The Words Matter Podcast with Oliver Thomson (Oliver Thomson)

Welcome to another episode of The Words Matter Podcast.

Once again, a huge thank you to those you that support the show via Patreon – every pledge helps, so a big warm thank you.

The response to the recent episodes and the qualitative research series has been immense – it seems like the podcast is rippling through the lives of more and more people.

I think we’re approaching 60,000 downloads since the podcast started 18 months ago or so. Coming up on the podcast I have series on clinical reasoning and critical physiotherapy, plus more AMAs (see previous AMAs here, here and here).

So on this episode I’m speaking with Dr Marianne Lea and Prof Bjørn Hofmann about their recent paper Dediagnosing – a novel framework for making people less ill (see paper here).

Marianne holds a Postdoc position in clinical pharmacy at the University of Oslo. She obtain her PhD in clinical pharmacy in 2019 and her research focuses mainly on multimorbid patients and how we can optimize the health care provided to them.

She also works as at the Hospital Pharmacies Enterprise, South-Eastern Norway and has over ten years of experience as a clinical pharmacist in the hospital setting, conducting tasks like medicine reconciliation, medicine reviews and deprescribing.

Bjørn is a scholar in philosophy of medicine and bioethics with a special interest in the relationship between epistemology and ethics. He is affiliated with the Department of Health Science at the Norwegian University of Science and Technology (NTNU) and the Centre for Medical Ethics at the University of Oslo. Bjørn originally trained in the natural sciences (electrical engineering and biomedical technology) and is now interested history of ideas, and philosophy.

His main fields of interests are basic concepts for health care including disease, causality, (over)diagnosis, medicalization and severity. He’s also interested in the norms of knowledge including  knowledge generation, evidence production, norms of science and forms of rationality. See more about Bjørn on Wikipedia here.

 So in this episode we speak about:

• What a diagnosis is, both from a social constructionist view but also the biological components which seek to categorise such diagnostic labels.
• The primary role that diagnoses and the process of diagnosis plays in healthcare and how they structure healthcare systems, economics and clinical specialisms.
• Bjørn and Marianne outline the problem of too much medicine and too much diagnosing.
• The process of de-diagnosis- That is, the removal of diagnoses that do not contribute to reducing the person’s suffering.
• Diagnostic creep and expansion and about the increase in diagnosis and disease screening.
• The powerful implications of a diagnosis including stigmatization, discrimination and guilt.
• The psycho-behavioural effects of embodying or living with a diagnosis plus the socialisation of it which can remain imprinted on the person.
• The positive and negative consequences of a diagnosis.
• And finally we talk about the relationship between de-prescribing and de-diagnosing.

So this was such a fun conversation – it drew together so many great topics which I’ve covered on the podcast. Many of us have a Spidey sense of the problem of overdiagnosis but we may unable to structure a solution to it – well fortunately Marianne and Bjørn have offered a compelling way to start to undo the harms of overdiagnosis.

As you’ll hear Bjørn offered to come back on the show and dive even deeper into the topics of medicalisation and overdiagnosis, to which I bit his hand off – so stay tuned.

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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

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Welcome to another episode of The Words Matter Podcast. 

We continue the clinical reasoning series, and I hope you enjoyed the first two episodes with Roger Kerry and Mark Jones where we covered how we can think about our practice, evidence and our patients.

However, given that the series is exploring clinicians’ reasoning around people with disease, it would seem prudent to consider what disease is both as a concept and phenomena but also the ethical and moral issues tied to and emanating from it and which motivate us to begin to reason about it.

As such, I’m speaking again to Prof. Bjørn Hofmann. I spoke with Bjørn in November last year – on Episode 55: about Dediagnosing- with his co-author Dr Marianne Lea.

Today we speak about his work on bioethics and talk around and about a recent paper of his titled 'Acknowledging and addressing the many ethical aspects of disease'. This is a two-part episode where the second part of the conversation focuses on his work on overdiagnosis and follows nicely from this episode.

Bjørn is a scholar in philosophy of medicine and bioethics with a special interest in the relationship between epistemology and ethics.

He is affiliated with the Department of Health Science at the Norwegian University of Science and Technology (NTNU) and the Centre for Medical Ethics at the University of Oslo. Bjørn's  main fields of interests include the basic concepts for health care including disease, causality, (over)diagnosis, medicalization and severity.

In this episode we speak about:

• What we mean when we say ‘disease’?
• Disease as both a concept and phenomena and how the concept of disease provides us with knowledge and guides our actions.
• Disease from a biological perspective, the experience of disease which we term called illness, and the societal perspective we call sickness.
• How these perspectives interact and how they might at times be in conflict with each other.
• We consider disease an an experienced phenomenon with a scientific description and a moral imperative
• We discuss the the moral functions, and why are they of great importance to patients and us as health professionals?
• And finally we touch on how the science and the ethics of disease relate.

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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.

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Welcome to another episode of the Words Matter Podcast.

On this episode of the CauseHealth Series, I’m speaking with Dr Kai Brynjar Hagen about his Chapter 10 that he wrote for the CauseHealth Book, titled ‘Lessons on Causality from Clinical Encounters with Severely Obese Patients’ (read Chapter 10 here).

Kai Brynjar is a Senior Consultant in the Regional Centre for Morbid Obesity, in the North Norway. He is also General Practitioner, District Medical Officer for Communicable Diseases and as you can imagine has his handful advising on the current pandemic.

He is Specialist in Community Medicine and is interested in ecological thinking in medicine, from the individual person to the policy level. And he is interested in primary causes of obesity development and factors that contribute to maintain obesity, such as trauma or other stressors (see his work here).

So in this chapter we talk about:

• The different roles that he has within the Norwegian healthcare system and how these relate to his thinking around causation.
• We talk about his view of causation in relation to obesity and how the biomedical view and diagnosis of obesity is insufficient to fully understand the whole person and the causal processes at play.
• Kai Brynjar contrasts the biomedical diagnosis of obesity (which focuses on medical symptoms such as diabetes or psychcobehavioural aspects such as diet or motivation for physical activity.
• We talk about how he strives for what he calls a ‘genuine’ causal diagnosis for severely obese patients.
• He tells us about the challenges of adopting a Whole Person Approach in larger structural and institutional settings which in he’s worked.
• We talk about about the main focus of his clinical encounters with obese patients, which is understand their life story- including their life as a child, and the centrality that this dialogue plays in the creation of a story together with the person.

So, this was another resonating conversation, with a clinician at the front line of helping people with complex causal stories. His compassion, warmth and sincere interest in obtaining a genuine understating of his patients’ causal story reverberated during our conversation.

So I bring you Dr Kai Brynjar Hagen.

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On this episode of the Words Matter Podcast, Dr Oliver Thomson spoke with Dr Thorvaldur (Valdi) Palsson. They talked about Valdi's excellent recent article (written with Ben Darlow, Greg Lehman and Samatha Bunzli) in Physical Therapy Journal titled "Changing the Narrative in Diagnosis and Management of Pain in the Sacroiliac Joint Area”. See full paper here.

Manual and musculoskeletal therapies and educators have, over the years, placed huge emphasis on the specifics and SIJ movement, function, palpation from both a diagnostics point of view and from the point of view of matching up the specific SIJ movement or positional dysfunction with a specific technique to correct it. Some therapies and therapists have built their career and professional identities on the mystical phenomenon of the SIJ 'dysfunction.

They talked about the the plausibility of manual testing and manual therapy to the SIJ, and the sorts of beliefs that practitioners and patients have in relation to the area. Then they go into the weeds, and discussed that by paying attention to the language that patients use provides us an opportunity to obtain interpretive portrayal of an individuals’ beliefs and experiences.

They also spoke about why words matter in relation to the SIJ regions and language provides an opportunity for us to begin to help shape new beliefs and news experiences in people with LBP/SIJ pain.

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In this episode I spoke with Dr Maxi Miciak. Maxi is a physiotherapist based in Canada, and is an Adjunct Associate Professor in the Faculty of Rehabilitation Medicine, University of Alberta.

Maxi received a doctorate in Rehabilitation Science in 2015 from the University of Alberta and was the inaugural Cy Frank postdoctoral fellow in impact assessment at Alberta Innovates, Canada.

Her PhD research resulted in the development of a conceptual framework of the physiotherapy therapeutic relationship, which offers a rich and insightful qualitative theory and it has received significant interest in scientific and clinical communities. Her excellent papers on the conditions and connections of the therapeutic relationship can be found here and here.

In this episode we:

• Dive into the nature of the therapeutic relationship as both a theoretical concept and also a central component to any interaction between patient and clinician.
• We talk about what constitutes a ‘good’ and perhaps not so good relationship with patients.
• We discuss the foundational conditions necessary for a therapeutic relationship to develop and how clinicians can be present with patients to help set the ground work for such a connection to be established.
• We also talk about how the fall out from COVID (such as virtual or tele healthcare, wearing PPE) might impact the sorts of relationships we want to develop with patients and Maxi offers useful workarounds to mitigate these negative affects
• I absolutely loved talking to Maxi, we really hit it off in podcasting terms, given this was the first time we’d spoken. She is also an experienced podcaster, and co-hosts the podcast Ignite Physio, which I thoroughly recommend subscribing and listening to, as Maxi has so much valuable and insightful knowledge and wisdom to share on the area of therapeutic relationships.

I bring you Dr Maxi Miciak.

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Welcome to another episode of The Words Matter Podcast.

In this episode of the CauseHealth Series, I’m speaking with Tobias Gustum Lindstad about Chapter 12 that he wrote for the CauseHealth book titled “The Relevance of Dispositionalism for Psychotherapy and Psychotherapy Research” (read chapter 12 here).

Tobias is a Clinical Psychologist both within secondary public mental healthcare and community-based primary care services, as well as in private practice. His research concerns the relevance of philosophy for psychology, psychotherapy research and mental healthcare.

He is the main Editor of the book Respect for Thought: Jan Smedslund’s Legacy for Psychology, coedited with Erik Stänicke and Jaan Valsiner, published by Springer (here).

So on this episode we talk about:

• The relationship between evidence (EBP) and psychological practice.
• The sort of evidence that is prioritised and the prevailing philosophical assumptions around knowledge and psychological healthcare.
• His criticisms of the value of the RCTs for generating knowledge which is meaningful for psychological practice, in particular being able to account for the unique meanings, experiences and perspectives that people have, and he likens this to what he calls ‘the medical pill model’ where psychological care is tested in the same way as a medical pill might be tested in an RCT.
• We talk about the problem of standardisation in psychological care and research.
• He tells me why Humeanism must be Replaced by dispositionalism in relation to causality in psychology.
• Finally, Tobias outline the major implications of dispositionalism for psychotherapy practice, including methodological pluralism, causal singularism, avoiding pseudo-empirical research and advancing the theoretical integration of psychotherapy perspectives.

So I really enjoyed talking to Tobias. It is clear he has thought very deeply about these important problems within clinical psychology and contributes wonderfully to the argument of how dispositionalism may go some way, if not all the way to addressing these fundamental issues in evidence-based psychological care.

So I bring you Tobias Gustum Lindstad.

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Welcome to another episode of The Words Matter Episode.

As usual I want to start by thanking all of you that are supporting the podcast via Patreon, your contributions all add up and make these conversations possible. If you’d like to contribute you can visit Patreon.com/thewordsmatterpodcast – every little helps.

So, we’re at the closing ceremony of The Qualitative Research Series. I hope you’ve enjoyed the episodes. I want to thank all my guests, that were incredibly generous with their time, knowledge and experience;  each one did a phenomenal job of communicating their qualitative expertise in an immensely engaging and passionate way.

They’ve been part of what I hope will be an incredibly valuable resource on qualitative research. If you haven’t listened to all the episodes, please do. And if you have listened to them all, go back and listened again from time to time as just like re-watching Game of Thrones, there are hidden nuggets, gems and insights which only become apparent on a second run.

So on this final episode of the qualitative research series, I’m speaking with Prof. Dave Nicholls in a special ‘Ask Us Anything’. I first spoke with Dave way back in episode 21 last year, in a hugely popular episode covering a range of topics related to the direction towards the end of professional healthcare practice, so if you haven’t listened to that episode, and want to hear more of Dave go back and have a listen (here).

Dave 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.

He 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.

So in this episode we talk about:

• How the nature and form that research education takes shapes the thinking and practice of healthcare professionals.
• The problem with the lack of sociological theories featuring in qualitative research and the absence of these theories in healthcare education.
• The continued dominance of the biomedical model in healthcare and how this relates to the sorts of knowledge, evidence and research that clinicians and students value; which is largely propositional, measurable and quantitative in nature.
• The problem of placing methods first, and that this process focussed research constitutes what he calls ‘quant lite’ rather than qualitative research. Dave has written a fair bit on qualitative research, see his CPN blogs here, here and here.
• Dave outlines his view on the problem of much of the current qual research and that many of the current batch of qualitative offerings is not fit for purpose and he outlines how post-qual provides a new way of thinking about and doing qualitative research (see paper here on the possibilities of post qual research).
• How healthcare is moving into a post-world; a postqualitative world, a postprofessional world and a posthumanist world.
• How his sociological and interest in Foucault motivates him to asks questions of the structures that guide practice and the discourses which precede us and define who we are.
• His view that the field of qualitative health research is replete with work examining the patient experience and that there are other, possibly more consequential sociological areas which need examining beyond this safe space for qualitative researchers. Dave talks about ‘bracketing out’ the patient experience from qualitative research…for a while at least.
• And with that we talk about the prominence of phenomenological qualitative research and how the possible rise of this particular methodology has been influenced by the deeper understanding of pain from a scientific perspective.
• And finally we discuss the incredible potential of qualitative research to give people other ways to see, to be and to experience the world.

So while this episode is badged as an AUA, it doesn’t meet this particular category or follow this particular style . This was part deliberate and part accidental. As rather than responding to your questions directly, we used them to create topics and themes of conversations which we hoped that by moving through, we would address some of the excellent questions that you sent in. The accidental part was that in all honesty we got carried away, and lost in conversation (which is easy to do when talking with Dave give the breadth, depth and pointedness of his views).

So if you were expecting a back and forth Q and A, this isn’t it. But we cover some extremely interesting and important topics related to qualitative research, healthcare practice and education. Dave has promised to come back for a ‘proper AMA’ and another time in the future, and we are planning a full blown Critical Physiotherapy Series, with him and his colleagues appearing on the podcast to really explore their critical reflections and challenges to healthcare practice and research so stay tuned.

