Does reading my posts make you stupid? (Full Version)

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TexasOrtho -> Does reading my posts make you stupid? (July 27, 2008 4:34:47 PM)

A recent conversation with a chiropractor made me think about a post I saw on the SS. The title was "Is EBP making us stupid?".  What followed on the thread was the usual group think and meta-stroking we've come to know and love from that forum.  I think this question could be easily answered by exploring the antithesis:  Is practicing based entirely on theoretical grounds making us stupid?  As an example, look at how the chiropractic profession has suffered in holding on to flawed theory without supporting evidence.

The question that should immediately arise from theoretical debates should be: how do we know a theory is flawed or sound?  Simple. It must be crammed through the hopper of the scientific method.  Hopefully the data that emerges allows us to reasonably connect the dots between the proposed theory and evidence.

Admittedly this is where some people go wrong in the name of EBP.  A specific outcome doesn't validate or invalidate a specific theory.  Jason Silvernail articulates the pitfalls of such an approach here (click).  However, as a professor once advised me - nothing is ever proven - only supported or refuted.  Evidence may lend support for a theory, but is rarely a validation of the theory.

Most seasoned therapists who practiced before the age of EBP understand this.  People were getting better under the care of physical therapists long before the first CPR was developed.  On the other hand, most therapists who pay attention to what EBP actually is understand that evidence and theory must be constantly reconciled with each other for our methods to evolve.  This unified approach to clinical decision making will prevent further fragmentation of our profession and get us rowing in the same direction.  Thanks for putting up with another rant.




Jon Newman -> RE: Does reading my posts make you stupid? (July 27, 2008 5:24:19 PM)

quote:

Does reading my posts make you stupid?


No, but reading them is revealing.  Here(<--Click) is a link to the conversation for anyone wanting to read for comprehension.  And here's one quote from one of the group

quote:

basing one's practice on evidence requires the ablity to determine if data actually offers evidence or not. The internal validity of a study is not ensured just because it is published. There is actually a lot of poor quality research out there and if you don't have the skills to identify it (see here) then the evidence you base your practice on might not be evidence at all.--Luke Rickards


quote:

I think this question could be easily answered by exploring the antithesis: Is practicing based entirely on theoretical grounds making us stupid?  As an example, look at how the chiropractic profession has suffered in holding on to flawed theory without supporting evidence.--Rod


I contend that the chiropractic profession did not base their practice entirely on theoretical grounds and that their suffering is due to an inability to modify their flawed theory, not because they simply had a theory. 




Jon Newman -> RE: Does reading my posts make you stupid? (July 27, 2008 5:59:00 PM)

Rod you may also be interested in reading this old RehabEdge thread-->click here

There's some good stuff there. 




TexasOrtho -> RE: Does reading my posts make you stupid? (July 27, 2008 6:24:32 PM)

Good stuff as always Jon.  I particularly liked the link on EBM you provided.  I need more time to sit and read it and will try to post my thoughts on it later. I guess my core thesis is that the intentional or unintentional missapplication of any theory, study, power tool, etc...will most certainly lead to adverse consequences.  Shouldn't this lead us to advocate a balanced approach to clinical decision making that incorporates all levels of evidence along with our clinical judgement?  I would submit it is the misinterpretation of EBM, not EBM itself, that leads to the fragmentation we see within our profession.  To me it is leading some folks to throw the baby out with the bathwater.




BB -> RE: Does reading my posts make you stupid? (July 27, 2008 8:18:13 PM)

Rod,

quote:

Shouldn't this lead us to advocate a balanced approach to clinical decision making that incorporates all levels of evidence along with our clinical judgement? 


You've completely glossed over the point that thread is making and in so doing have provided an example. 

Evidence (all of the levels) is meant to inform our clinical reasoning, not replace it.

quote:

I would submit it is the misinterpretation of EBM, not EBM itself, that leads to the fragmentation we see within our profession. 


This is a point that has been made repetitively throughout that discussion.  Perhaps all of "the usual group think and meta-stroking" distracted you from noticing that.  I could of course characterise you by how such descriptions have become "the usual... that we all love," but only "the usual" part would be true.  C'mon now, Rod.  You really make me laugh sometimes, and other times you really don't.

