cream cones



Shill -> RE: Self-policing opportunity (May 16, 2008 8:29:03 AM)

This is actually quite a nice discussion/exercise towards the Ethics and Jurisprudence license renewal requirements that some states have.  Culture, religion, ethics of marketing are all discussed.  It might be nicely reorganized into a different thread.  These topics, as John Duffy mentioned early on, are not those that people love jumping into, as they cause the hairs along the spine to raise, claws to be unsheathed, etc,etc.  However, they are quite important. 
In my reflection on life, religion, clinical practice patterns, I find myself gravitating back towards the idea that no one person can be completely free of thoughts, practices, ideas that somewhat contradict their other thoughts, practices, or ideas.  I think if someone is completely without self contradiction, without some slight hypocrisy in some ways, then this is when ideas start to become a bit scary, perhaps even radical.  That said, too much self contradiction, is not so hot either, as we then all dine on milk toast.  Its about balance.   Recognizing when one's thoughts are falling towards the side of imbalance, recognizing when a provider is too far to one side than the other is what we all need to be able to do.



SJBird55 -> RE: Self-policing opportunity (May 16, 2008 8:57:20 AM)

I glanced through that Pinker document, Jon.  All I can say is that one man's view of a 555 page document really doesn't have strength.  I haven't seen or read the original paper on dignity, but I know that I'm not going to trust that Pinker is 100% accurate in his view.  That document wasn't "science."

The Horsemen thing...  you know, I don't have any issues with discussing religion.  I think it is okay to disagree or argue or not appreciate Christian views.  What I didn't appreciate was a "soft" blanket statement that basically indicated Christians may have a weakness in believing anything. 

Our nation was built on Christian principles.  Obviously there has to be value within those principles for the founding fathers of this nation to actually use Christian principles.

Generally, with physical therapy, our interventions aren't at a level that impact the crossroads of life.  We aren't creating lives... we aren't terminating lives... we aren't genetically altering lives.  We work with the life that is presented to us and we attempt to improve the quality of life or in the case of hospice, palliative care.

From a Christian perspective, I know I would have a very, very difficult time providing care to a male who sexually abused kids; to a murderer; to a mom who killed her kids; to a kid who killed parents; to someone who preyed upon the older population and swindled millions from them... 1) forgiving that person would not be easy  2)  why would I want to provide services to improve their quality of life when what they did with their lives goes so much against my Christian beliefs?  3)  what if I did provide services and goals were met and the person returned to function and performed a heinous crime?  4)  Can I really be a Christian in that kind of situation?  I honestly don't know.  I have never been in that kind of situation.  Granted, I can only speak for my perspective of when Christian beliefs have an impact with provision of physical therapy services.  For me, the described situation would be so very much more challenging because of the beliefs of Christians than interpreting research or implementing research.  In all honesty, our research isn't at some crossroad of morals.  I don't know if that makes sense... but from a religious perspective, in our field, we aren't put into a religious dilemma of certain interventions being "right" or "wrong" morally.  I don't think that just because I can generally believe what is in the Bible easily translates that little proof is required to believe much of anything.  I also don't think that it is an accurate assumption to assume that Christians easily and readily believe what is written in the Bible.  I know I struggle, challenge and question certain aspects of the Bible.



Sebastian Asselbergs -> RE: Self-policing opportunity (May 16, 2008 9:58:08 AM)

I have a hard time understanding your last post, SJ, with regards to treating people on the wrong side of society`s laws.
I have worked in a psych hospital with murderers, have seen thieves and abusers from our local prison, and have very likely treated very bad people along the way who just haven`t been caught yet.
That is the duty I have as a practising PT under the local laws and under our local standards of practise. These also seems to fit with the christian examples Jesus is said to have set for us.
So, you seem to be saying you do not do well with that...

And with regards to the soft blanket statement - it must have really hit a tender spot, because there was no mention of the whole group of christians, there was JUST a suspicion that because certain people believe in all kinds of unproven and scientifically unlikely events, that it seem to make some of those people possibly more likely to be vulnerable to other unrealistic issues.  And I still agree with that.  Do I see this in all people of any faith - of course not.
That is an unfair assumption - it is like saying : `You say rapists are mainly men - thus you are saying all men are rapists` .

The Pinker article is a personal piece - no-one said anything different. Still makes you think, and that is a good thing. (especially in my case - I need all the help I can get!)