Find Dave on Twitter @DaveNicholls3 and @CriticalPhysio

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Welcome to another episode of The Words Matter Podcast.

In this episode of the CauseHealth Series, I’m speaking with Dr Roger Kerry about his Chapter 13 that he wrote for the CauseHealth book titled ‘Causal Dispositionalism and Evidence Based Healthcare’ (read Roger's Chapter here).

Roger is an Associate Professor in the Division of Physiotherapy and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Nottingham. He specialises on risks and adverse events of manual therapy, neck pain and headache as well as clinical reasoning (see his research here). He holds a PhD in Philosophy with the doctoral dissertation Causation and Evidence-Based Medicine (see here). 

On this episode we talk about:

• His background as a physiotherapist, educator and researcher and how causation has featured in these areas of his work.
• The development of CauseHealth of which he was a founding member of the network.
• Roger’s Philosophy PhD which looked at causation in relation to EBM and how this related the CauseHealth project.
• The inferential gap or problem of induction
• The nature of clinical reasoning and clinical expertise.
• What is the ‘best available evidence’ in relation to causal dispositionalism.
• Whether there is objective ‘Truth’ in healthcare.
• What we ‘do’ with RCTs, and what does dispositionalim do with/say about RCTs and how the theory may change or support our clinical and research methods.

So this was an absolutely wonderful discussion with Roger, I’d been wanting to have him on the Podcast for ages- and it was well worth the wait. You'll hear him say  at the end of our chat that it was like going three rounds with Mike Tyson…but the feeling was completely mutual given the ground that we both covered in the conversation. This is a real treat.

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Welcome to another episode of The Words Matter Podcast.

I want to give a huge thanks to the people that support the show via Patreon, I couldn’t do this without you – so thanks again.

So, in we’re into the fourth episode of the Qualitative Research Series, and today I’m with Dr Victoria Clarke about thematic analysis.

Victoria is an Associate Professor of Qualitative and Critical Psychology at the University of the West of England. She teaches and conducts research in the intersecting areas of qualitative and critical psychology, sexuality and gender, family and relationships, and appearance and embodiment.

Together with her long-time co-author and collaborator Prof. Virginia Braun, Victoria has been central in developing, explicating and disseminating qualitative research methods, in particular thematic analysis.

The immense impact that Victoria and Virginia have had on qualitative methodological scholarship and practice is evidenced by the fact that their original 2006 paper on TA has received over 100,000 google scholar citations. Truly incredible.

Victoria’s books include the award-winning textbook Successful Qualitative Research, and their new book titled Thematic Analysis A Practical Guide, both of which she co-authored with Virginia. Their new book will be released in October 2021, and you can pre-order your copy here.

So in this episode we speak about:

• The history of Thematic analysis (TA).
• TA as being a ‘method-ish’ meaning it sits between both method and methodology. For example, it has a defined set of methods, but also has depth in how these methods are conceptualised and operationalised, including the research values and reflexivity to use them; meaning that that TA also has characteristics of a methodology.
• We talk about TA’s emergence as an immensely popular qualitative research approach.
• We talk about that as TA isn’t welded to a particular theory or onto-epistemological perspective, that this is in fact a feature which offers researchers theoretical flexibility and utility rather than a bug which would otherwise limit or bog down those wanting to embark on qualitative inquiry.
• We talk about reflexivity and how this value is nurtured within reflexive TA.
• We talk about some of the main criticisms and misconceptions of TA.
• We talk about the annoying notion of data saturation, and it’s links to positivism, and how to respond to peer-reviewers’ equally annoying requests to demonstrate the definite, final and ultimate position of saturation (see Victoria and Virginia's paper on data saturation here).
• We talk about presenting participants’ demographic information as a way to help readers of qualitative research to locate the findings within their own realities and assess the study’s transferability (see papers by Janice Morse here and here).
• Finally, Victoria shares her thoughts on post-qualitative research, which amongst other things, rejects systematic and somewhat repeatable qualitative methods, such as those that sit with TA. And to give you a heads up, that in the penultimate episode in this series, I’ll be speaking with Dr Jenny Setchell about post qualitative research.

So this was just another incredibly enjoyable conversation. Victoria really puts voice, passion, and argument behind reflexive TA, which I think has at times been unfairly portrayed as ‘atheoretical’ by methodological purists.

As Victoria and Virgina make clear in their paper 'Can I use TA? Should I use TA? Should I not use TA? the pursuit of the perfect qualitative approaches may be seen as a ‘hallowed methods quest’. The broad church of qualitative research calls for methods and methodological pluralism to suit the different questions, contexts, and resources that qualitative researchers have.

Find Victoria on Twitter @drvicclarke

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Welcome to another episode of The Words Matter Podcast. 

In this episode I’m delighted to speak with Physiotherapist Dr Kieran O’Sullivan.

Kieran graduated as a physiotherapist from the University College Dublin in 1999. In 2004 he completed an MSc in Manipulative Therapy at Curtin University of Technology, Perth, Western Australia. In 2005, he started lecturing at the University of Limerick.

In 2008 he was awarded specialist member status by the Irish Society of Chartered Physiotherapists. From 2016-2019, he took a 3-year career break to act as Lead Physiotherapist at the Sports Spine Centre at Aspetar, Qatar, and he shares his experience of this in the episode.

His research interest is musculoskeletal pain and injury, particularly persistent spinal pain. He completed his PhD on persistent low back pain.

In this episode we talk about:

• The progression of the BPS model and the barriers and facilitators influencing this progression.
• His experience of working within the different cultural and social contexts at Aspetar, Qatar.
• The systemic, organisational and structural factors related to clinicians practice behaviour and the challenges of implementing a BPS framework.
• The 'swinging pendulum' argument of the the BPS model in MSK practice.
• How we might inadvertently trivialise, invalidate or stigmatise patients experiencing MSK pain.
• His ideas around approaching MSK colleagues who hold misconceptions, unhelpful beliefs or adopt outdated treatment models.
• A communication strategy which has been affiliated with him - the 'Kieran O’Sullivan talk back Technique' 

Kieran has been a frequently requested guest, and it’s clear why. I really enjoyed talking to Kieran, his calm, warm and wise words were really effective in charting a way forward to overcome some of the challenges of implementing a biopsychosocial approach to practice.

Kieran is on Twitter @kieranosull

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Welcome to another episode of The Words Matter Podcast.

Thanks to all of you that support the podcast via Patreon, it means so much and really helps the podcast grow. If you’d like to support the podcast for as little as a pound or a couple of dollars per episode (here).

I’m taking a break from the Outsider episodes to explore the area of clinical reasoning, and to kick off the series I’m speaking with Dr Roger Kerry, whom I chatted with on the podcast last year in episode 35 where we discussed causation in relation to evidence based practice (EBP) as part of the CauseHealth Series.

Roger is an Associate Professor in the Division of Physiotherapy and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Nottingham. He specialises on risks and adverse events of manual therapy, neck pain and headache as well as clinical reasoning (see his research here). He holds a PhD in Philosophy with the doctoral dissertation Causation and Evidence-Based Medicine (see here). 

So on this episode we talk about:

• How EBP offers a backdrop to our clinical reasoning. The framework is now omnipresent across healthcare and Roger talks about how it should or could shape clinicians’ thinking, reasoning and interaction with patients.
• Some of the main developments, issues and questions resolved and those un-resolved around EBP.
• What it means to clinically reasoning within a EBP.
• How EBP makes us sensitive to the different sorts (and weighting) of knowledge and evidence and we discuss the implication of this with our clinical reasoning and the potential conflicts.
• Whether clinicians think like scientists and whether clinical reasoning is sciency?
• The similarities and differences between the scientific method and diagnostic reasoning such as data collection, hypotheses formulation, testing and inductive and deductive reasoning.

It’s always an absolute pleasure speaking with Roger; his laid-back style defies the intense consideration he has given to the deep philosophical problems of EBP which while as clinicians we may never fully appreciate (nor necessarily are required to) they help keep us on our toes and be aware and alive to how complex clinical practice is which should motivate us to ensure that our thinking and reasoning remains sharp and purposeful.

Find Roger on Twitter @RogerKerry1

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Welcome to another episode of The Words Matter Podcast.

In this episode of the CauseHealth Series I’m speaking with Professor Anna Luise Kirkengen about her Chapter 15 show wrote titled Broken Child – A Diseased Woman.

Anna Luise is Professor of General Practice in the Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), and has worked as General Practitioner for 30 years.

She specialises on the health impacts of childhood violation and is author many papers on the topic and also two books titled The Lived Experience of Violation - How Abused Children Become Unhealthy Adults and Inscribed Bodies - Health Impact of Childhood Sexual Abuse, ‘Creating Chronicity.

In this episode we speak about:

• Her experience as a GP and researcher, and the importance of patient stories and why she thinks phenomenology and whole person approaches are a crucial and ethical requirement for all healthcare professional.
• We speak about the problem with the biomedical model from a clinical and research.
• We speak about how she sees the body as being inscribed and saturated with meaning and how healthcare must stop thinking of the silent body and the speaking mind.
• We talk about how frameworks that endorse mind-body dualism are deeply problematic, and how she sees all experience as embodied.
• Finally, Anna Luise shares how she facilitates the patients’ narratives and her openness to encourage patients to confide, in detail, their stories of harm, shame and abuse.

So this was a rich and detailed conversation with someone who has spent decades seeking to understand whole people; their suffering, their hardship and their lives. Anna Luise shares some specific details of the people she has encountered through her work that have been abused as children. If you think this might be too difficult to hear, you may choose to skip a couple of minutes from around 24 minutes in.

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On this episode I spoke with Dr Noor Abdal, a physiotherapist who has a special interest in persistent pain.

Noor and I both completed our PhD's around the same time at the University of Brighton, and were part of the same 'methodological group' employing constructivist grounded theory (GT) to try and figure things out. We resisted the temptation to launch into a discussion about GT and qualitative research (but a podcast is coming focusing on this topic...), but if you'd like to read more about GT see my paper here on what GT is all about.

In this podcast we spoke about Noor’s clinical work as a Biopsychosocially orientated physiotherapist in Kuwait and how she’s integrating psychologically-informed practice in her management of patients with chronic back pain (CLBP).

We also talked about her PhD research which explored illness identities amongst Kuwaiti women experiencing chronic low back pain (CLBP). She developed a grounded theory to describe and explain the impact of cultural, social and emotional experiences on women’s manifestations of CLBP and their behaviours towards it. We also chatted about how MSK clinicians can relate this theory to their clinical practice.

This was almost a catch-up with an old friend in addition to the podcast. 

Find Dr Noor Abdal on Twitter on Instagram

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Welcome to another episode of The Words Matter Podcast.

So we are up to Chapter 4 of the CauseHealth Series, and I hope you’ve enjoyed the previous episodes.

In this episode I talk again with two of the editors of the CauseHealth book (download here), Dr Rani Lill Anjum and Dr Elena Rocca about Chapter 4 which they co-wrote titled ‘When a Cause Cannot be Found’ (read Chapter 4 here).

In this episode we talk about:

• Medically unexplained symptoms (or MUS) and how such health conditions, which defy a clear biomedical explanation, offered a practical and clinical challenge for CauseHealth to take on (see paper here by Rani, Roger Kerry and others).
• We talk about how the mere accumulation of more biomedical knowledge and scientific discoveries won’t necessarily lead to a satisfactory explanation of MUS in individual patients, and how and why a dispositionalist view of causation offers a deeper and person-focused understanding to the complexity associated with MUS.
• We discuss the Problem of Uniqueness –and outline the challenge this poses both practically (i.e. clinically and methodologically), and also the broader and more fundamental philosophical challenge of medically unexplained symptoms.
• We talk about how methodological and evidential pluralism and inclusivism can help provide this deeper contextual understanding, which is not captured by RCTs and other quantitative methods alone.
• Finally, we talk about how other forms of evidence such as patient narratives, case studies and qualitative research, which don’t traditionally get involved with causation, that when taking a dispositionalist view, do in fact have lots to say and contribute to in regards to causation in healthcare

This episode really made me reflect on the role and contribution of qualitative research towards causal explanations in healthcare whether it be recovery or the onset of pain and illness.

The dispositionalist view opens up space for qualitative methodologies and methods to sit at the table of causation and offers researchers from these disciplines a theoretical framework to allow rich, detailed and sometimes abstract qualitative evidence, constructed from multiple individual perspectives and experiences to add to a causative understanding of individual patients.

Find Elena and Rani on Twitter 

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Welcome to another episode of The Words Matter Podcast.

On this episode I speak with Dr Giacomo Rossettini. Giacomo is an MSK physiotherapist and researcher from Italy. He competed his PhD’ degree in Neuroscience in 2018 and has been working as a physiotherapist since 2009 specializing in Rehabilitation of Musculoskeletal Disorders.

He is a lecturer of Methodology and Clinical Practice of the Cervical Spine in the Master’s program of Rehabilitation of Musculoskeletal Disorders at Genova University and, he also lectures at Verona University: Bachelor’s program of Manual Therapy in Physiotherapy.

In the last 2 years he has promoted in Italy his course on "placebo, nocebo effects and contextual factors in physiotherapy and musculoskeletal pain”.

Giacomo has a growing track record of research into placebo, nocebo and contextual effects in relation to MSK healthcare practice (see here). Some of his excellent papers on these topics can be found here, here and here and have contributed to the Words Matter online course (see here).

In this episode we talk about:

• the nature and definitions of placebo, nocebo and contextual effects.
• how enriching our clinical rituals can constitute a contextual effect and boost placebo.
• avoiding nocebo through unhelpful clinical practice, communication and interaction.
• touch on the ethics of utilising contextual factors to enhance the placebo effect.
• we discuss the challenge of the lack of contextual factors and the ability to control such factors which has been placed on clinicians through face masks and conducting appointments via telehealth during the pandemic.

Huge thanks and applause to Giacomo for stepping up to the challenge and chatting in English- if we were relying on my Italian the podcast would never have happened and we’d all miss out on his incredibly informant information and experience.

I bring you Dr Giacomo Rossettini

Find Giacomo on Twitter @GiacomoRoss86

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Welcome to another episode of The Words Matter Podcast.

