Be suspicious of any simple story

[Barrett Dorko]

This video about story reiterates much of what has been said here about the its nature.

I hover above my messy life and it is incomplete. Stories compel me, drive me, occur to me and teach me. I imagine teaching via the ones I make up.

They are all untrue, and what I can do about that Tyler Cowen makes clear.

Not much.

What is your story? What stories do you hear? What makes you suspicious?

(Thanks to Carol Lynn for finding the video)

[Barrett Dorko]

I thought that these questions would generate a response.

Perhaps having to watch the video (16 minutes) was asking too much.

The point is this: We can't talk about story's tendency to mislead us without telling yet another - and a misleading one at that.

As has been said here before, it is when we tell the patient how we interpret their story that our personal biases are revealed. Around me I commonly hear patients asked exactly where they hurt. After being told the "therapist" grows silent and appears thoughtful. The patient may see this reaction as legitimate concern. I see it as an effective method of shutting the patient up by another who is clueless and willfully ignorant.

Yea, I said it.

By shutting down another's story without encouraging its completion through meaningful interpretation the opportunity for teaching and learning is lost, and "therapy" once again disappears.

[keithp]

Originally Posted by Barrett Dorko

What is your story?

Your posting yesterday had me thinking.

Something I wrote for tomorrow:

Publicly, I have been telling everyone that my transition is for personal reasons. The hours are better. The insurance costs are less. I have more flexibility with my scheduling. My reasoning gives me an easy out, a politically correct means of leaving on good terms.

Privately, I had convinced myself that I am leaving because it is an opportunity to grow. I can spend more time with my patients, learning to communicate with them more effectively. I will have a chance to read and study more. I will integrate new scientific ideas into my care, independent of the malicious, uninformed, ego-centric resistance of others.

Yesterday, Kelly (a friend, and colleague) approached me in the hallway and inquired as to my reason for leaving. I shared with her my private story, the story of my personal journey. She looked at me puzzled, “But home care is way beneath your skill set.”

Her words, have brought to mind a different and less common storyline, more palpable today than yesterday. My story is one of good versus evil. It is a conflict between all that is "therapy" in my field, versus all that is "physical"; a battle between all that is right and all that is mostly wrong.

It is the a story of a personal battle that I must not lose…even if the care that I have to offer my patients is considered “beneath me”.

Respectfully,
Keith

[keithp]

Originally Posted by Barrett Dorko

What stories do you hear?

To a new PT student who entered the clinic for the first time, but will be there longer than I will be:

This guy has some wicked pain in his thigh...very discy. He isn't centralizing yet, but we'll get him.

Have you met Keith? Be careful with him. He will tell you that this guys pain is all in his head. He will try to bring you over to the dark side. Be very wary...he'll f#ck you up in the head.

Respectfully,
Keith

[Barrett Dorko]

Keith,

I'd welcome you to my world but I know you've already been here a while.

With your blog post you've done it once again - and I know something about how hard that is to do.

Inherent to your post is the separation of people into two groups - those who deserve "good" therapy (whatever that is) and those who are offered something else.

I had to abandon my solo practice after 28 years because the referral sources were given the oportunity to make that distinction when a national corporation moved into town and offered the doctors money.

Guess who they sent to me?

[nari]

Keith,

I am curious about this perceived difference in quality between home care and clinic care. Why would any PT believe home care is inferior? Cannot understand that mind set.

I know one PT who has been doing home care for about 12 years; she loves the independence and lack of distracting elements, citing a study which indicated patients do much better in their own familiar setting.

Nari

[Diane]

How about be suspicious of any story, period?
Nice example of dogma-busting blogpost about a dogma-busting neuroscience paper.

[Barrett Dorko]

Thanks for the link Diane.

I agree, we simply cannot trust stories. The problem is that there's nothing to replace them that I know of.

As I once heard reported on Radio Lab, Galileo told stories and was well-understood. Newton refused to and spoke to an empty room for 17 years. (See this)

[Diane]

Here is another blogpost, about the dogma-bust, by Janet Kwasniak.

Unfortunately, stories (however clumsy and linear and untrue, ultimately, they may be) are to motivated human cognition as a downward incline is to a bicyclist. And unfortunately, linear information is the only kind we have to exchange, whether it be teaching (passing it on) or learning (taking it on). EVERYTHING has to go through our own Occam's BS detector, always. Especially anything we choose to teach, if we're serious about not passing on BS.