SJBird55 -> RE: Self-policing opportunity (May 16, 2008 11:01:47 AM)

Well, if you aren't a Christian, Bas, then you might not understand where I will wrestle with the beliefs I am supposed to follow.  Those particular examples that I provided where I would have a difficult time are not just because the act performed was illegal... but because my role as a Christian is supposed to be to forgive and to not judge.  How can I not judge those types of actions; can I forgive those types of actions?  How am I professionally supposed to have compassion and care? 

So, since Crevidence made the soft blanket statement... Crevidence, was the soft blanket statement aimed toward Christians?  I tend to believe it was because you use the Virgin birth and the Resurrection as prime examples.  What population other than Christians believe in those two examples.  Of course that kind of statement would be taken personally by me since I am a Christian.  I am and will disagree that because I am a Christian I have some tendency to believe more readily anything that seems impossible.  I can only speak for myself and I know that I am not wired that way.  I question; I challenge - in fact, I always have.

I gave my own personal example of when practicing Christianity for me would be difficult.  For me, I don't follow unsound non-evidence-based physical therapy principles... for me, Christianity is more about how one lives ones life; it is more in choices I am supposed to be making to behave as a Christian.  Generally speaking, from a religious perspective, physical therapy and the choices I make during my days really don't keep me awake at night wondering if I'm making the right choice that are in alignment with my Christian beliefs.



Sebastian Asselbergs -> RE: Self-policing opportunity (May 16, 2008 11:59:22 AM)

Well, I do not know if I am a Christian. I have found that calling oneself one thing does not make that a fact. What does it mean ?

Even you call yourself a Christian and clearly have trouble at times BEING one. So, is it THAT difficult to see how certain people may have their problems with the tenets of a religion conflicting with ethics of a profession ?  Maybe (likely) NOT you, but others...

I really do not know if I am a christian - and I think that works just fine in my practice.



Jon Newman -> RE: Self-policing opportunity (May 16, 2008 12:31:04 PM)

SJ, do you think "Christian principles" are unique to Christians?  When I hear the phrase "Christian principles" I wonder what makes the principles Christian.  To me, saying "Christian principles" is like saying "Chiropractic manipulation."  Do you agree?



SJBird55 -> RE: Self-policing opportunity (May 16, 2008 3:00:34 PM)

Jon, if one doesn't believe in Christ, do you think the principles would be the same?  I think people who are not Christians can have principles very similar to Christian principles.  We have many laws that coincide with Christian principles.  I guess the difference would be in why the principles are relevant. Take for example... killing someone is wrong.  Why is it wrong?  Some could say it is illegal.  Why is it illegal?  Because it is a law. Why is it a law?  Because some group of people decided that killing someone would be wrong and be punishable and killing someone would not be an acceptable behavior in society.  Christians might have a different perspective.  Killing is wrong because one of the 10 Commandments addresses killing.  Lives are to be respected because there is a bit of Christ in each of us.  Killing someone would be considered a mortal sin and any sin, whether it is mortal or not, errodes the relationship one has with God.  I'm not sure if I agree or disagree with your final statement.  I'm not sure what you are trying to convey.  I honestly can't see where some manual technique can be compared to something that is broad and covers the way Christians should lead their lives.

LOL  Of course I have difficulty, Bas.  Peter had the same problem and denied knowing Christ 3 times.  And Peter was one of Christ's closest friends... he was the "rock" from which the Church was built... I'm sure Peter believed himself to be the most loyal of the disciples... but when push came to shove, in the heat of the moment, even Peter couldn't be a Christian at that moment when Christ was being physically beaten.  I'm not going to sit here and lie and say it's easy and a walk in the park.  Yeah, I fail... I fail miserably sometimes. 

What I still don't get is how since Christians can apparently believe something that seems impossible and apparently unproven that by that alone, Christians might be willing to believe in accupuncture meridians and FRS lumbar segments.  I'm sorry, but I honestly am not getting it.  In the real scheme of things and with life in general - accupuncture meridians and FRS lumbar segments are such nothings.  They don't matter.  My faith and the decisions I make during my life matter... they matter big time to me.  I think there is a difference in the unproven things we may believe and the hierarchy in which we place them in our lives.  When I'm on my deathbed, whether I believed in FRS lumbar segments or not is going to be an irrelevant issue... whether I believe in Christ or not might be a different story.



Jon Newman -> RE: Self-policing opportunity (May 16, 2008 3:37:04 PM)

quote:

Jon, if one doesn't believe in Christ, do you think the principles would be the same?


In short, yes of course.  The principle of not killing people requires the action of not killing people whether you are Jewish, Christian, Muslim, atheist, etc.  The principle does not belong to anyone exclusively.

quote:

I guess the difference would be in why the principles are relevant.