As usual, I want to start by thanking everyone that supports the show via Patreon and for those of you that share the podcast. The growth of the podcast over the past 6 months has been incredible, and I’m frequently getting messages from people across the globe and professional and academic landscape saying how much they’ve enjoyed the conversations – so a sincere thank you.

Like many of you, I’ve had a bit of a break over the summer and hopefully you have caught up on the incredible qualitative research series, so perfectly finished off by my chat with Prof. Dave Nichiolls.

And on this episode I’m continuing to explore the philosophical and conceptual side of the social world by speaking about relativism with Prof. Martin Kusch.

Martin is professor for applied philosophy of science and epistemology at the University of Vienna, and previously he was Professor of Philosophy and Sociology of science at the Department of History and Philosophy of Science at Cambridge University.

Martin has published widely on the philosophy of social science, social epistemology, the sociology of knowledge and the history of psychology. He also has a long-standing interest in everything to do with relativism and has published extensively in the area, including the books The Routledge Handbook of Philosophy of Relativism, Social Epistemology and Relativism, The Emergence of Relativism and Relativism in the philosophy of science. 

So on this episode we talk about:

• Relativism as a spectrum concept, with many different views of the doctrine ranging from radical to the more subtle.
• The many different domains of relativism, such as aesthetic value, taste, morality or epistemic justification.
• Martin sets out his five key ingredients of relativism, regardless of view or form of relativism. These principles are: Standards dependence, plurality, conflict, convergence and symmetry.
• How the commitment to equal validity, aka the ‘anything goes’ form of relativism is often by critics to define relativism in the most implausible way in order to attack it, and therefore can avoid engaging in the more nuanced, sensible and interesting versions of relativism.
• Why our sense taste is often used as a ‘test case’ for the plausibility or implausibility of relativism.
• We talk about the main opponent of relativism, namely absolutism.
• How relativism provides us with a sense of epistemic humility, but importantly this does automatically assume a position of epistemic tolerance.
• How methodological relativism has been used to good effect in the social sciences such as anthropology, ethnography and many of the qualitative research approaches which I've discussed on this podcast before.
• Finally, Martin offers his views about the different ways that we might access a reality, and what relativism has to say about notions of a single objective reality.

So it was a complete privilege speaking with Martin – I’d been dreaming of wanting to explore relativism on the podcast for a long time and had been hovering over the direct message button on Martin’s Twitter profile for many months – his friendliness and enthusiasm to share his knowledge and expertise podcast was just brilliant.

He really is one of the foremost thinkers and writers of relativism, and here are some of his excellent talks and videos, including an excellent TedX talk he gave in 2019 titled Scientific expertise in the age of post-truth.

Find Martin on Twitter @MartinKusch

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Welcome to another episode of The Words Matter Podcast.

So this is the first episode after the CauseHealth series, which was a phenomenal experience and I’m delighted that it seems to have landed far and wide across the healthcare landscape.

The series was epic, and I’m recording this a couple of days after the release of the final episode with Rani, Matt and Christine, so it feels a bit like the morning after the night before.

The CauseHealth experience has had an impact on the focus I want for the podcast, and I think the series may have shaped the trajectory and the sorts of conversations I want to have and bring to you.

So exploring the underlying assumptions, theory and philosophy of clinical practice will now certainly be on the agenda of the show. But also, in many ways it’s business as usual and I’ll continue to have a focus on the stories, language and relationships which are fundamental to clinical practice and the health care of people.

So please stay tuned, listen, re-listen to the episodes and subscribe to the Podcast.

On this episode I’m speaking with Karime Mescoto. Karime is a physiotherapist originally from Brazil. She is currently a final year PhD student at the University of Queensland, where her research is looking critically at the biopsychosocial model in relation to low back pain.

Her research is underpinned by critical theory utilising the qualitative research methodologies of Foucauldian discourse analysis and ethnography to understand how the BPS model is conceptualised, enacted and embodied and the power dynamics within it, around it and underneath it in the management of low back pain (listen to Episode 21 with Prof. David Nicholls where we touch on similar themes related to critical theory).

In this episode we talk about:

• Karime’s excellent critical review of the BPS model and how it has been conceptualised by researchers and the associated discourses about it.
• The fragmentation off the BPS model and how there is often an emphasis (albeit unintended) on the biological aspects.
• How the social aspects are often forgotten, de-emphasised and marginalised and why the social is everywhere and cannot or shouldn’t be avoided.
• Finally, we discuss the underlying and overlying power structures within clinical practice and an audio recording on the this important topic with two of her PhD supervisors Dr Jenny Setchell and Dr Rebecca Olson (listen here).

I really enjoyed talking to Karime. Her fresh outlook on an oldish model, using even older theory gives a new perspective and uncovers the hidden assumptions, meanings and power of the BPS model and how these may play out during research and when clinicians interact with patients.

Karime is a future star, and I cannot wait to read her further work in this crucial area of clinical practice.

Find Karime on Twitter @KarimeMescouto

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Welcome to another episode of The Words Matter Podcast, and the first episode of the CauseHealth Series.

We begin our journey through the brilliant CauseHealth Book titled Rethinking Causality, Complexity and Evidence for the Unique Patient. The book can be downloaded for free here or order a hard copy online here.

This CauseHealth Series of podcasts is dedicated to the late Professor Stephen Tyreman, a member of the CauseHealth team, and a colleague of mine at the UCO (see one of his final papers on person-centred care here - absolutely brilliant paper).

In this episode I'm talking with the three Editors of the book and authors of the first chapter Dr Rani Lill Anjum, Dr Samantha Copeland and Dr Elena Rocca (see chapter 1 here)

In this episode we talk about:

• What CauseHealth is, about the project and its aim.
• Why is philosophy relevant for clinical practice?
• The current challenges faced by clinicians and posed by the traditional evidence based paradigm (and the problem that CauseHealth looks to address).
• How revising our assumptions about the nature of causation will lead to a revision what counts as evidence and the sorts of methods used to generate such evidence.

If you liked the podcast, you'll love the Words Matter online course in effective language and communication when managing back pain - ideal for all MSK therapists and students (discounts for students available)

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Welcome to another episode of The Words Matter Podcast.

Only 6 months late, here is the Ask Me Anything number 3, where I respond to your questions you've sent me. Given how much time has passed since the last one (back in September last year) there was quite a library of questions to choose from, so I’ve selected a bunch to cover a range of topics.

So in this episode I share my thoughts on:

• The upcoming Qualitative Research Podcast Series.
• The need for still having three evidence facing MSK professions (physiotherapy, chiropractic and osteopath? Should we drop the labels and focus on clinical competency? Or does each profession have something unique that it brings to the table?
• My most influential non-therapy related books.
• What I have changed my mind about since starting your podcast.
• My best resources for explaining chronic/ persistent pain (in the absence of pathology) from a BPS perspective to patients.
• How I would use language differently with children.
• How the CauseHealth Series  (see here) has influenced the way that I practice and any adaptations I have made because of dispositionalism.
• My favourite philosopher and whether I use a particular philosophical framework in my clinical practice.
• On whether it is better to specialise in a field (eg headaches, shoulder or LBP) than be a general MSK clinician as a new graduate.

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Welcome to episode 16 of The Words Matter Podcast.

On this episode I speak with philosopher Dr Rani Lill Anjum.

Rani is Research Fellow in Philosophy at the Norwegian University of Life Sciences. Many of you will be aware of the research project she leads called Causation, Complexity and Evidence in Health Sciences, AKA CauseHealth. She is one of the leaders of the Norwegian University of Life Sciences Centre for Applied Philosophy of Science.

In this episode:

• Rani takes us through the CauseHealth project and one of its major outputs 'the Book' named ‘Rethinking causality, complexity and evidence for the unique patient (see here). This is excellent resource, with contributions from philosophers and clinicians to help tackle  with the philosophical biases that tacitly motivate evidence-based and person-centered clinical practice.
• She helps us dip our toe into the concept of causation and the different ways it can be conceptualised, and the importance of these conceptions with how we recognise evidence in relation to our clinical practice.
• We talk about what is a paradigm and the dominance of the scientific paradigm which underpins many of the assumptions of evidence-based practice.
• We touch on the reliance of RCTs in generating causal evidence and the potential contribution of other methods, including qualitative research to contribute to a better understanding of casual relationships.

So it all gets pretty philosophical, and this episode might require more than one listen. This sort of philosophy is hard. I know when editing the episode, and re-listening, the excellent information and philosophical concepts sunk deeper into my brain and became more obvious- so please stick with it- it’s well worth it.

I cannot recommend the CauseHealth book highly enough- it’s a fantastic resource and can be downloaded for free from Springer.

Rani also has an excellent video on Youtube presenting these ideas in more detail-  the video is here and is well worth watching to get a grip of this important area.

Find Rani on Twitter @ranilillanjum and @Cause_Health

See here for more about Rani

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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 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

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Find Nathalia on Twitter @nathaliaccosta1

Welcome to another episode of The Words Matter Podcast.

So this is part 2 of my conversation with philosopher and epistemologist Dr Carlo Martini, discussion the nature of expertise and how we recognise the associated attributes of an expert. If you haven’t listened to the first part of our conversation, go back and listen to that first so that this episode makes more sense.

So in this episode we speak about:

• The two dimensions to medical communication and we distinguish between scientific misinformation and disinformation.
• We talk about how the we recognise expertise while standing in the shoes of the layperson?
• We talk about who should be tasked with recognizing expertise
• And we talk about public perception of expertise and unsurprisingly we use the current pandemic as an exemplar of when experts disagree as well as as the propagation of medical misinformation and in some cases disinformation.

So I hope you enjoy this second part of my chat with Carlo, it’s been great to have him share his own expertise on the subject of expertise. 

Find Carlo on Twitter @MartiniCarlo

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Welcome to another episode of The Words Matter Podcast.

Again, I want to start by thanking all of you that are supporting the podcast via Patreon – its hugely appreciated and keeps the episodes flowing.

So we have reached episode 6 of the qualitative series, flying high above the different methodologies and occasionally landing to get a deeper sense of their philosophies, theories and methods.

Today I am excited to speak with not just one, but two phenomenologists to give us a really rich view of  phenomenology and its application to qualitative research.

Kathleen Galvin is Professor of Nursing Practice at the University of Brighton in the UK. Her research spans phenomenology, philosophy, qualitative research, the arts and humanities in health and action research. Her current research programme explores peoples’ experiences of a range of health issues, and using phenomenological-oriented philosophy develop novel theoretical framework for caring practices. This includes contributions to new theoretical perspectives on well-being, suffering and humanising approaches to human services.

Dr Pirjo Vuoskoski is a Senior Lecturer in Health Sciences (Physiotherapy Teacher Education) at the University of Jyväskylä in Finland. She teaches and conducts research in the intersecting areas of qualitative research and phenomenology, and physiotherapy. Pirijo is particularly interested in experiential phenomena and phenomenological contributions in regard to learning, teaching and assessment, in physiotherapy, educational and healthcare contexts. Methodologically, her particular interest is applied Husserlian (descriptive, pre-transcendental) phenomenology. She is currently working on phenomenological research that attends to the lived experiences of peer learning and mentoring, and practice-based assessment.

Alongside Prof. Kathleen Galvin and Dr Kitty Suddick, Pirjo will shortly be co-editing a special edition in the International Journal of Qualitative Methods that draws upon and honours the foundational contribution of philosophical thinking to a range of diverse phenomenological research perspectives.

So in this episode we speak about:

• Phenomenology as both a philosophical theory, method and also a qualitative research methodology.
• About the farther of phenomenology Edmund Husserl and distinguish between his epistemological project and the ontological approach offered by his student Martin Heidegger.
• Kate and Pirijo share their views on the different respective phenomenological qualitative research approaches, namely hermeneutic and descriptive; using Dr Kitty Suddick's PhD research as an example of hermeneutic and Pirijo's PhD work as an example of descriptive phenomenological qualitative research. 
• The idea of the ‘lifeworld’ in relation to phenomenological research (see paper on lifeworld research by Karen Dalhberg here and her paper on the phenomenon of loneliness here).
• What makes phenomenological research phenomenological (see paper here).
• How phenomenology, when used a as a framework for qualitative enquiry informs the methods such as data generation, sampling and data analysis.
• The concept and practice of ‘bracketing’ in phenomenological qualitative research.
• Finally, Kate and Pirijo offer some helpful advice about both embarking on phenomenological research but also incorporating phenomenology into practice (Kate recommends a book by Fred Wertz 'Five ways of doing qualitative analysis here)

So this was an absolute treat. To witness two experienced interlocutors share their deep knowledge of phenomenology was such an experience. The conversation begins by digging quite deep into some of the rich philosophy of phenomenology, but surfaces again mid way to locate these important ideas to the practice of qualitative research.

Find Pirijo on Twitter @h_pirjo

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Welcome to episode 6 of The words Matter Podcast. On this episode I spoke with Dr Jerry Draper-Rodi.

Jerry is a Senior Research Fellow at the University College of Osteopathy and is an academic clinician. His current roles include working as the Head of Continual Professional Development and as a Research Lecturer at the UCO, running an osteopathic practice in Oxford, and delivering CPD in BPS skills to clinicians mostly in France.

He is the treasurer of the Society for Back Pain Research, and a fellow of the International Osteopathy Research Leadership group at the University of Technology Sydney (Australia). Jerry was awarded a Professional Doctorate in Osteopathy in 2016.

His doctoral research was on the acceptability, feasibility and likely impact of a biopsychosocially-informed e-learning programme for non-specific LBP on experienced osteopathic practitioners' attitudes to back pain. See some of his published research here and here. 

Jerry is on the PhD supervisory team for David Hohenshurz-Schmidt who was my guest on episode 2 of this podcast where we talked about MSK going remote in light of COVID..

Jerry is a colleague and friend of mine at the UCO; our desks sit opposite each other in the same office. In between (or sometimes instead of) doing work we have endless chats often centring around our passion and occasional frustrations of enhancing students and clinicians’ practice towards a BPS approach to back pain.

Jerry, like many of us, came from a strong biomedical approach manual therapy background. So I was really keen to speak with him about his experience of breaking free from his traditional training and how he perceives his transition and the transition of others towards a BPS approach. Including how he manages the resistance, obstacles and opportunities to incorporating the BPS framework into clinical practice.

I really this enjoyed talking with Jerry, it was really helpful to have insight from someone who has successfully made the tradition and is now immersed in BPS practice, teaching and research.