If we were to make a graph called "Story", with "pure BS" at the top, and "Absolute truth" across the bottom, and set a little person out onto it to find his or her way, without telling them the labels or orientation, the resulting line would go all over the place pretty haphazardly I'm afraid.

I saw a graph a bit like that lately. It was about the difference between climate and weather. It was an animation. It showed a guy out walking a dog. The guy ("climate", or "long term trend") plodded steadily in a given direction. The dog ("weather", or "short term trend") went all over, zigzagged but ultimately moved in the same direction as the guy, since they were linked. But, they are not the same thing. And in science the "guy" is invisible - all anyone has is the average of whatever the "dog" does, and inferences raised by that zigzag trend line.

Likewise, BS and truth are not the same thing. But they do tend to be yoked together, like it or not, by story.
No "true" story will ever ever be completely true. No BS will ever be complete BS without at least one iota of "truth".
We're dead.

[keithp]

Originally Posted by nari

I am curious about this perceived difference in quality between home care and clinic care. Why would any PT believe home care is inferior? Cannot understand that mind set.

I think that home care is often perceived to be where lazy, disinterested, check-cashing therapists go to make a living. I am certain that this is true in some instances, but certainly would not be true in all/most cases.

The other thing is that ortho clinicians, in my experience, consider themselves better trained than acute care or home care clinicians (or any other for that matter). After all, the acute care clinician is not spending 10 minutes looking for an ERS dysfunction, applying postural restoration techniques, or (insert meso-paradigm here). Basically, home care is considered to be a rudimentary and less intellectually challenging brand of therapy. As long as a therapist looks at the patient as a series of parts to fix, they are probably right.

I don't see things that way anymore.

Respectfully,
Keith

[nari]

As long as a therapist looks at the patient as a series of parts to fix, they are probably right.

This is a quite accurate assessment, whether it is in the home or the clinic. Reminds me of times not so long ago when a patient was referred to as THIS back from ER, or leg or some other bit.

It's hard to tell, in these days of huge multi-disciplinary clinics, whether things will get worse or not. Home care sounds perfect...

Nari

[Diane]

Keith,
When you stop caring about external perception of your choices, and consider what your choices will mean for your own life, your own "self", your own development, your own writing, your own integrity, your own evolution as therapist, your own lifespan as a human primate social groomer, you will be able to relax and embrace them as being the best for any dead guy to have picked.

[Jon Newman]

Originally Posted by Diane

Keith,
When you stop caring about external perception of your choices...

Or, as is often the case, misperception (assuming such a thing exists).

Although, if your main interest is in being accurately perceived by those you encounter then you simply can't stop carrying about how others are interpreting you.

[keithp]

Originally Posted by Diane

No "true" story will ever ever be completely true. No BS will ever be complete BS without at least one iota of "truth".

I am envisioning an American crime drama with the all-too-familiar scene, set in a courthouse:

Bailiff: "Please raise your right hand. [the witness raises their hand in compliance] Do you swear to tell the truth, the whole truth, and nothing but the truth?"

Perhaps we might reply, "No...but I promise to be honest." ?

Respectfully,
Keith

[Diane]

As honest as we can.

Check out this video featuring Robert Trivers, discussing deception at many, many biopsychosocial levels. It's about 16 minutes, really good.
http://fora.tv/2011/10/04/Robert_Tri...eive_Ourselves

[amacs]

Originally Posted by nari

Keith,

I am curious about this perceived difference in quality between home care and clinic care. Why would any PT believe home care is inferior? Cannot understand that mind set.

I know one PT who has been doing home care for about 12 years; she loves the independence and lack of distracting elements, citing a study which indicated patients do much better in their own familiar setting.

Nari

Inherent elitism that in some sense "manual" therapists are at the top of the tree in terms of interventional capacity? ANd perhaps of among those the manipulative and the sports therapist vie for primacy?

are more neurocentric paradigms in danger of becoming similarly elitist (we have "special") knowledge.


money and power, money and power

regards

ANdy

[Barrett Dorko]

I think we have to be very careful with the use of the word elite these days. It has come to mean something other than intelligent, informed, thoughtful, well-trained and educated - which is the way it was originally meant.

So-called elite pracitioners in many disciplines these days are portrayed as money-grubbing and uncaring. This is unfair, and, since the word now has many conflicting connotations it has become meaningless.