Cory Blickenstaff




TexasOrtho -> RE: Does reading my posts make you stupid? (July 27, 2008 9:10:43 PM)

Cory, you should know by now my jab was not directed at you or other reasonable minds on that forum.  The very fact that forum exists illustrates my point on unnecessary fragmentation.  We now have Rehabedge, EIM, and the SS.  All very good forums frequented by enthusiastic and intelligent individuals.  Why do we need three different forums?  I don't mind the extra clicks, but it does beg the question:  Does the existence of numerous forums indicate we really are this fragmented in our ideals and approaches or does it fulfill some personal, financial, or political agenda of those who run the forums themselves?

I really enjoy all three forums (even though I must appreciate one from afar [:D]), but it seems to hinder our momentum as a profession.  The main idea of my post was likely lost on you and was a recurrent theme during my tragically brief encounter with SS.  There is no US and no THEM in science-based medicine.  There is only the judicious use of the best available information.  This includes understanding theoretical basis of what we do, but also having some form of objective evidence connecting the dots.  Anyone who tells you differently is selling a con-ed course.




BB -> RE: Does reading my posts make you stupid? (July 27, 2008 11:10:00 PM)

quote:

This includes understanding theoretical basis of what we do, but also having some for of objective evidence connecting the dots.


I'm curious what makes you think that the discussion was in violation of your statement?  The argument being made is that there is movement towards evidence only medicine that bears resemblance to the googlization effect (see the article linked at the beginning of the SS thread) and runs contrary to what evidence based medicine is supposed to accomplish:  sensible, informed clinical reasoning.

There are more than 3 forums and, while their existance may be for any variety of reasons (anyone who wants to can start one), each's popularity may be telling of fragmentation.  I don't think it is much of a stretch to see that there are fragments in our profession.  Just go to MFR chat for a glaring slap in the face demonstration of that.

Cory




Hpsg -> RE: Does reading my posts make you stupid? (July 27, 2008 11:20:53 PM)

When I look at who is selling con ed courses, I see a lot sold/promoted here, a lot sold/promoted on EIM. MFR chat is all about Barnes, and promotion/sale of his courses. It doesn't look like there is any sales/promotion of con ed at SS.




TexasOrtho -> RE: Does reading my posts make you stupid? (July 27, 2008 11:57:01 PM)

There is nothing wrong with the sale or promotion of con-ed courses.  HPSG.  Dorko indeed does pimp his courses on "Barrett Dorko's Forums", and I don't blame him for it. 

The point (mostly just an observation really) was that many of the bright minds on the various forums could stand to sacrifice a little ego in the name of moving the profession forward.  Theory, evidence, practice are all things we need to balance.  Devotion to one at the expense of the others seems to dilute the effort.  I guess I just see energy that could be directed in a more positive manner for our profession.  When someone disagrees or offers a dissenting opinion, it's the take your ball and go home (form another forum) mentality.

Like I said it was simply a rant that we could be doing more with what we have.




TexasOrtho -> RE: Does reading my posts make you stupid? (July 28, 2008 12:07:11 AM)

quote:

ORIGINAL: BB
The argument being made is that there is movement towards evidence only medicine that bears resemblance to the googlization effect (see the article linked at the beginning of the SS thread) and runs contrary to what evidence based medicine is supposed to accomplish:  sensible, informed clinical reasoning.
Cory


I do see misrepresentation of evidence, but what makes you (or anyone) think that we have moved towards an "evidence only" medical model?  I haven't seen this as a systemic problem within the profession. In fact, it has been quite the opposite for many years.  Although Sackett's definition has been around for quite some time, EBM is still relatively young.  The important thing is that it is a well defined and defensible construct.  Again, I believe the problems have arisen because of the missapplication of the principles of EBM, not EBM itself.

In this respect a better question might be "Is the misuse of EBM making us stupid?".  I would answer a resounding 'yes'. 