This should be interesting to all MSK clinicians but especially those who are struggling to break free from the biomedical chains or perhaps are unsure or anxious about what a BPS future might hold. I bring you Dr Jerry Draper-Rodi.

Find Jerry on Twitter and Instagram

Subscribe to www.wordsmatter-education.com , and if you liked the podcast, you'll love the Words Matter online course in effective language and communication when managing back pain - ideal for all MSK therapists or students.

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Welcome to another episode of The Words Matter Podcast.

We’re on episode 15, and we take a minor detour away from the common theme of previous episodes to talk to Professor Dave Newell about conspiracy, dogma and belief within our respective professions osteopathy and chiropractic.

Dave graduated from Plymouth University with a PhD in molecular biology in 1986, and he holds positions of Professor of Integrated Musculoskeletal Healthcare and Director of Research at AECC University College and the post of Senior Research Fellow at Faculty of Medicine, University of Southampton.

The last last 30 years have been spent teaching and generating research in chiropractic institutions internationally holding the position of Research Director in two other chiropractic programs in the UK and abroad. Dave has considerable experience in teaching research methodology, critical thinking and the natural sciences as well as curriculum design, validation and accreditation of chiropractic programs.

He has published extensively in areas relevant to musculoskeletal conditions in general and the chiropractic profession in particular. Dave's contemporary interests and expertise include Patient Reported Outcomes, Service Provision Research and the role of contextual factors in the therapeutic encounter.

Dave is also one of the hosts of icarechirocast, an international podcast discussion with influencers and leaders in the chiropractic profession. 

In this episode we talk about:

• The continued tension between evidence-based practice and the practice of osteopathy and chiropractic.
• The importance of critical thinking, scientific reasoning and how evidence is either misinterpreted or over interpreted in conspiracy thinking.
• The role of dogma within osteopathy and chiropractic practice; the origins and spread of these traditional dogmas and their appeal to modern day clinicians and students.
• We discuss the continued challenge and pursuit of professional identify for both the chiropractic and osteopathy professions and the barriers and facilitators to developing a progressive and contemporary epistemology of practice.
• We go in the anti-vaccination views within chiropractic, osteopathy and complementary and alternative medicine (CAM) more generally

As you will hear, Dave and I could have talked all afternoon, and if it wasn’t for the hottest day of the year in the UK, we probably would have continued the discussion into the evening.

If your not an osteopath or chiropractor, there’s still plenty in this episode for you. Dave has a real breadth and depth to his knowledge which will have value for all critically minded clinicians.

I bring you Professor Dave Newell.

Find Dave on Twitter @NewellDave

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Welcome to another episode of The Words Matter Podcast.

On this episode I speak with Dr Peter Stilwell. Peter holds a Kinesiology degree from the University of Calgary, Doctor of Chiropractic degree from the Canadian Memorial Chiropractic College, and graduate degrees (MSc and PhD) from Dalhousie University.

He is currently a Postdoctoral Researcher at McGill University and his research interests include pain, suffering, and patient-clinician communication. 

Many of you will be familiar with Peter’s excellent paper with Katherine Hartman on moving beyond the BPS model toward a 5-E enactivist approach to understanding and managing MSK pain.

In problematising the BPS model in the way that it did, the paper really caused me to reflect on how I viewed and implemented the spirit of BPS  into my work. I know that the paper was a similar stimulus for many other of my own colleagues and clinicians across the MSK professions.

So in this episode we:

• Delve into some of the underlying assumptions and lack of theoretical foundations of the BPS model and how enactivism addresses these gaps.
• We talk about some of the issues of the BPS model in regards to its vagueness in its application and its tendency to crudely separate out complex component properties of the experience of pain.
• We also get into metaphors and how his qualitative research has illuminated the way in which metaphors are used and interpreted by both clinicians and patients.

Whilst it was my intention to drill down into his paper and enactivist model, time got the better of us- and I’ll be sure to invite Peter on for a follow up episode.

As ever with these podcasts, I enjoyed every minute of talking with Peter. His expression “I just wants to do it all” exemplifies his passion, determination and productivity in the furthering if knowledge in person-centred MSK practice.

His excitement and hunger is both palpable and infectious and have no doubt he will further build on his already significant contribution to knowledge in this area.

Find Peter on Twitter @Peter_Stilwell

And more about his work here

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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.

On this episode I’m speaking with physiotherapist, educator and researcher Dr Clair Hebron. Clair is Principal Lecturer at The University of Brighton, where she is course leader for the MSc Musculoskeletal Physiotherapy. As you’ll hear, Brighton University is how Clair and I know each other, where both of us were PhD students.

She has a special interest in musculoskeletal care and works with students and researchers exploring related areas such as health promotion, exercise prescription and conceptual research exploring understandings of more abstract ideas such as the therapeutic alliance, person-centredness and holistic care.

Clair has developed an interest in qualitative research methodologies such as phenomenological, phenomenographic and grounded theory approaches and utilising research integrating art, health and science.

So on this episode we talk about:

• Clair’s journey as a PhD student and her research exploring the dose-dependent effects of spinal mobilisation
• The personal challenges of applying reductionist research methods to a complex therapeutic intervention, but also how these experiences contributed to her current interest in phenomenological and conceptual research to explore a more complex and ambiguous topography of MSK practice.
• The false dichotomy associated with the hands on, hands-off debate in MSK therapy (see her 2017 paper here).
• Her rich and insightful qualitative work and how this research offers a perspective of the excellent work physiotherapists are doing but also where more changes need to occur
• Simple strategies to incorporates to start a more psychologically informed way of being as clinicians.
• Clair reads a powerful poem from a physiotherapist experiencing back pain, and the persons own feelings of guilt and embarrassment.

I had organically planned to talk with Clair about the current (but perpetual) debates within manual therapy, but was delighted not to dwell on previously well trodden discussions.

It was telling that a conversation by two MSK/manual therapists talked about the topics we did, and it is hopefully indicative of the journey individual clinicians and whole professions are making away from patients being mechanistic bodies needing fixing towards being people with complex situations, histories and experiences needing support.

Find Clair on Twitter @C_Hebron

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Welcome to another episode of The Words Matter Podcast.

As usual I want to start by thanking all of you that are supporting the show via Patreon, it really makes a difference - so thanks again.

So after seven episodes exploring qualitative research and the value of it’s methodologies and methods, it’s now time to dismantle all of that and talk about everything that’s wrong with qualitative research and why we should move beyond it!

I’m only half joking….because on this episode of the Qualitative Research Series I’m speaking with Dr jenny Setchell about a counter movement against qualitative research in the form of Post qualitative research.

Jenny is an NHMRC Research Fellow in Physiotherapy at the University of Queensland Australia. Her research interests include post-structuralist critical perspectives on healthcare and she has been published extensively across health journals (see Jenny's research here).

Her PhD was in psychology and focussed on weight stigma in physiotherapy. Jenny is experienced in a range of qualitative and post-qualitative research methodologies and she is a founding member, and co-chairs the executive committee of the international Critical Physiotherapy Network. She is also a member of the International Society for Critical Health Psychology.

 So on this episode we speak about

• Post-qual research as a way of re-thinking the reasoning and thinking which has underpinned the practice of qualitative research (see key paper here on post-qual by Simone Fullagar).
• How Post-qual challenges the humanist tradition of qualitative research (see here for seminal paper on post-qual here by Elizabeth St. Pierre)
• The idea of thinking with theory which post-qual strongly advocates (see book here in the same name by Alecia Jackson)
• How post-qual draws inspiration from critical post-humanist debates around how humanness has been taught around dualistic ways of thinking.
• How post-qual strongly rejects any theory–method divide that reduces qualitative methodology to a matter of technique (see paper here by Jenny's former PhD student Tim Barlott on the dissident interview which had a post-qual tone).
• How post qual is concerned with contravening what has become normal, routine and expected in qualitative research so that the approaches to research inquiry align with post-theories.
• What post qual has to say about data, methods, analysis.
• What can qualitative researchers take away from post qualitative research and whether we need to take ‘all of it’ and jump ship completely or that there are some useful way of reflecting on perhaps changing the way that we think about and practice qualitative research.

I absolutely loved talking to Jenny. She’s had such an interesting and diverse career, and this comes through in the cool, gentle yet confident way she talks about post qualitative research; who’s arguments could shake the most dedicated qualitative researcher. But there was nothing fanatical about Jenny; her balanced view of post-qual and how she feels that it can sit alongside more traditional qualitative and quantitative research approaches was just brilliant.

Find Jenny on Twitter @JenSetchell

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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.

On this episode I'm speaking with pediatric pain scientist and psychologist Dr Melanie Noel.

Melanie is an Associate Professor of Clinical Psychology at the University of Calgary, and a full member of the Alberta Children's Hospital Research Institute and the Hotchkiss Brain Institute.

She teaches and supervises within the CPA-accredited Clinical Psychology Graduate Program in the Department of Psychology at the University of Calgary.

And her behavioural research lab is based within the Vi Riddell Children's Pain and Rehabilitation Centre at Alberta Children's Hospital.

Melanie completed her PhD in Clinical Psychology and Dalhousie University Canada, and held a Post-Doctoral Fellowship in Pediatric Pain Research at the Seattle Children's Research Institute. 

The overarching aim of her research is to understand and harness the influence of cognitive-behavioral factors, like pain memories, on children’s pain trajectories using developmental frameworks. Her interests cover the areas of acute pain (such as painful medical procedures such as surgeries or vaccinations) and chronic pain in a variety of clinical and healthy populations.

Her clinical interests include child clinical and pediatric psychology populations, with particular interest in the intersection between children's physical and mental health.

So in this episode we talk about:

• public health messaging in relation to pain, in particular the influence of these messages on children.
• the nature and prevalence of paediatric chronic pain, and some of the key predictors for such pain states.
• diagnostic uncertainty for children with chronic pain and their parents.
• her research in the area of children's anxiety and pain memories as cognitive-affective mechanisms underlying trajectories of pediatric pain and future pain as adults.
• the  dynamic and dyadic relationship between a parent’s mood and behavioural responses to a child’s  chronic pain and how parents’ protective responses (such as pain catastrophising) influence a child’s pain experience.
• her strategies to reconstruct and re-frame a Childs pain experience to engender more positive behaviours and attitudes towards pain.
• At the end of the show you’ll hear our surprise that Melanie and I share a common experience, with her having triplets and me being a triplet.

So this was an absolutely fascinating talk, with someone really at the edge of knowledge in this crucial field. Melanie’s sheer enthusiasm and passion  for her work is a joy to listen to as well as her compassion for the participants and patients that are involved in her work.

On many instances the conversation is directed to the role of parents, rather than clinicians; but this episode has huge value for those without children, and significant value even if you never see children in your clinical work.

If you seek to obtain an understanding of where your adult patient’s pain beliefs, emotional responses and behaviours may originate from this podcast offers a real insight.

Find Melanie on Twitter @MelanieNoel

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Welcome to another episode of The Words Matter Podcast.

Once again, I want to start by thanking everyone that supports the podcast via Patreon – your contribution makes a huge difference to the quality and regularity of the episodes.

So if you want to pledge a pound, euro or dollar to each episode please visit The Words Matter Podcast Patreon page; if not that’s fine – please enjoy the episodes and share far and wide.

In this episode I’m speaking with Dr Carlo Martini. Carlo is Associate Professor of Philosophy of Science in the Faculty of Philosophy at Vita-Salute San Raffaele University (UniSR) in Milan and Visiting Fellow and Adjunct Professor at the Center for Philosophy of Social Science (https://tint.helsinki.fi) at the University of Helsinki.

His primary research interests are in philosophy of the social sciences, social epistemology and science communication. Carlo works on the role of expertise in knowledge transfer from science to policy, on scientific disinformation and public trust in scientific experts. See Carlo's work on the epistemology of expertise here.

Carlo is currently leader of the work package Behavioral Tools for Building Trust in the H2020 Project Peritia (Policy Expertise and Trust). We speak about Carlo’s work on the Peritia project in part 2.

So in this episode we speak about:

• The nature of expertise and the different conceptions of it.
• We distinguish between genuine and bogus or pseudo expertise.
• We talk about some of the attributes of expertise and that expertise is more than just knowledge acquisition or hours of practice or years of experience in a particular field.
• We talk about the purpose and function of expertise, and if experts don’t get better outcomes, then what’s the point?
• We talk about the role of tacit knowledge and distinguish between knowing that and knowing how.
• We talk about how we recognise expertise, how it is perceived and whether or not expertise is just in the eye of the beholder?
• Expert judgement and models of decision-making (see paper by Emanuel and Emanuel here), and we situate this in the context of evidence based practice (see Carlo's work on EBP here and here).
• We talk about Carlo’s collaboration with the CauseHealth project and he links expertise with the adoption of person-centred care and we allude situations when more practitioner-led care might be the more person-centred approach to take. And now is a good time to point you towards the phenomenal CauseHealth Series of 16 episodes involving conversations with the author of each chapter of the excellent CauseHealth book. 
• Finally we question the notion of ‘patient as expert’ and we both reflect on a paper written by the colleague of mine Prof. Stephen Tyreman who wrote a paper also critically evaluating the notion of patient as expert (see paper here). It deserves to be restated that the CauseHealth Series was dedicated in memory of Stephen owing to the significant contribution and impact he had on CauseHealth and colleagues and students alike.

This was a brilliant conversation with Carlo, which brought together several areas which the podcast has explored  (eg EBM, CauseHealth, Knowledge and philosophy in practice) to get a handle on what expertise is and the implications for the conceptions that we arrive at. In part 2 we talk about the public perception and confidence in expertise. 

Find Carlo on Twitter @MartiniCarlo

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Welcome to another episode of The Words Matter Podcast. In this episode, I spoke with Matthew Low.

Matthew is a Consultant Physiotherapist in the south of England, and is a Visiting Associate at the Orthopaedic Research Institute at Bournemouth University. 

He qualified from the University of Southampton and completed his Masters degree in Neuromusculoskeletal Physiotherapy at the University of Brighton, and is a member of the Musculoskeletal Association of Chartered Physiotherapists (MACP).

Matthew has lectured and examined for pre- and post-registration students at a number of Universities in the South of England, and has lectured on subjects such as motor control, spinal manipulation and clinical reasoning skills (see here for his CPD courses).

