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.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 @TheWordsMatterPodcastTwitter @WordsClinicalFacebook Words Matter - Improving Clinical Communication ★ Support this podcast on Patreon ★

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 inductionThe 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.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 @TheWordsMatterPodcastTwitter @WordsClinicalFacebook Words Matter - Improving Clinical Communication ★ Support this podcast on Patreon ★

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.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.Follow Words Matter on:Instagram @Wordsmatter_education @TheWordsMatterPodcastTwitter @WordsClinicalFacebook Words Matter - Improving Clinical Communication ★ Support this podcast on Patreon ★

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 constructedAnd 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 EngebretsenIf you liked the podcast, you'll love The Words Matter online course and mentoring to develop you clinical practice  - ideal for all MSK therapists.Follow Words Matter on:Instagram @Wordsmatter_education @TheWordsMatterPodcastTwitter @WordsClinicalFacebook Words Matter - Improving Clinical Communication ★ Support this podcast on Patreon ★

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.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.Follow Words Matter on:Instagram @Wordsmatter_education @TheWordsMatterPodcastTwitter @WordsClinicalFacebook Words Matter - Improving Clinical Communication ★ Support this podcast on Patreon ★

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.Follow Words Matter on:Instagram @Wordsmatter_education @TheWordsMatterPodcastTwitter @WordsClinicalFacebook Words Matter - Improving Clinical Communication ★ Support this podcast on Patreon ★

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;Matt’s journey into dispositonalism and CauseHealth.EBM in context of MSK practice and how has it shaped and impacted his practice.We talk about how a dispositionalist view of causation can frame the clinical questions and problems within MSK care.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.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.We talk about the co-construction stories as a way of mutually identifying dispositions with the personAnd 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 @MattLowPTIf you liked the podcast, you'll love The Words Matter online course and mentoring to develop you clinical practice  - ideal for all MSK therapists.Follow Words Matter on:Instagram @Wordsmatter_education @TheWordsMatterPodcastTwitter @WordsClinicalFacebook Words Matter - Improving Clinical Communication ★ Support this podcast on Patreon ★

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.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.Follow Words Matter on:Instagram @Wordsmatter_education @TheWordsMatterPodcastTwitter @WordsClinicalFacebook Words Matter - Improving Clinical Communication ★ Support this podcast on Patreon ★

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-makingFinally, 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 @samdotCIf you liked the podcast, you'll love The Words Matter online course and mentoring to develop you clinical practice  - ideal for all MSK therapists.Follow Words Matter on:Instagram @Wordsmatter_education @TheWordsMatterPodcastTwitter @WordsClinicalFacebook Words Matter - Improving Clinical Communication ★ Support this podcast on Patreon ★

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 If you liked the podcast, you'll love The Words Matter online course and mentoring in effective language and communication when managing back pain - ideal for all MSK therapists and students.Follow Words Matter on:Instagram @Wordsmatter_education @TheWordsMatterPodcastTwitter @WordsClinicalFacebook Words Matter - Improving Clinical Communication ★ Support this podcast on Patreon ★