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 healthcareThis 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 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 ★

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 @ElenaRoccaPDIf 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 ★

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_HealthSee here for more about Rani.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.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, 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)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 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 mobilisationThe 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 occurSimple 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_HebronIf 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)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.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 principlesThe 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 @DaveNicholls3If 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.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 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 PIPThe 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_ResearchIf 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)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 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 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)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 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 @kieranosullSubscribe 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_educationTwitter @WordsClinicalFacebook Words Matter - Improving Clinical Communication ★ Support this podcast on Patreon ★

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