He has an interest and has published in areas of person-centred care, motor control, the theory of causation within the healthcare setting, philosophy, reflective practice and critical thinking skills. He also runs his own excellent blog with his reflections, thoughts and analysis of musculoskeletal physiotherapy, as well as being heavily involved with the brilliant CauseHealth project.

In this episode we touch on many different subjects relevant to contemporary clinical practice. Matthew has a brilliant grasp of a broad range of important, complex and sometimes challenging areas- and we attempt to tackle some pretty big topics, all of which really require a dedicated podcast each to fully unpack. 

So this episode could be titled the knowledge sink given we threw everything into it! Matthew will most certainly be back, so please let me know what topics you’d like us to talk more about.

We talk about the nature of knowledge which we use as clinicians, the assumptions of dominant knowledge structures and how these related to past and current conceptions of evidence-based practice.

We dip into the challenge of applying evidence to our our practice and locating the individual patient in the the ocean of research evidence.

We discuss on the role of clinical expertise and subjective judgement in evidence-based decision making.

This episode will valuable to clinicians who are contemplating the complexity of their clinical practice as well as those that like a sprinkling of philosophy on their clinical work.

Find Matt on Twitter and Instagram and his Blog Perspectives on Physiotherapy here

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Welcome to another episode of The Words Matter Podcast.

In this episode of the clinical reasoning series, I’m speaking with Sanja Maretic. Sanja is an osteopath who works in a non-traditional osteopathic role as a pain clinician in the pain management service.

Sanja has a background in humanities and passion for the intersection between healthcare and humanities and as such she published a qualitative study titled “Understanding patients' narratives” A qualitative study of osteopathic educators’ opinions about using Medical Humanities in undergraduate education (see paper here). And Sanja wrote a truly captivating review for the CauseHealth book which I have linked here.

So on this episode we speak about,

• Narrative-based approaches and the role and function of narratives in the care of people.
• Structural competency (see paper here by Metzl and Hansen) as a framework to appreciate the complex social contexts and structures which guide people health, illness and recovery (see paper on narrative humility here by DasGupta).
• How hearing our patients’ narratives enables us to know and see them, the social structures surrounding their lives and environment
• How narrative analysis can be used to think critically about our practice and the narratives which surround our clinical realities.
• How incorporating the arts, poetry and humanities into healthcare education will help widen the therapeutic gaze of clinicians beyond the mere biomedical.
• Sanja’s experience of journeying and finding her way into a multidisciplinary pain setting.
• The notion of ‘listening hands’ in relation to touch and palpation in manual therapy and how this may or may not facilitate the construction and understanding of a person’s narrative and life-world.

This was such a wonderful conversation; Sanja speaks truly as a clinician in the way she passionately describes her work and her endeavour to better understand and the lives of those people she cares for.

Find Sanja on Twitter @MareticSanja and Instagram @MareticSanja

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Welcome to Episode 5 of The Words Matter Podcast.

In this episode I spoke with Dr Kjartan Vibe Fersum. Kjartan is a Specialist Musculoskeletal Physiotherapist and a researcher. He divides his time between private practice in Bergen, in Norway and he is also an Associate Professor at University of Bergen. 

His research interests lie in the diagnosis and management of musculoskeletal pain disorders and he lead two RCTs investigating the efficacy of Cognitive functional therapy for low back pain, published in The European Journal of Pain in 2013 and 2019.

Kjartan also was part of the team that wrote the open access paper by Peter O'Sullivan et al., (2018) outlining CFT as a framework for disabling LBP here.

He is also part of the international collaboration group pain-ed.com, which is an excellent resource that translates and communicates the latest pain research to the public and health care professionals. 

I was really delighted and keen to speak to Kjartan. He’s been a key individual in the development, testing and teaching of CFT - which is perhaps the most cogent, coherent and comprehensive framework to guide therapists clinical reasoning  when helping people with LBP.

In this episode we talk about the journey of CFT, and the core skills and principles which centre around communication and CFTs contribution to clinical MSK practice. We chatted about the role of more traditional MSK skills such Manual therapy.

We also touched on the current evidence base of CFT, including his experience in leading two clinical trials intro the approach.

Kajrtan was a fantastic guest. He shares his exceptional expertise both passionately and energetically, which I’m sure you’ll enjoy. I bring you Dr Kjartan Vibe Versum.

Find Kjartan on Twitter and Instagram 

 
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Welcome to another episode of The Words Matter Podcast.

As always, a huge thank you to those of you supporting the podcast via Patreon – you help enable these conversations to become possible. f you’d like to contribute you can visit Patreon.com/thewordsmatterpodcast – every little helps.

Before we start I want to mention that a good friend of the podcast, Dave Nicholls who I spoke to on episodes 21 and 51 has a new book coming out titled Physiotherapy Otherwise, which is a follow up to his phenomenal book The End of Physiotherapy. I haven’t fully read it yet, but I am certain it will be immensely thought (and hopefully action) provoking and transformative like the it’s predecessor. The book will be available to download for free as a pdf and ePub in early January and I’ve provided the link here.

So in this episode I’m introducing a series of conversations with clinicians or former clinicians who feel they’re outsiders of their healthcare profession, sharing their experiences, struggles and how things could change. I’m calling this series the outsider series and I hope by speaking to people that feel like professional outsiders for a range reasons and in different ways, we can learn more about our professional selves and how we relate (or not) to each other and the idea of our respective professions. The intention of these episodes is not to further deepen any divisions within professions, but to better understand where and why divisions might exist.

Papers discussed in this episode:

• Cant, S.L. and Sharma, U., 1996. Professionalization of complementary medicine in the United Kingdom. Complementary Therapies in Medicine, 4(3), pp.157-162.
• Tyreman, S., 2011. Values in complementary and alternative medicine. Medicine, Health Care and Philosophy, 14(2), pp.209-217.
• Tyreman, S., 2008. Valuing osteopathy: what are (our) professional values and how do we teach them?. International Journal of Osteopathic Medicine, 11(3), pp.90-95.

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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.

On this episode I’m speaking I’m speaking Dr Filip Maric.

Filip is a physiotherapist with a background in musculoskeletal physiotherapy, as well as in philosophy, ethnology and psychoanalysis. His doctoral research employed the qualitative methodology of autoethnography to explore the ethical foundations of physiotherapy.

More recently, this work has led him to the in-depth exploration and development of environmental physiotherapy and with that, the relationship between health, physiotherapy, and the question of the environment. And we talk about his work in this area towards the end of the episode.

He is the founder and executive chair of the Environmental Physiotherapy Association and teaches and researches at UiT The Arctic University of Norway located in Tromsø.

So in this episode we speak about:

• His recent paper he wrote with David Nicholls (who I spoke with on episode 21), titled 'The fundamental violence of physiotherapy: Emmanuel Levinas’ critique of ontology and its implications for physiotherapy theory and practice', published in Open Physio Journal (here).
• How ontology, epistemology and ethics relate to each other, and how fundamental this relationship is to physiotherapy.
• His radical critique of physiotherapy as it applies to the philosophical foundations of physiotherapy and the notion of enforcing of professional identities
• The work of the philosopher Emmanuel Levinas, who’s perspective on ethics and ontology Filip utilised in his PhD to radically interrogate the theory, practice and identity of physiotherapy.
• Levinas's notion of ‘otherness’, meaning the openness for cultural differences and social diversity which has implications for how we relate to and interact with patients in clinical practice.
• The post professional era of musculoskeletal practice.
• The broader implications of his reconceptualisation of physiotherapy, and it not bing just about human health but ecosystem and planetary health. And how this incorporation of environmental concerns into the project of physiotherapy is greater than the concerns and differences between individual professions and practitioners, but it is  trans professional – and further contributes to a post professional era.

This was a really interesting conversation with Filip; he’s gone places with his thinking and argument where very few have dared to go.

It might at first appear that Filip’s strong critique against the current conceptualisation of physiotherapy is some sort of 'professional vandalism' or trouble making. But if you listen closely you’ll hear Filip’s aim is de-construction, not destruction to better understand where and how physiotherapy is and to begin to offer places where it could possibly go, albeit in a different form.

Find Filip on Twitter @filipmaricpt

Please support the show if you can by contributing 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.

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.

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Welcome to another episode of the Words Matter Podcast. 

We are now up to Chapter 7 of the CauseHealth book, and have entered part 2 of the book where will discuss the clinical application of the of the dispositionalist view of complexity and person-centred care that CauseHealth advocates.

In this CauseHealth Series episode I’m speaking with Christine Price about her Chapter 7, titled The Complexity of Persistent Pain – A Patient’s Perspective (read chapter here).

Christine has experienced neuropathic (nerve) pain, which she has lived with since an injury in 2008. She writes blogs and talks about her experiences of living well with pain, directed at both clinicians and patients. She is a regular presence on twitter, posting resonating content, which check and remind clinicians on who and what we should be centring our practice on. You can find Christine on twitter via her handle @LivingWellPain.

So in this episode we talk about:

• Christine's persistent pain journey and her experience of the care she received early on.
• With the benefit of hindsight (and with a philosophical framework of causal complexity!) she reflects on the biomedical assumptions and models which lead to a standardised and ultimately ineffective management approach for her pain.
• How her own understanding on causation influences the way you understood her initial onset of pain and persistence in the first year.
• How Christine later met a physiotherapist Matt Low (who has been on the podcast twice previously (here and here), and is on the next episode of the series) and experienced care informed by a dispensationalist clinical framework, and the changes that resulted in she thought about her neuropathic pain and the subsequent self-management.
• How she developed an interest in philosophy, and became involved in the CauseHealth research and network.
• Finally, Christine’s chapter has been by far the most downloaded chapter in the book. We touch on why this might be the case and the main messages she wated to convey in the chapter and the importance of communicating philosophy to clinicians but also patients.

I’d been looking for an opportunity to speak with Christine on the podcast for a long time- and this CauseHealth Series was the perfect setting. There is so much to learn from Christine’s story and her perspective on how mono-causal biomedicalism limited her recovery and her experience of the impact of a therapeutic interaction with a clinician adopting a complex view causality, with a clinical gaze focused on Christine as a person and her unique dispositions.

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Welcome to another episode of The Words Matter Podcast, and second in The CauseHealth Series, exploring the book 'Rethinking Causality, Complexity and Evidence for the Unique Patient (download here).

n this episode I’m speaking again with Dr Rani Lill Anjum, philosopher at the Norwegian University of Life Sciences (NMBU), and CauseHealth project leader, talking about her chapter 2, Dispositions and the unique patient. 

On this episode we talk about:

• Why the unique patient and the concept of medical uniqueness.
• Why do we need to think about philosophy when we address these clinical and evidential concerns?
• The ontological foundations of EBM, with particular respect to the nature of causation (see Rani's paper here and recent BMJ paper here).
• Dispositionalism as an alternative philosophical framework for person-centred healthcare.
• Practical implications: What does this mean for the clinician? How does the philosophical foundation matter in practice? (dispositionalist take home messages).

Find Rani on Twitter @ranilillanjum and @Cause_Health

See here for more about Rani.

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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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Welcome to another episode of The Words Matter Podcast.

This is the 3rd episode of The CauseHealth series, exploring the book Rethinking Causality, Complexity and Evidence for the Unique Patient (you can download the book here). And today I’m speaking again with Dr Elena Rocca about chapter 3 which is titled Probability for the Clinical Encounter (see full chapter here).

Together with Dr Rani Lill Anjum and Dr Samantha Copeland, Elena is one of the Editors for the CauseHealth book.  Elena is an Interdisciplinary Researcher with background in pharmacy, biology and theory of science at the Norwegian University of Life Sciences (NMBU) (see her research here).

In this episode we talk about:

• The different conceptions of probability including frequentism and propensity theory.
• The different ways that probability features in the natural world compared to the social word, and relate this to the some of current challenges of predicting behaviours of societies during the pandemic.
• Where, how and in what form probability and probabilistic reasoning comes into clinical practice.
• The overlap between developing an empathetic relationship and obtaining causal evidence from knowing the person suffering.
• The dilemma which at the core of CauseHealth which is making decisions about a person informed by evidence or knowledge which are not from that person, but in the form of theory, research evidence or previous experience.
• I really enjoyed talking to Elena. She held my hand brilliantly through a challenging topic and we tried to clearly link probability to clinical practice, so as with all these CauseHealth episodes, this chapter should provide an inviting doorway into her chapter 3 on probability.

Find Elena on Twitter @ElenaRoccaPD

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Welcome to another episode of The Words Matter Podcast.

I’ll again start by thanking all of you that support the show via Patreon – it really makes these conversations possible, and it's fantastic to see a growing community of researchers, students and practitioners support the show and find value in the episodes.

If you’d like to show your support for the podcast, you can pledge as little as £1 per episode by visiting Patreon here.

So, we're half way into the Qualitative Research Series, and to bring you up to date:

Episode 1 eased us in to qualitative research with Perri Tutleman. In Episode 2 we explored grounded theory with Prof. Jane Mills and Prof. Melanie Birks. In Episode 3 I spoke about Ethnography with Dr Fiona Webster. And in the last episode I spoke with Dr Victoria Clarke about Thematic Analysis.

If you haven’t listened to all them, I strongly urge you go back and catch up, as they’re fantastic entrances to their respective topics and there is also a little cross referencing to previous and future episodes - which will give you a rounded view of the series as it unfolds.

The series is shaping up really nicely, and I hope it will become a useful resource for those wanting to orientate themselves with qualitative research theories, methodologies and methods.

In this episode, I’m speaking with Dr Charlotte Albury about conversation analysis. Charlotte is a qualitative researcher that holds a Mildred Baxter fellowship from the Foundation for the Sociology of Health and Illness, and a Fulford Junior Research fellowship at Somerville College, at University of Oxford.

She has held multiple grants including grants from the NIHR school for primary care research, and the British heart foundation. Charlotte is course director for Oxford Qualitative Courses, which are expert-led practical short courses in qualitative methods, including conversation analysis, but also a range of other qualitative approaches.

She has led several research projects which use conversation analysis to identify how to optimise clinical communication including her current work  using conversation analysis to investigate COVID risk communication (see Charlotte's work using conversation analysis here, here and here).