Jon Newman -> RE: Does reading my posts make you stupid? (July 28, 2008 12:55:52 AM)

Hello Rod,

quote:

I really enjoy all three forums (even though I must appreciate one from afar [image]http://physicaltherapy.rehabedge.com/image/s2.gif[/image]), but it seems to hinder our momentum as a profession.--Rod


Are you suggesting that all but one forum should close off discussion for the betterment of the profession?

quote:

When someone disagrees or offers a dissenting opinion, it's the take your ball and go home (form another forum) mentality.--Rod


This would be one of the many reasons multiple forums are important. 




ginger -> RE: Does reading my posts make you stupid? (July 28, 2008 12:58:25 AM)

Rod , love your heads up approach to saying your bit. Gives an easy target though for those keen to willow the poppies. Not a reason to stop however. After all Ghengis khan united the Mongols,( he had a sword however.).




proud -> RE: Does reading my posts make you stupid? (July 28, 2008 1:25:22 AM)

quote:

ORIGINAL: TexasOrtho

The point (mostly just an observation really) was that many of the bright minds on the various forums could stand to sacrifice a little ego in the name of moving the profession forward. 


I agree 100% with this statment Rod. Moving the profession forward involves a significant amount of patience and willingness to let go of much you may have invested years in studying.

There is much out there that really does belong in the waste basket( JFB-MFR...or at least it's theories). But the three forums DO have a significant number of bright minds ALL with much to offer. The key is being willing to listen to dissenting opinion...respectfully respond/discuss.

This is something I have learned over the past two years.

So Rod....you got it right. Again.




SJBird55 -> RE: Does reading my posts make you stupid? (July 28, 2008 2:17:41 AM)

There are 3 sites because some sites do not allow for true open discussion.  The other issue is that each site has its own unique qualities and strengths.

Of course sites are going to have continuing education courses listed - that's part of how the sites are financially supported.  EIM courses are taught by some very high caliber therapists - have you seen the faculty over there?  The faculty of the EIM courses really are shaping and trying to change the variability of physical therapy practice and are doing their best to get the message of what evidence is out there and the strength of that evidence.  SS isn't some elite, wonderful site because it doesn't have continuing education courses being marketed.  And Diane, for you to suggest that is ludicrous. 

The SS site exists because years ago that main crew of therapists broke away from this site due to irreconcilable differences (of which I was a part of).  SS is a safe haven for some therapists to communicate their thoughts without others really questioning those thoughts AND it exists so those that all have the same sort of perspective continue to validate and re validate their thoughts to make it appear that they are absolutely correct with their thought processes.  Those on that site do not want to accept the differing thoughts or accept that as a profession a mix of their common thoughts/perspective/point of view with the thoughts/perspective/point of view of those that oppose is what will strengthen the profession.

I tend to believe that those over at SS are fearful of EBM because mathematics/statistics are not viewed as very valuable.  Blink and Super Crunchers have excellent examples of how mathematics/statistics can assist us in being better clinicians.  It's tough to swallow that sometimes just a few variables are required to make good clinical decisions.  The EIM site is an excellent resource with awesome capabilities to share files.  I try to stay on top of what research/forms or whatever are uploaded there.  There have been times that the EIM site has saved my butt when working with a patient as a great place to go to get information to assist with my clinical decisions - information based on clinical research.  The discussions at EIM are generally a higher caliber of discussion, in my opinion.  RE is more like the "Cheers" of the sites - everyone knows your name :)  There isn't much thought control police.  Some of you need polite reminders to check your PM boxes.  This site is pretty low key, generally social... with reasonable discussions.  The other thing, for those of us banned from SS for our differences of opinion, RE actually allows for us to communicate our thoughts without being banned.  Some of the moderators at SS do come here and post, so SS really isn't shutting down thoughts.




Jon Newman -> RE: Does reading my posts make you stupid? (July 28, 2008 2:45:54 AM)

I've seen excellent conversations and some not so good ones on all three sites.  By the way, there are more than three sites aren't there? 

I think the quality of the conversation depends on the participants, the material they bring and their ability to interact sufficiently cordially so that the topic, rather than personalities, get the focus.  Well that's my take on what makes a good discussion.  Not that everyone is able to do that.  In fact I'm better now, I think, than I was in the past.   It's a learning process.