I remember standing in line at the health center at Ohio State prior to the disco era. A shorter line leading to better care was reserved for the varsity athletes. This was the dawn of "sports medicine." I didn't like the implications then and I don't like them now. The new meanings of "elite" come to mind.

As far as stories go, now I seem to be working in a department possessed by their telling because the staff thinks that every story constitutes "therapy." That's absurd.

After all, aren't stories supposed to have a point?

[nari]

Sports physios certainly have a 'place in the top storey' but who put them there is another question.

I agree with Barrett that the word 'elite' has lost all its original meaning. Perhaps the sports physios became 'elite' because they work with 'famous' sporting elites, therefore they are special. So it is not what they do with their patients, it is the patients who count.

Bah humbug.

Nari

[Diane]

Originally Posted by nari

Perhaps the sports physios became 'elite' because they work with 'famous' sporting elites, therefore they are special. So it is not what they do with their patients, it is the patients who count.

Whether they are the upstairs maid or the kitchen wench, they are still just the help, hired to help to elite athletes.

Whether the elite athletes are the upstairs maid or the kitchen wench, they are still just high-paid meat cogs in the big corporate sport machine.

Another analogy: sports PTs are to elite athletes as grooms/jockeys are to racehorses.

[Barrett Dorko]

I have always grown infuriated when it is said "Athletes are more highly motivated and have a higher ain threshold." This is thoughtless.

[amacs]

My use of the term elite was intended very much in a self-referential way.

I am very fortunate, perhaps privileged (and in the same breath cursed) to know what elite really is or means - I do not recognise it in this profession in the terms or way it is usually used.

regards

ANdy

I wonder what Ken's take on elite is? Ken?

[Sheffphysio]

My take, for what its worth. Is have a face that fits, know the right people, say what they want to hear, be unbelievably charismatic and certain in yourself. Hope nobody calls your bluff.

[Barrett Dorko]

I find it interesting that these last two opinions are from the UK, and I agree with them both.

Here in the states elite is commonly used in a pejorative fashion. It is clearly an extension of the anti-Intellectualism popularized by many on certain radio and TV shows as well as others running for national office.

[amacs]

Originally Posted by Barrett Dorko

I find it interesting that these last two opinions are from the UK, and I agree with them both.

Here in the states elite is commonly used in a pejorative fashion. It is clearly an extension of the anti-Intellectualism popularized by many on certain radio and TV shows as well as others running for national office.

Interesting indeed and I think it depends on context. Certainly the term is overused and can often be pejorative, perhaps indeed that was the slant I was taking in my intial post but there are other occasions when I am aware of a different usage usually among specific or between specific groups. To me the likes of premiership footballer have yet to learn the meaning of the word.

Someone else who might have an interesting perspective would be Jason

On a different note I note the return of Paul Scholes Dave!

regards

ANdy

[Sheffphysio]

Desperate times, desperate measures. We ain't got the cash to compete. Add that some useless **** in midfield and we need to bring back the ginger wizard.

[Diane]

Something that may shed a bit of light: Story as "logic structuring", by Randy Olsen, scientist turned film maker.

Excerpt:

The information people prefer ABUNDANCE, the entertainment people thrive on SCARCITY.

And this is what is at the heart of storytelling. You hold people’s interest by withholding (artfully) the information they are seeking — keeping the clues scarce — forcing the audience to follow your thought processes that lead to the eventual answer.
... If he were a scientist he would start his report with the trivia question, immediately give you the answer, then progress forward. But a storyteller poses the question then doesn’t “pay it off” until the end of the report/story. It’s a way of approaching the process of communication. Yes, it’s manipulative, but it can be done in a totally honest and “non fact-bending” way. If you do it well, people enjoy and appreciate the journey.

That’s what storytelling is about.

[amacs]

Originally Posted by Diane

Something that may shed a bit of light: Story as "logic structuring", by Randy Olsen, scientist turned film maker.

Excerpt:

And every course is a story, some even come in installments ...



Regards
ANdy

[Diane]

Exactly. And they do NOT have to spin off into fiction.

[amacs]

Originally Posted by Diane

Exactly. And they do NOT have to spin off into fiction.

Too many indulge in "faction"

[Barrett Dorko]

Great find. I've printed it out.

Before people had the opportunity to listen to radio, then movies etc. they were better storytellers.

I think.

[byronselorme]

I really enjoyed Tyler Cowen. Thanks for that Barrett. I think that is what I wrestle with and have gained great insight in when watching and learning from my simplistic classifications of something so complex as another human being.

Thank you