So in this episode we speak about:

• Conversation analysis (CA) as a qualitative method to uncover the machinery and mechanics of social interaction.
• The history of CA and its emergence from the US sociology science in the 1960s.
• CA as a chimeric research methodology, with features and assumption which seems to align with quantitative or positivist research (such as notions of discovery of truth, the somewhat detached-objectivity of the researcher and 'quantifying' aspects of the data (such frequency counts); but also features which are familiar to qualitative research such as the analysis of textual data such as transcripts and the study of social interaction and phenomena). A fascinating hybrid.
• The the sorts of research questions that CA seeks to address.
• How Charlotte has used CA to understand communication between patients and clinicians to uncover the different strategies and outcomes of talk (see here for Charlotte’s PhD thesis and work here). 
• The Jeffersonian system of transcription in CA, which is very particular to CA, and the methods of data analysis once the transcriptions are generated.
• And finally Charlotte offers some advice for those considering embarking on a CA study or just want to find out more about the method.

So this was such an insightful conversation about an area of qualitative research which was quite unfamiliar to me. Charlotte describes the purpose and methods of CA incredibly clearly, providing a real insight into how conversation analysis proceeds.

The granular, almost reductionist detail of data analysis and the somewhat realist-objectivist notions of CA may initially not be your cup of tea, if you’re an interpretivist or social constructionist - but hold your horses! The forensic attention that conversation analysis gives to the specific words, language and talk offers something valuable to all qualitative researchers interested in understanding and portraying human interactions and social processes. 

I certainly learnt a great deal which I will take with me into my current and future qualitative projects.

Find Charlotte on Twitter @AlburyCharlotte

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Welcome to another episode of The Words Matter Podcast.

As always, a huge thank you to those of you supporting the podcast via Patreon – you help enable these conversations to become possible. f you’d like to contribute you can visit Patreon.com/thewordsmatterpodcast – every little helps.

So, on this episode I’m continuing with the Outsider Series where I speak with clinicians who feel they’re outsiders of their profession; sharing their experiences, struggles and how things could maybe change.

And this may be the last outsider episode for a while, as I’m pausing the series to commence the much-anticipated clinical reasoning series, with some fantastic guests, so stay tuned, but there are plenty more outsiders planned to share their experiences.

Today I’m speaking with former osteopath Rob Jonah. Rob qualified as an osteopath in the UK a couple of years ago, having changing from his previous career as a plumber. He talks about his experience as a student and initial period in professional practice; a combination of which lead him to leave the osteopathy profession and return to his plumbing career.

Rob’s experience of being an osteopath is just that, his experience. And as you will hear it’s a largely negative one. However, I believe that by hearing his experience of how he entered the osteopathy profession and then abruptly left those of us in clinical education and leadership may learn how we can better develop new osteopaths who are on the edge of professional life and support new clinicians post-qualification.

I know Rob personally, and he’s not some disgruntled and bitter new grad that couldn’t hack it as an osteopath. It was clear to me that he wanted to make it work, he gave it his all and that leaving the profession was a difficult and undesired last resort. I hope and I think you will come to the same view after listening.

If you want to have more context into Rob’s decision to leave the osteopathic profession, you can check out the place where he announced his decision on his Instagram profile @How2Move.

Needless to say, it sounds like Rob’s in a much better place now and I wish him the best in his return to his previous career (see here).

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Welcome to another episode of The Words Matter Podcast. 

On this episode I’m continuing with the Outsider Series where I speak with clinicians who feel they’re divorced from their profession, and share their experiences, struggles and how things could change.

And today I’m speaking with Aaron Kubal. Aaron is a chiropractor in the United States who works with people experiencing pain via telehealth exclusively. He has developed a large social media following, which he uses to advocate for evidence-based, person-centered care, as well as criticise harmful/unsupported narratives & practices. Aaron's non-conventional journey through the beginning stages of his career has positioned him as an outsider within his chiropractic profession.

So it was great to speak with Aaron, his journey to the outsider resonates with mine (see my outsider episode here). And many of you will know Aaron from his incredibly engaging Instagram posts and Tiktoks where he transfers knowledge and evidence around the care of people experiencing pain, and smashed head on the myths and dogma which surround chiropractic and MSK practice. Sailing against such a strong current, it’s not surprising that Aaron feels like an outsider of his profession.

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Welcome to another episode of The Words Matter Podcast.

Thanks again to all of you that are supporting the podcast via Patreon – your support is making these episodes and this qualitative research series possible. And you can visit the Patreon here if you’d like to support the show.

So, we’re up to episode seven of this qualitative research series, and today I’m speaking with Dr Anna Rajala about critical theory.

Anna originally trained as a Physiotherapist (Pirkanmaa University of Applied Sciences in Finland), and then pursued Master of Art’s in Philosophy, Politics and Economics of Health (UCL in London).

She recently completed her PhD in Humanities, at the Centre for Applied Philosophy, Politics and Ethics, at the University of Brighton, UK. Her thesis analysed the relationship between theory and practice of the critical theorist Theodor Adorno’s  philosophy and her work re-reads the relationship in the context of ethical theories and concepts used in physiotherapy.

Anna is currently working as a Researcher in the Academy of Finland funded project Assembling Postcapitalist International Political Economy at Tampere University in Finland, in which she is analysing global physiotherapy discourses on dementia, politics, and economics. 

She is Co-chair of Critical Physiotherapy Network, co-Editor-in-Chief of the peer-reviewed journal of the Finnish Death Studies Association, and co-founder of a mental health physiotherapy webpage. Read more about Anna's work in her blog here

Anna’s research interests include German and French philosophy, medical humanities, ethics, politics of affect, and philosophy and global political economy of dementia, mental health, incontinence, and rehabilitation.

She has published on the embodied value of long-term care and critical physiotherapy ethics, and she is currently preparing both single- and co-authored publications on Critical Discourse Analysis and diverse economies of dementia rehabilitation, deconstructive readings of incontinence-related political economy, and a critical reading of Shakespeare’s character Richard III.

So she perfectly qualified to walk us through critical theory.

In this episode we speak about:

• Critical theory as a framework for pursing qualitative research (see book here by Jerry Willis that we mention in our chat).
• The reach of critical theory into political, social and economic life.
• How qualitative research which is situated in critical theory looks to challenge the taken for granted assumptions, social norms and practices and the understanding of discourses and power inequalities.
• How critical theory is also critical of itself and has gone some way to evolving away from its Marxist roots.
• How critical research tries to go beyond merely describing the social world and its problems but has a moral focus on change, action and emancipation as a result of the knowledge it generates.
• Finally Anna shares some of her own research using her critical theory lens and offers advice for those wanting to begin to explore and think with critical theory (see here).

So this was such an interesting and enlightening conversation with Anna. As you’ll hear, I was somewhat daunted by the theoretical, social and political weight and breadth of critical theory and I was concerned I would feel like a child lost in an amusement park when trying to convey its history and relevance to qualitative work – but fortunately Anna held my hand firmly and skilfully guided me through the conversation.

While we didn’t dive deep into critical theory, as we would have never likely never surfaced – I think that we covered sufficient ground to introduce some of its major premises and positions and hope it provide an entrance point for those wanting to learn more – I know it certainly did for me.

Find Anna on Twitter @AnnaIlonaRajala  

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Welcome another episode of the Words Matter Podcast.

On this episode I spoke with Tom Jesson. Tom is a musculoskeletal physiotherapist from Northumberland in the UK, who has recently moved to Michigan, in the USA.

Tom has developed an interest in sciatica after a popular twitter thread and continues his deep immersion into the sciatica literature.

I first became aware of Tom from his excellent episodes both as a host and guest on the Physio Matters Podcast, where he has talked about his deep dive into the sciatica literature and also a truly exceptional episode with John Launer on Narrative medicine, and recently an engaging and insightful episode with Tina Price on her experience of living with sciatic pain.

Having listened to Tom’s thoughtful analysis and discussion on these topics, I had to get him on the podcast to talk about these issues further.

In this episode we talk about:

• The different diagnostic labels associated with sciatica and the implications of using these terms with patients.
• The issue of accuracy and precision both from a medical and terminological perspective.
• The challenge of naming and labelling complex subjective phenomena relating to a pain experience.
• The sacrificing of precise terms for terms for which are more meaningful and functional for the person with sciatica.

Tom was a brilliant guest and I really enjoyed the conversation. It’s clear he’s really taken time for think deeply and critically about these important and often extremely challenging areas of clinical practice.

Find Tom on Twitter @thomas_jesson and check our his excellent newsletter for all things sciatica and radicular pain related  https://tomjesson.substack.com/ and for more about Tom see his personal website tomjesson.com

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Welcome to another episode of The Words Matter Podcast.

A quick note to thank all of you that support the podcast via Patreon, your contributions make a big difference (contribute here).

So we are into episode four of the clinical reasoning series, and I continue my conversation with philosopher of medicine Prof. Bjørn Hofmann where we develop our discussion which started on the ethical implications of disease in the previous episode to now moves on to overdiagnosis and medicalisation.  

And for reference we speak around Bjørn’s 2016 paper titled "Medicalization and overdiagnosis: different but alike." Published in the journal Medicine, Health Care and Philosophy (see paper here and see Bjørn’s other work on the topic here)

In this episode we speak about: 

• Distinguishing between the concepts of medicalisation and overdiagnosis and discuss their main drivers.
• How medicine, health care,  and health professionals have become ever more diligent in defining, detecting, preventing, and treating disease – covering more ground than ever and how this can lead to the adverse situation of overdiagnosis.
• The positive and adverse effects of giving someone diagnosis
• What Bjørn terms the ‘asymmetry of aversion’ meaning that for many health professionals is worse to overlook something than to over do something which may facilitate over diagnosis.
• The role of AI and machine learning to address the crudeness and imprecision in some our diagnostic labelling and processes.
• High and low-value care and the role of healthcare economics on how readily we dip into the diagnostic toolkit and medical testing.
• How the expansion in the concept of disease (and diagnosis) has lead to over diagnosis and medicalization
• And finally we discuss what can we do to reduce the detrimental expansion of disease and subsequent over diagnosis.

So this was another wonderful conversation with Bjørn. He is able to transfer incredibly thought provoking yet fundamental questions to clinical practice and our care of people, and I have immensely grateful to him for giving up so much of his time.  

Welcome to another episode on The Words Matter Podcast, I’m Oliver Thomson.

So on this episode of the CauseHealth Series, I’m speaking with Dr Karin Mohn Engebretsen about her Chapter 11 of the CauseHealth Book, titled “Reflections on the Clinician’s Role in the Clinical Encounter”. Karin is a Gestalt Psychotherapist, working in private clinical practice in Oslo, Norway.

Her doctoral research (see here) was on phenomenology and medically unexplained symptoms, with particular focus on burnout. She has Published a series of research papers from her PhD studies, many of which are open access (see here, here and here).

 So in this episode we talk about:

• Her journey into Gestalt psychotherapy and the congruence of her clinical role with dispositionalism.
• Burnout, and how it been treated in a reductionist way, with the attempt to reduce it to depression.
• Her experience interviewing participants in her PhD studies, who were experiencing burnout and how they felt about such a simple reduction of their situation.
• Her experience of tensions working in the tension between different paradigms/methods (positivism, constructivism, phenomenological).
• How she sees any therapeutic process as a function of the relationship between the interacting therapist, client and their common field as a whole.
• The important role clinicians have in the the clinical encounter, and the zone of intersubjectivity where meaning and causal stories are constructed
• And finally, Karin has some suggestions for those of us who are not psychotherapists, but would like to adopt a more embodied-relational understanding and approach to their clinical practice.

So this was really enjoyable discussion, with someone who has integrated dispositionalist theory with existing research and practice theories, namely existential phenomenology and constructivism.

This episode offer a real insight into the utility and compatibility of causal dispositionalism for person-centred clinical practice for all forms of healthcare, not just psychotherapy.

So I bring you Dr Karin Mohn Engebretsen

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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.

So this is the first episode of the Qualitative Research Series, where my guests and I fly above to get a broad overview of qualitative research but then also land on areas to get a more detailed sense of the different theories, methodologies and methods of qualitative research.

In addition to todays episode, the conversations coming up include Grounded Theory with Professors Melanie Birks and Jane Mills, Phenomenology with Dr Pirjo Vuoskoski, Thematic Analysis with Dr Victoria Clarke, Critical approaches with Dr Anna Rajala , Post-qualitative approaches with Dr Jenny Setchell, conversational analysis with Dr Charlotte Albury and there will be a final special qualitative research Ask Us Anything episode with Prof Dave Nicholls. Dave and I will be discussing and answering your questions on qualitative research and related topics.  

So in this first episode of The Qualitative Research Series I’m speaking with Perri Tutelman. Perri is a PhD Candidate in Clinical Psychology at Dalhousie University (Halifax, Canada). Her research is focused on understanding the pain experiences of children with cancer across the disease trajectory (see here and here). She has published several qualitative studies that explore the lived experiences of patients, families, and healthcare providers in the areas of pain and serious illness. She actively mentors graduate students interested in qualitative methods and recently co-guest edited a Special Issue on Qualitative Research and Pain for the Canadian Journal of Pain, and there were some a great webinar on the Special edition with Perri and the other contributors here. 

So in this episode we speak about:

• Perri’s journey into qualitative research from a her background as a psychologist trained in quantitative research methods
• What qualitative research is and what it isn’t, and that it is more than just type of data collected
• Qualitative research as a heterogeneous family of methodologies, each with different philosophical, historical and theoretical backgrounds and underpinnings- the challenge this diversity this can bring but also the richness and flexibility.
• The different foundational assumptions of qualitative research (such as views on knowledge, reality and truth) and how these support, justify and inform the research methods (such as data collection, analysis sampling).
• Locating qualitative research in context of quantitative research and evidence based practice – and what it offers and where it fits.
• The role, value and contribution of qualitative research for generating knowledge about all aspects of pain and pain management.

So this was such an enjoyable discussion with Perri and the perfect opener of the series. Hearing Perri’s journey into qualitative research, her early challenges and frustrations and how she is now using qualitative approaches resonates with my own experiences and I’m sure many of you that have also had to grapple with initial discomfort of stepping into a different research paradigm.

It was great to share this and introduce some of the key aspects of qualitative research and also talk through valuable contribution that qualitative research can make to building a rounded and relevant evidence-base to support clinical practice.

Find Perri on Twitter @PerriTutelman

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Welcome to another episode of The Words Matter Podcast. 

As always, a big thank you to those of you supporting the podcast via Patreon – really takes the edge of the cost of producing these two-weekly episodes, so thank you.