Yes, that's what I'm saying.  Many subscribe to the same principles although the story behind each may be unique.  Thus the only thing that distinguishes a Christian principle and a non-Christian principle is whether the Christian notion of God gives his stamp of approval on the principle.  Actually, to be precise, whether the people who speak for God (or have spoken for him) give (gave) His stamp of approval.  It's a difference of whose authority one subscribes to, not a difference in principles themselves. 

I thought my example regarding "chiropractic manipulation" versus "manipulation" would provide enough emotional distance and be familiar enough to see the point I was making, which is why I used it.  I think you got what it was I was trying to convey.



Sebastian Asselbergs -> RE: Self-policing opportunity (May 16, 2008 5:29:19 PM)

This is getting a bit convoluted. [:D]

Now being a christian requires perfection, or at least, perfect behaviour?
"but when push came to shove, in the heat of the moment, even Peter couldn't be a Christian at that moment when Christ was being physically beaten"

It always worries me when biblical quotes and writings are taken literally. I bet you there are listers here who have done as I have - tracked the translation and editing history of the bible. It is so often looked at as if it has been unchanged, unedited since day one (pun intended) and virtually "lifted" in its entirety from the first century.

I can't help but vent a bit here about the issue of Peter as the rock of the church (the catholic one). I am inclined to think that if Jesus indeed viewed Peter as the rock of his future church (=community), he would cringe at what that rock has become. A top heavy, doctrine laden, pope-led hierarchy, changing bible interpretation by committee, changing bible content and so forth and so forth.

I'll stop now - I realize I may be offending some people here. For that, I am sorry if that is the effect indeed.

And SJ, unless there is a uniform definition of what makes a christian, what you say as a christian is limited to what your behaviour and beliefs are. I know too many who take much straight from the bible and hold it as proof evolution does not exist for instance. Who firmly believe that the universe is only about 6,000 years old. These are christians too. And likely to believe a hell of a lot more weird stuff.

Now, if we had seen a quote from the q'uran at the bottom of an islamic university page, or a quote from L. Ron Hubbard at the University of Scientology, I bet crevidence would have offered the same concern. I would have.



TexasOrtho -> RE: Self-policing opportunity (May 16, 2008 5:34:26 PM)

Bas I'm glad we can respectful on such a sensitive issue.  This is from Webster:  Faith -

1.  Confident belief in the truth, value, or trustworthiness of a person, idea, or thing.
2. Belief that does not rest on logical proof or material evidence. By definition we all have faith in one form or another, and it's a matter of the journey not the destination.  I screw my faith up on a daily basis and can only hope to work toward the ideals of my faith.  I think most of the bad press we see regarding religion and spirituality is not an indictment of the faith itself but the enourmous screw ups along the way. 



TexasOrtho -> RE: Self-policing opportunity (May 16, 2008 5:44:37 PM)

quote:


I can't help but vent a bit here about the issue of Peter as the rock of the church (the catholic one). I am inclined to think that if Jesus indeed viewed Peter as the rock of his future church (=community), he would cringe at what that rock has become. A top heavy, doctrine laden, pope-led hierarchy, changing bible interpretation by committee, changing bible content and so forth and so forth.

I'll stop now - I realize I may be offending some people here. For that, I am sorry if that is the effect indeed.

[snip]
Now, if we had seen a quote from the q'uran at the bottom of an islamic university page, or a quote from L. Ron Hubbard at the University of Scientology, I bet crevidence would have offered the same concern. I would have.


Now you've dropped the gloves Bas.  [;)] Peter as "The Rock" is high theology that even the most learned scholars of faith disagree upon.  How can you or I (or anyone on a physical therapy forum) possibly hope to debate this to a reasonable end?  You nor I do not have the background to debate these issues on a productive level, any more than two high-school dropouts could debate the merits of different mobilization techniques for the shoulder.  I think you should continue to develop your faith as you see fit.  One of the merits of adulthood is supposed to be the epiphany that no one really cares what you think on such matters, as faith is highly personal.  Sorry, but you did strike a nerve on this issue with me. 

Let's retire this particular issue if you don't mind. [:)] Frankly, you should be more concerned with why Canada can't field a team in the NHL Finals.

Regarding whether you or Crev would have the same degree of fear or worry regarding quoting Scientology or the Q'Ran, no one could speculate.  Your judgement (and you would most certainly be judging) of raw peer-reviewed data on the basis of the authors spiritual beliefs is your problem.  It does not make the data any more or less relevant to the objective eye.

You're a good egg Bas, but the tone of your posts sounds like you've been burned.  I can only pray (seriously) you find what you are looking for.



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