Of course I disagree with Rod's and SJ's accusation that dissent gets you banned but we've been over that ground before and either the conversation didn't stick or they didn't accept it in the first place.  I won't bother going down that road once again.  They're entitled to their opinions. 




proud -> RE: Does reading my posts make you stupid? (July 28, 2008 2:59:58 AM)

Ginger...what on earth does willow the poppies mean?




PTupdate.com -> RE: Does reading my posts make you stupid? (July 28, 2008 3:06:09 AM)

I think I see Rod's frustration......there are different schools of thought, and certainly different cliques as well.  A shame all can't collaborate and create something that would truly benefit the profession.

As far as banning PT's:  I think something really sinister should occur for that to happen...not simple dissent and differing opinions, but slander, false accusation and the like.  At least here, I could probably say "F_ck you" to David A. and not get banned

I think the 3 main forums in use by PT's are beneficial in their own unique way.  I'll read the discussions on SS, but really never come away with anything that I believe makes me a better PT.   EIM and MyPTspace are just laid out too weird...it reminds me of my home office....stuff here, stuff there, stuff everywhere.  This place, perhaps considered "PT lite" is always my fall back site.

The weirdest part is realizing that all 3 sites have PT's with great minds and spirits, and all probably resolve the typical patient problem in the same time, just using differing methods.    Instead of everybody ganging up on each other, I'd rather see a collective gang up on the other 98% of PT's who are apathetic, lazy and clueless




TexasOrtho -> RE: Does reading my posts make you stupid? (July 28, 2008 3:08:45 AM)

All good comments.  Incidentally Jon, you'll notice I've never protested my being banned from the SS.  I told Diane to kiss my ass when she told me to stay off her threads (which is every freaking thread on that forum). It was this behind-the-scenes dialogue that resulted in my banishment.  Not the fact I disagreed with them.  There were irreconcilable disputes between myself and the moderators and they are the moderators.  Ergo, I got moderated.  I agree that disagreeing with the moderators will not get you banned, however you cannot argue that those who do disagree are treated with a degree of hostility unbecoming those who claim to be on such high intellectual ground. 

I still visit the site to mine some very good information and get a good chuckle from time to time.  Proud's trying to carry the torch, but will likely end up bannished as SJ and myself.  I remain unapologetic for anything I've said over there and have no regrets. It was fun while it lasted. 

I don't think the forums should be consolidated.  As SJ said each forum has its strengths and drawbacks.  It just seems odd that a group of licensed professionals with graduate degrees in the same field of study can't seem to get it together without getting their panties in a twist.  My original post was only an observation or rant; not a call to action. 

I don't know what willowing the poppies is either.  I'm guessing you have to have willowed a few poppies to get that reference? [:D]

John.  As usual...you complete me.




BB -> RE: Does reading my posts make you stupid? (July 28, 2008 6:12:01 AM)

Back to your rant, Rod: 

quote:

  In this respect a better question might be "Is the misuse of EBM making us stupid?".  I would answer a resounding 'yes'. 


This point is made in the discussion.

I believe your rant is based on the title of the discussion, which is a play on words of the article on which it is based. Link: Is Google Making Us Stupid?

quote:

what makes you (or anyone) think that we have moved towards an "evidence only" medical model?


If I had a dime for every time I've been asked "yeah, but where's the RCT or outcome study?" during a discussion on proposed mechanisms and physiologic processes, I'd have a crapload of dimes.  Data is replacing reasoning.  Data is meant to inform reasoning.

Cory




ginger -> RE: Does reading my posts make you stupid? (July 28, 2008 11:33:36 AM)

"willow" is an aussie alternative to cutting off, pruning, the "poppies", are those whose heads are raised sufficiently high to enable those who would shoot at them to aim well and eliminate them. A litlle Oz slang courtesy of ww2 , for cutting  off the high achievers or aiming for the officers first. Sorry to have assumed the dialect of my region was part of multiregioneal vernacular, clearly there are mismanaged euphemisms and colloquialisms that have yet to sail away from the shores of this wide brown land.
As for SS, I can only agree with SJ ,Rod  and others that the ruling elite at that site seem to have squeezed dissent out by a combination of intellectual thuggery and  tribalism intended to appear open, while being anything but. This site is fresh air .




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