The line-up for the upcoming clinical reasoning series is being finalise, covering topics such as ethics or disease, values based-practice and reasoning, thinking narratively, embodied reasoning plus cognitive perspectives such as hypothetic-deductive reasoning, pattern recognition and knowledge schema. I’ve got some wonderful guests planned, some have appeared on the podcast before while others have not and I’m super excited to talk with them all and hopefully create a rich, insightful and hopefully useful resource for clinicians and students.

A final note, Episode 21: Saying the unsayable and thinking the unthinkable - a critical look forward with Prof. David Nicholls seems to be having a resurgence over a year after it was recorded, and I’m frequently receiving messages from you saying how much the episode resonated. I’m not quite sure the reasons for this or what to make of it. As radical as Dave’s view might be i.e. to reboot physiotherapy and osteopathy and start again (see Dave's books here, here and his new one here), the idea at least seems to speak to the crises of existentialism, lack of belonging, identity and the general discomfort or dissatisfaction of where we currently find ourselves with respect to our clinical practice and profession. Anyhow, I’ll keep digging in this topic I’m with Dave again and others too and see where we arrive at and what the solutions might be. Listen to our second brilliant episode here.

So, on to your questions of which there were lots, and as usual I’ve tried to select a good spread of topics.

• I really enjoyed the qualitative research series, I was wondering how do you integrate qualitative research findings into clinical practice? See my chat with Matt Low here and Roger Kerry here for the CauseHealth Series (here).
• What was your journey from positivist research to constructionist? See here for essential social constructionism reading Ken Gergen here, Kathy Charmaz here, Berger and Luckman and Bury’s social construction of medical knowledge and see a rebuttal paper here. Plus my recent chat with Prof. Martin Kusch on Relativism here.
• What is the best paper you have read or authored? My favourite papers as a clinician here and here, as a researcher here and here and here and as an author here and here.
• In qualitative research are themes constructed or are discovered?
• Why do osteopaths and other MSK practitioners prefer guru experts over solid fundamental evidence? See recent episodes with Dr Carlo Martini on expertise here and here.
• Do you think there is anything unique about osteopathy that distinguishes it form other similar MSK professions?
• Also, as a clinician who is also a researcher, academic. Did you ever struggle with the transition? Also feeling lonely and not know how or where you fit in ? Any tips?
• As a practicing MSK clinician what is the most useful MSc/PhD?

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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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Welcome to another episode of The Words Matter Podcast.

Following my commitment to explore the theoretical aspects and philosophical underpinnings of clinical practice, I’m diving in with both feet in this episode. As today I’m speaking with Dr Sabrina Coninx and Dr Peter Stilwell.

Sabrina is a philosopher currently located at the Institute for Philosophy at the Ruhr University Bochum in Germany. She is a postdoctoral researcher and scientific coordinator of the Research Training Group Situated Cognition. She has a Bachelor in Psychology and Philosophy, and a Master and PhD in Philosophy with a focus on Philosophy of Mind and Science. Her philosophical work is empirically informed and aims to contribute to debates across disciplines, including clinical practice. Her research focus is on pain, emotions, suffering, and affective disorders. For more information on her work see here. For more information on the RTG 'Situated Cognition' see here.

Peter is currently a Postdoctoral Researcher at McGill University and his research interests include utilising qualitative methodologies and involve theoretical/conceptual approaches to explore pain, suffering, and patient-clinician communication. Peter spoke with me on the podcast last year, and many of you will be familiar with his excellent paper from 2019 with Katherine Hartman introducing enactivism as a theoretical framework to move us beyond the biopsychosocial model. He’s been very busy since then, and he published a number of related papers including his most recent one with Sabrina which we speak about in this episode. Find our more about Peter and his work here.

So in this episode we speak about:

• Phenomenology as a philosophical framework.
• Enactivism and the value of this theoretical perspective for understanding pain and practice.
• We also speak about enactivism in relation to dispostionalism (see CauseHealth Series here) and try to tease out some the differences and similarities between these two theories.
• How enactive approaches can help us address the ‘integration problem’ (which is focus of their new paper), and how enactive approaches can causally integrate different phenomena such as neuropeptides with knees with cognitions with spines and with social relationships.
• We speak about affordances as potential opportunities to better care for, treat and manage people living with pain.
• How the concept of affordances can help us understand differences (beside mere temporality) between acute and chronic pain.

This was just a thrilling conversation. The combination of Sabrina’s perspective as a philosopher and Peter’s ability to bridge and translate these ideas with his clinical background was a complete joy. Their passion, curiosity and willingness to explore all sorts of different topics related to their paper was such fun. 

Find Peter and Sabrina on Twitter @Peter_Stilwell and @sconinxphil

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Welcome to another episode of The Words Matter Podcast. As usual, thank you to all the support via Patreon – every pledge is hugely appreciated.

So I did say that the previous episode with Rob Jonah would be the last outsider episode for a while, in order to make way for the clinical reasoning series.

However, there’s time for one more and I’m delighted to squeeze this one in before Dr Roger Kerry kicks off the Clinical Reasoning Series where we talk about sciencey thinking in the context of evidence informed clinical reasoning.

So make sure you hit the subscribe button on your podcast player so you don’t miss out on what will be a brilliant collection of conversations.

On this outsider episode, I’m speaking with Dr Gita Ramdharry. Gita is a Consultant Allied Health Professional in Neuromuscular Diseases at the Queen Square Centre for Neuromuscular Diseases UCLH in London. She is an Honorary Associate Professor at UCL and a Visiting Professor at Kingston University.

She has worked as a physiotherapist since 1995 and developed a special interest in neurology early on. Gita completed a PhD in 2008 looking at walking patterns, endurance and orthotic interventions for people with Charcot-Marie-Tooth disease. See more about Gita’s research here.

Last year, Gita wrote a wonderful blog post on her experiences of the interaction and sometimes clash between the physiotherapy professional culture and her own mixed heritage and cultural background. The blog is titled 'Awakening to the impact of culture on how we deliver care and treat our colleagues'.

In her blog Gita talks about the challenges she perceived as student, educator and clinician in feeling like a cultural outsider in relation to physiotherapy. I’ve linked the blog in the show notes and would encourage you to have a read as it’s the perfect accompaniment to our conversation.

This is the first time that I’ve directly focused on culture and ethnicity on the Podcast and Gita provided the ideal opening to these important issues and I’ve taken so much away from listening to her experience and I am sure you will too.

Find Gita on Twitter @gitaramdharry

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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. This is an impromptu podcast given that the world is in the grip of the COVID19 pandemic, and we are all having to adjust to new ways of living, thinking and being- including how we practice as clinicians.

Dr Oliver Thomson speaks with osteopath and  David Hohenshurz-Schmidt, an osteopath and PhD student in Pain Research, about how communication skills have now been thrust into the forefront of musculoskeletal and MT practice, given that we are now unable to touch their patients due to the pandemic.

In this episode they spoke about the shift in skills necessary for manual therapists and MSK clinicians to conduct appointments remotely either online or via telephone, and thee requires a change in how clinicians (and patients) conceptualise and see value in all different aspects of the clinical practice, such as the nature of ‘treatment’, their therapeutic role and their professional identity.

David is an osteopath and graduate of the University College of Osteopathy (UCO) in London, and he’s also currently in private clinical practice. He completed his MSc in Neuroscience from King's College London, where he focused on pain research using fMRI. He published his MSc research in Frontiers in Neuroscience Journal, not a bad start to a research career! See here for the full paper)

He’s currently in the midst of a PhD at Imperial College London, where he’s part of the pain research group (lead by Prof. Andrew Rice here) investigating methods to improve how we assess effectiveness of non-drug, non-surgical therapies for pain, including manual therapies, CBT, body-mind therapies, acupuncture. Moe about David's research here.

David and colleagues at UCO have developed a free webinar (see here) to offer advice and guidance for osteopaths and all MSK clinicians to move their clinical work remotely. It's a great resource and I found it extremely helpful for my own transition online.

You can reach David on Twitter at @davidhosch

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Welcome to another episode of The Words Matter Podcast.

In this episode of the CauseHealth Series I’m speaking with Dr Brian Broom about his Chapter 14 that he wrote for the CauseHealth Book titled “The Practice of Whole Person-Centred Healthcare” (read chapter here).

Until early 2019 Brian was a Clinical Immunologist at Auckland City Hospital and is Adjunct Professor in Psychotherapy at Auckland University of Technology. He is trained in internal medicine and psychotherapy and now works to train clinicians to practice whole person-medicine and healthcare (see here).

Brian has written three books addressing this issue: Somatic Illness and the Patient’s Other Story, Meaning-Full Disease: How Personal Experience and Meanings Cause and Maintain Physical Illness and Transforming Clinical Practice Using a MindBody Approach: A Radical Integration.

In this episode we talk about:

• His interesting professional journey from immunology, psychiatry and to psychotherapy.
• How immunology and psychotherapy seem to be rooted in different paradigms- and how he has managed to bridge the two and addressed any tensions and challenges.
• The role and value of the story in his whole-person perspective.
• Relationship-based care; which resonates with my conversation with Dr Maxi Miciak in episode 9, and it will be worth re-visiting that podcast off the back of this one (listen here).
• What he calls ‘Hearing stories’ and making diagnoses and how these two pursuits relate.
• Medicine as body only practice and traditional psychotherapy as mind/story only practices and how his whole-person approach avoids this dualism.

This was an absolutely captivating conversation with Brian. The sincerity and compassion in the way in which he tells his own story of his whole person-centred approach really illustrates the way that practice needs to change to be truly person-centred.

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Welcome to another episode of The Words Matter Podcast.

So we’ve reached the end of the CauseHealth Series, and in this final episode I’m speaking with Rani Lil Anjum, Matthew Low and Christine Price who share their reflections on the podcast series from the perspectives of philosopher, clinician and patient.

We also discuss some of the practical recommendations which appear in the final section of the book (here), and that are needed in order to re-situate person-centred healthcare within a new paradigm.

It has been a real privilege for me to be speak to each and every author of this ground-breaking resource (free to download here). Like so many of you, I’ve learnt so much personally from each of the conversations.

What has become clear to me during this series is that not only does CauseHealth offer novel a framework for understanding causation, but it also moves us to take a critical look at all of our assumptions around so many areas of healthcare practice, whether it be the nature of evidence, the role of clinical judgement, how patients and clinicians might relate to each other as well as broader issues of public health policy.

So in many ways, for me CauseHealth offers a bold formal theory of genuine person-centred care, which has explanatory power that reaches far, wide and deep into our healthcare practice, policy and our patients' lives.

So I bring you Rani, Matthew and Christine.

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Welcome to The Words Matter Podcast. On this episode I talk again to consultant physiotherapist Matthew Low.

Matthew and I spoke on episode 07 and many of you requested to 'get Matt back' which despite me trying to get this trending on Twitter I couldn’t break through the big political story of the hour.

Matt and I continue our discussion about the nature of clinical practice and how evidence and the patient can help is navigate the Rocky undulating terrain of MSK care.

We also go further into the role of bias and subjectivity in clinical practice and how we can help manage, understand and incorporate the patient’s values and preferences into clinical decision-making.

One reason I always enjoy talking to Matt is the extensive clinical expertise he brings to the conversation.

The clarity with which he is able to verbalise his ‘real world’ clinical reasoning and practice and whilst also drawing upon and situating these aspects in the philosophical, theoretical and research knowledge is both immensely engaging and impressive.

Expertise such as this are something to behold, and not easily found in MSK care.

We also talk about the Chapter he wrote for the new CauseHealth, Book Rethinking Causality, Complexity and Evidence for the Unique Patient. Matt’s captivating chapter titled 'Above and Beyond Statistical Evidence. Why Stories Matter for Clinical Decisions and Shared Decision Making'  formed an outline of our conversation. 

The book is completely free to download and is an essential resource for all clinicians. Click here to access it.

I hope you enjoy my second conversation with Matt. It is really just more of the same from him-  clear, wise and insightful.

Find Matthew on Twitter and Instagram and his Blog Perspectives on Physiotherapy here.

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Welcome to another episode of the Words Matter Podcast.

We continue our journey into the CauseHealth book, and this time talking again to Dr Samantha Copeland about Chapter 6 (see chapter 6 here), which is titled ‘The Guidelines Challenge’. Chapter 6 closes Part 1 of the book, the Philosophical Framework, and the next episode represents Part 2, the Clinical Application, where quite rightly, I’ll be speaking with Christine Price about her experience as a patient, of complexity and her persistent pain (see all episodes of the CauseHealth Series here).

In this episode we talk about:

• The original aims and purpose of clinical guidelines, and how they were developed to operationalise evidence-based practice.
• The ontological and epistemological assumptions around causation that are built into guidelines.
• The tension between evidence based guidelines and a dispositional view of causality for understanding health, disease, and the effectiveness (or not) of medical Interventions.
• The sorts of evidence (methods) which make up guidelines and what is the problem/conflict here when practitioners implement these to individual patients.
• How guidelines should be developed to account for the particulars of individual patients? (not just methodological pluralism but a revised ontology of causation).
• How guidelines should be utilised or viewed by clinicians.
• The integration of guidelines with expertise, judgement, decision-making
• Finally, we talk about Lessons learned from Oxford ‘Guideline Challenge’ conference, and in the show notes have linked a editorial paper by Samantha and colleagues (see here) which outlined the major problems and positions presented in relation to guidelines, and how dispostionalist theory might provide some solutions to enable the better development and utilisation of guidelines for person-centred care.

So this episode has it all; EBM, clinical reasoning, judgment, ethics and even AI. Samantha does a fantastic job in articulating hers and the CauseHealth’s vision of guidelines. 

Find Samantha on Twitter @samdotC

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Welcome to another episode of The Words Matter Podcast.

So this is the second episode of the Qualitative Research Series, and today I’m speaking with Prof. Melanie Birks and Prof. Jane Mills, who for me are amongst the most influential communicators, educators and developers of grounded theory in the past decade – so its a real treat to have these superstars of GT contribute to this qualitative series.

Melanie is a Professor of Nursing (Quality and Strategy) at James Cook University in Australia. She has an extensive publication track record, including numerous textbooks and articles on grounded theory. Her research interests are in the areas of educational accessibility and relevance, and preparation of a well-prepared health workforce. She is committed to promoting quality, evidence-based education and practice through these endeavours.

