The following blog post is a social commentary on events that I have witnessed on social media with regards to recent debates, discussions and at times, all-out verbal brawls among physiotherapists. I’ve seen everything from fair play and agreements, to insightful discussion, to profanities and name-calling.
Conveniently enough, I recently stumbled across a presentation by Jonathan Fass at the 2017 San Diego Pain Summit that inspired this blog post and much of the rhetoric within it. It was kindly brought to my attention by a peer. This presentation is an absolute must listen for every clinician. It is approximately one hour long. Please take the time to give it a listen.
For the longest time, I’ve been plagued by the questions: How can I effectively get my message across? What am I doing right? What am I doing wrong? What can I learn from this experience? Over the last 10 months, I’ve tested different methods of delivery with InfoPhysiotherapy.
Understanding Cognitive Dissonance
My latest post on the current evidence for the use of kinesio tape was one of my more controversial posts. I received a good amount of support, but an even more overwhelming amount of resistance. Not only was this inevitable, it’s a normal and natural process. According to a study published by Hart et al. in 2009, cognitive dissonance, “motivates people to defend themselves by seeking more congenial [pleasant or agreeable because suited to one’s taste or inclination], than uncongenial information”. The latter reinforces defense motivation and accentuates congeniality bias or confirmation bias.
Can I simply assume that I was met with resistance because people know what they know, and they do not want to hear anything new? Of course not! What if my delivery method was ineffective? What if I had eased into the topic more gently? What if my method of choice allowed the information to be perceived more as threat than genuinely useful?
This brings me to my next point. Dissonance also occurs when the person is met with information that is inconsistent with their values or perceptions (Harmon-Jones et al., 2015). Why is this relevant? When presenting information that contradicts their values, it can be perceived as a threat, as well as a personal attack on the very integrity of the care they provide. This can manifest as an urgent and immediate reaction that is often defensive in nature. Although we aren’t intentionally trying to threaten the integrity of their practice, perhaps that is what they are hearing? IF this is in fact what they are hearing when I try to communicate my message, then the conversation is over. Neither side has benefited from the exchange and quite frankly, I’ve done a terrible job at communicating my intended message.
It’s Time To Educate, Not Alienate…
What if the people we are trying to reach out to are willing to listen but we just aren’t communicating the message properly? What if they are providing resistance today, but are willing to listen tomorrow? We communicate and interact with each other every day. In practice, we communicate with our patients, with our colleagues, and with other healthcare professionals. As Jonathan Foss mentions in his presentation, what we do today affects everyone, and if we can get that message across effectively, then we can, in turn, help our patients.
In order to accomplish this, we need to adopt a mix of strategies to properly communicate our message. Everyone has their own way of learning. Some will have more intrinsic motivation than others to seek out information and further their knowledge on their own. That’s ok. We need to be able to identify which types of clinicians will benefit from which learning strategies so that they are matched to a learning strategy that best suits them.
There seems be a more positive and receptive response when the information provided (whether congenial or not), is deemed as useful by the recipient (Hart et al., 2009). Perhaps we can learn from this. Perhaps shouting out, “oh look, here is a paper I found on this topic?” is not the approach we should be taking. Perhaps the accuracy of the information doesn’t matter as much as whether or not the information can be useful to our audience. What if we could learn from the information provided? What if it could introduce a new way of thinking or take our clinical reasoning in a different direction? What if this information is is a stepping stone to something new or something better?
Optimizing Learning Through Social Media
I believe that it’s time we re-frame our approach and deliver our content and communicate our message in a different way. We need to modify our teaching strategies to better suit the learning approaches of our audience. If we don’t adapt and change our approach, I’m afraid all we’ll have is chaos, and we will all be lost among it.
I’ve come to realize that we can’t just blast people with the facts. If they are not seen as useful, no one will listen. What if we proposed an alternative or solution to the problem? What if we provided them with tools to form their own opinions and come to their own conclusions? What if we provided opportunities for others to direct their own learning? What if we focused on gaps in our scientific literature or asked insightful questions to instill scientific curiosity rather than focus on ignorance in knowledge? In the words of Jonathan Foss, “it’s time that we gently lead, not push”.
Stay Humble, Stay Professional, Stay Classy
Publishing your opinions and beliefs on social media can be absolutely terrifying. It’s a different level of vulnerability that most people aren’t used to. We need to foster safe environments for debate and discussion. We need to foster a safe environment for everyone to exchanges ideas and learn from one another… especially for students. They are the next generation of physiotherapists to come. We need to set the stage for them.
You don’t need to be a researcher to be sharing and discussing research. You just need a fair understanding of research methodology and critical appraisal. You don’t need to be experienced to have an opinion. I can’t possibly tell you how much I have learned from the students I have co-supervised. They have taught me a tremendous amount about my practice and about being a better clinician. These are common misconceptions that should be put to rest.
Just know that if you choose to speak up, and if you want to be heard, you need to accept the fact that there will be resistance or push-back. This is normal and in fact, It’s inevitable. However, if you are met with resistance, don’t retaliate with anger. We don’t do this to our patients. We don’t do this to our loved ones. Why should we do this with our colleagues?
My mission with InfoPhysiotherapy has always been to narrow the knowledge translation gap. Teaching, informing and education is what I genuinely love to do, alongside treating patients of course. I’m determined to make the latest research more accessible and easier to assimilate and integrate into practice. These are part of my core values. We also need to identify our core values as physiotherapists. We mustn’t forget that deep down, our core values are to genuinely try to help our patients get better and improve their quality of life, and I genuinely believe, that as physiotherapists, we all aspire to be better. Whether we agree or not on a certain topic, we are all working toward the same goal. If we keep this in mind before engaging with our peers, perhaps we’ll lower our guard and be more tolerant of each other’s opinions.
If you wish to discuss, engage, collaborate, or simply ask questions, it would be an absolute pleasure to connect with you all. I look forward to future insightful discussions and debates.
As always, thank you for reading.
Anthony Teoli MScPT
Registered Physiotherapist & Founder of InfoPhysiotherapy