Jane is the Dean and Head of the La Trobe Rural Health School, and she is considered one of Australia and New Zealand’s foremost nurse academics with extensive experience leading and managing teams in both government and tertiary sectors. Her research portfolio focuses on rural and public health, health workforce, and health system strengthening. Jane’s career vision is to contribute to a just society by fostering research and graduates that make a positive difference and she believes education and research are powerful vehicles for change.

So in this episode we speak about:

• What grounded theory (GT) is and what is it not.
• A brief history of GT, the context in which it arose, underpinning philosophies, and the different generations.
• Melanie and Jane's own epistemological positions on GT and how they arrived at them (see here for example).
• GT in context of other qualitative methodologies; what aspects and methods are common and which are somewhat distinctive of GT.
• What constitutes a GT study but also the product of a GT study, namely a grounded theory – and we touch on what makes it grounded and what is meant by theory.
• The importance of the position of the researcher, including managing ‘bias’ and preconceptions, reflectivity and the role of the researcher
• Some of the key methods of GT.
• The notion of theoretical sensitivity, which guides theoretical sampling, theoretical coding and theory development.
• What constitutes quality in GT, and how do we know when we have developed a ‘good’ GT.
• Their tips and advice for embarking on or engaging with grounded theory research (see their FAQ paper here). And for a paper on how I've operationalised constructivist GT see here.

As you will hear, I was really excited to speak with Melanie and Jane. As I say in the out chat, the first edition of their book Grounded Theory: A Practical Guide was a great help to me during my doctoral research and subsequent teaching and supervision around grounded theory. And I was honoured to make a small contribution to their second book, and wrote a short piece on how I used non-participant observation and video-prompted reflective interviews to facilitate theoretical sufficiency and grounded theory development (see here).

And keep a look out for the 3rd edition of their book, which is due out next year.

Find Melanie and Jane on Twitter @melbirks @profjanemills

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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.

So we’re up now up to episode 13- and the high quality conversation just keeps coming, and this one is no exception.

In this episode I speak with David Nolan. David is an MSK physiotherapist working within the NHS at Sheffield Teaching Hospitals, in the north of England. He is a full time clinician currently spending his clinical days between Occupational Health and primary MSK care as an extended role musculoskeletal Physiotherapist at PhysioWorks in Sheffield.

As we discuss in the podcast, his research interests are around manual handling and lifting. In this episode we discuss:

• His research looking at the views around lifting of physiotherapists and manual handling advisers and how these relation to their back beliefs. See papers here, here and here. We’ve repeated his study with osteopaths due to be published later on this year with similar findings.
• We touch on how lifting and back pain beliefs are constructed and the common sources of such perceptions.
• We talk about his systematic review (see here) which looked at the differences in lifting between people with and without back pain.
• David shares his extensive clinical experience in assessing and managing lifting beliefs and behaviours in people with back pain.

You might notice a bit of interference in sound during the first 8 minutes which shouldn’t distract you from David’s incredibly valuable insights to lifting and back pain.

Find David on Twitter @DMNPhysio

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Welcome to another episode of The Words Matter Podcast, and the first Ask Me Anything episode. Thanks for all your questions, please keep them rolling in for future AMA episodes.

In this AMA I discuss:

• The main barriers that I encounter for musculoskeletal clinicians/osteopaths to adopt a biopsychosocial approach to their practice.
• Recording diagnoses in clinical notes, and moving away from specific tissues to other factors salient to the persons' situation and experience.
• How I got into academia, my PhD journey and suggestions for those wanting to begin to dip their toes in.
• The main challenges I experienced moving from student to novice and then to a more experienced clinician.
• My view on how evidence-based practice can and should blur the boundaries of musculoskeletal therapies, professional identities and distinctiveness. 

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Welcome to another episode of The Words Matter Podcast.

I hope you enjoyed the previous two episodes of the Qualitative Research Series; the first one introducing qualitative research with Perri Tutleman and the last episode on grounded theory with Professors. Jane Mills and Melanie Birks. I found the conversations so enjoyable and look forward to continuing through the series.

So we continue our journey into and across qualitative research, and in today’s episode I’m speaking about Ethnography with sociologist Dr Fiona Webster. Fiona is an Associate Professor at Western University London, Ontario, Canada. Her research interest lies in the sociology of chronic pain and other chronic health conditions, with a particular focus on using critical and institutional ethnographic approaches.

Fiona has published extensively using and ethnography including a powerful ethnographic study of chronic pain management in primary care, titled 'The social organization of physicians' work in the midst of the opioid crisis', published in the journal PLoS One (see here).

She has also written a book titled 'The Social Organization of Best Practice An Institutional Ethnography of Physicians’ Work’ which explores how best practice for acute stroke care was developed, translated and taken up in medical practice across various sites in the province of Ontario (see here).

So in this episode we talk about:

• What ethnography is, its problematic history and its place as ground zero for qualitative research.
• Ethnography’s ability to captures complex, naturally occurring social interactions in contexts that are not subject to experimental control (see a really useful paper by Fiona introducing ethnography here).
• The different epistemological approaches within ethnography and touch on Hammersley’s critique ‘What’s wrong with ethnography’ which articulate the methodological and epistemological confusion which he perceived within ethnography, namely 'naive realism' and 'relativism'. I would suggest you also real Grant Banfields rebuttal “What’s really wrong with ethnography where he proposes 'subtle realism' as a solution to the confusion).
• The way in which ethnographic research is carried out, from data collection (such as participant observation, field notes and interviews) and some of the ethical issues of prolonged immersion in the field and who can be researched in the research field.
• The Hawthorne effect, that is peoples' change in behaviour when they know they’re being observed and how this does (or doesn't) relate to ethnographic observation.
• Data analysis and reflexivity within an ethnographic study.
• Finally, Fiona suggests some classic and influential ethnographies for those wanting to find out more about ethnography, including the books Forgive and Remember: Managing Medical Failure, The Spirit Catches You and You Fall Down, Boys in White and finally the autoethnography Leaving the Boys: A Story of Motherhood and Career, Feminism and Romance.

So this was just a wonderful conversation with Fiona. She describes the theory and practice of ethnography perfectly, and her powerful insights into institutional ethnography and the rich data and findings that ethnography generates just made me want to do some ethnography!

Find Fiona on Twitter @FionaWebster1

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Welcome to another episode of The Words Matter Podcast.

In this episode of the CauseHealth Series I'm speaking with Professor Ivor Ralph Edwards about his Chapter 9 of the CauseHealth book (download for FREE here) titled Causality and Dispositionality in Medical Practice (read his chapter here). Ralph is Professor of Medicine and Senior Advisor (and Former Director) at the Uppsala Monitoring Centre, the WHO Collaborating Centre for International Drug Monitoring.

He has worked in clinical toxicology in the fields of drug abuse, acute and chronic poisoning, toxicity from industrial chemicals as well as adverse drug reactions. He now works on medical and legal aspects of causality evaluation, as well as issues of risk and benefit evaluation and data mining approaches to support signal detection and evaluation.

In this episode we talk about:

• Ralph’s view of causation early in his career as a medical career.
• His role in leading the global work to improve clinical reporting on possible side-effects.
• We talk about how when working on medicine safety globally, he sees that different dispositions in different population groups affect how they response to medicines.
• Ralph gives us examples from his own clinical work where some of the dispositionalist features of causality have been important.
• We discuss the time it takes for a causal story to emerge.
• Finally we discuss the problem of relying too much on quantitative evidence and statistics to measure and standardise medical practice and treatments.

It was pleasure speaking with Ralph. He has a vast and varied experience in medicine, and it was great to hear the role that causal dispositionalism has played in his work. His many anecdotes, great sense of humour and a voice for a podcasting, made the conversation all the more enjoyable.

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

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Facebook Words Matter - Improving Clinical Communication

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

If you liked the podcast, you'll love the Words Matter online course in effective language and communication when managing back pain - ideal for all MSK therapists and students (discounts for students available)

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Facebook Words Matter - Improving Clinical Communication

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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Facebook Words Matter - Improving Clinical Communication

Welcome to another episode of The Words Matter Podcast.

A quick note to thank all of you that support the podcast via Patreon, your contributions make a big difference (contribute here).

We’re about halfway through the clinical reasoning series and today I’m speaking with Dr Euson Yeung. Euson is a physiotherapist and an Assistant Professor in the department of Physical Therapy University of Toronto.

His primary area of teaching and research interest is in orthopaedic manual therapy as well as the assessment and facilitation of clinical reasoning among health professional learners. Euson completed his Masters in Education at the University of Toronto (Adult Education) and his PhD with the Rehabilitation Sciences Institute at the University of Toronto.

In this episode we hover around a research paper he published year titled ‘Making Strange’: Exploring the Development of Students’ Capacity in Epistemic Reflexivity published in the Journal of Humanities in Rehabilitation

So on this episode we speak about:

• How the process of reflexivity and in particular epistemic reflexivity calls us to question, or to ‘make strange’ the taken-for granted ways in which we practice.
• We talk about the organizational and social structures which surround healthcare interactions, and the embedded assumptions within our practice.
• We talk about how reconceptualising practice also entails Imagining other ways of how our practice could be.
• We talk about the challenges of becoming more enraging in reflexivity.
• And we discuss ways that clinicians can better support the more reflexive aspect of their practice and thinking.

So I really enjoyed talking with Euson; the work he is doing within physical therapy education is fundamental.

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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Facebook Words Matter - Improving Clinical Communication

Welcome to another episode of The Words Matter Podcast, and second Ask Me Anything episode.

Thanks for all your questions, please keep them rolling in for future AMA episodes.

In this AMA I discuss:

• Three things I wish I'd known before becoming an osteopath.
• My view on 'telehealth' and online MSK healthcare.
• How I use 'pain education' in my clinical practice.
• My experience of teaching manual therapy skills.
• How I transitioned to a BPS-orientation.
• Managing patient preferences and expectations for manual therapy.
• The role of historical concepts and traditions in my practice. 

Subscribe to www.wordsmatter-education.com , and if you liked the podcast, you'll love the Words Matter online course in effective language and communication when managing back pain - ideal for all MSK therapists and students.

 
Instagram @Wordsmatter_education
Twitter @WordsClinical

Facebook Words Matter - Improving Clinical Communication 

Welcome to another episode of The Words Matter Podcast.

So we continue our exploration of the CauseHealth book (download for FREE here), via this CauseHealth Series, and we have reached the midway point. In this episode I’m speaking with Matthew Low about his Chapter 8 titled Above and Beyond Statistical Evidence. Why Stories Matter for Clinical Decisions and Shared Decision Making (read Chapter 8 here).

Matthew is a Consultant Physiotherapist in the south of England, and is a Visiting Associate at the Orthopaedic Research Institute at Bournemouth University. Many of you will be aware of Matt’s excellent writing and thinking (see here, here and here), and he’s been on this podcast twice previously in episodes 7 (here) and 10 (here) about evidence, practice and knowledge.

In this episode we talk about;

1. Matt’s journey into dispositonalism and CauseHealth.
2. EBM in context of MSK practice and how has it shaped and impacted his practice.
3. We talk about how a dispositionalist view of causation can frame the clinical questions and problems within MSK care.
4. We talk about the role of clinical judgement; can we have too much? And who wins in a fight, evidence or judgement? And what to think and to do when these knowledge domains collide.
5. We talk about stories OR statistics…or stories AND statistics, and how both forms of evidence can complement each other to give a vivid portrayal of the individual person and their story.
6. We talk about the co-construction stories as a way of mutually identifying dispositions with the person
7. And we talk about the practical/clinical consequences of adopting a dispositionalist perception on causation.

As expected, this was another hugely satisfying and insightful conversation with Matt, he has so much to offer on causality, evidence and person-centred care. His vast clinical experience, means that his perspective is very much ‘from the trenches’, making the theory all the more accessible and usable for clinicians. So please enjoy, and Matt will definitely be back in a Words Matter Quadrilogy later this year, so stand by.

Find Matthew on twitter via @MattLowPT

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

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Facebook Words Matter - Improving Clinical Communication

Welcome to another episode of The Words Matter Podcast. 

So we continue on the clinical reasoning series, and on this episode I’m speaking with Mark Jones. And if you haven’t already listened to the previous episode in the series “Do clinicians think link scientists” with Roger Kerry, I suggest you take a listen as my conversation with Mark builds nicely from there.

Mark is an Adjunct Senior Lecturer in the University of South Australia with 35 years’ experience teaching undergraduate and postgraduate physiotherapy.

He has a special interest in biopsychosocial health care and the teaching and assessment of clinical reasoning in physiotherapy. Mark has conducted and supervised research in the areas of clinical reasoning and musculoskeletal physiotherapy with over 90 publications including three editions of the text “Clinical Reasoning in the Health Professions” and the text “Clinical Reasoning for Manual Therapists”. His latest text “Clinical Reasoning in Musculoskeletal Practice” was published in 2019.

And he has been on one of the major contributors to the development of clinical reasoning theory within MSK healthcare in the last 30 years, and we discuss some of his key work, including the seminal work with the late Louis Gifford and Ian Edwards (see Ian's work on clinical reasoning here here and here).

So on this episode we talk about: 

• The development of clinical reasoning theory beyond mere diagnostic reasoning.
• Different aspects or strategies of clinical reasoning such as procedural, predictive and collaborative reasoning.
• The pursuit of a structural or pathological diagnosis.
• Mark's own clinical reasoning framework involving hypothesis categories.
• Clinical reasoning within a biopsychosocial framework.
• Diagnostic reasoning approaches such as hypothetico-deductive reasoning and pattern recognition.
• Clinical reasoning in novice compared to expert clinicians.
• And finally we discuss the role of metacognition to mitigating errors in reasoning.

So it was truly and honour speaking with Mark. The label ‘pioneer’ is probably over used, but in Mark’s case it captures his status perfectly. His work on clinical reasoning theory was one of the cornerstones of my own doctoral work into clinical reasoning (see here here and here) and helped make explicit the processes behind my thinking and doing in my clinical practice – which up until engaging with Mark’s work were completely unbeknownst to me.

His knowledge of the field is incredibly extensive as is his ability to communicate and make this information accessible to clinicians and students.

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.

Follow Words Matter on:

Instagram @Wordsmatter_education @TheWordsMatterPodcast

Twitter @WordsClinical

Facebook Words Matter - Improving Clinical Communication