Thinking Out Loud In Public

38,367. New Grad Physical Therapy released my article, 8 Lies I Learned In Physical Therapy School, on January 9th, 2018 around 8 AM. A week later, my article was viewed 38,367 times. I am pretty happy with that. So happy in fact, that checking my phone for how many views it had became an obsession and everyone around me became severely annoyed. It is surreal to think that 4,000 words I typed on my laptop, on a small desk in my apartment, reached tens of thousands of healthcare professionals. The article was met with overwhelmingly positive responses, but received some negative reactions too. Some people refused to read it based on the title alone. Some suggested the language I used was overly aggressive and prevented them from really engaging with it. Some even disagreed with all of my points, provided specious explanations on why they were right, and refused to actually talk about it with me directly. Some people just ignored my responses. There were a handful of people that were critical, but it was clear to me they were acting in good faith. However, the public discussion and debate that it started was uniquely exciting.

Sam Harris, famous author, podcast host, and neuroscientist, once elegantly described what he does as “thinking out loud in public.” I have always loved that job description; think and write about interesting topics, talk to interesting people, debate interesting questions. This blog, and my writing on NGPT, is my way of thinking out loud for the physical therapy profession. But reflecting on the “success” of my first semi-viral article, I have learned that there are hazards that come with public discourse. And while I have seen some of these on social media discussions, it is a bit more intense when your thoughts are the focus. We can borrow some things from philosophers to make things smoother when we think out loud.

Diverging Opinions and Provocative Debates

Unfortunately, there is a wealth of beliefs held by members of our field that are tangential to the evidence, as well as some that are in direct contrast with it. This can harm our patients, ourselves, and the profession as a whole, and should be called out as such. When discussions about these controversial topics are had there is always one person who denounces the conversation and says something like this:

“Why are we always being so critical of every treatment approach? The point of these discussions is to elevate our profession and not bring each other down. They are simply trying to help their patients and you are only being negative.”

This is instantly irritating and prompts the quickest of eye rolls. This person is probably well-meaning, but the sentiment of shying away from critical debate and discussion, while shared by many, is decidedly unhelpful. There is some reason to believe we need to be careful of how we express dissenting opinions, but we still have to express them. My goal is to elevate this profession, and it requires difficult conversation, honest appraisals of the best research, and the willingness to engage with people that have different opinions.

Building Steel Men

In your interactions online, can you honestly say that you truly understand what you are arguing against? Why does your debate opponent believe what they say they believe? In Intuition Pumps and Other Tools for Thinking, philosopher Daniel Dennett lays out Rapoport’s Rules, a short list of steps to follow when critiquing an argument, originally described by psychologist Anatol Rapoport:

How to compose a successful critical commentary:

  1. You should attempt to re-express your target’s position so clearly, vividly, and fairly that your target says, “Thanks, I wish I’d thought of putting it that way.”
  2. You should list any points of agreement (especially if they are not matters of general or widespread agreement).
  3. You should mention anything you have learned from your target.
  4. Only then are you permitted to say so much as a word of rebuttal or criticism.             (Dennett, 33-34)

Put simply, we ought to be able to accurately summarize positions against our own, know where our intuitions converge with our opponents’, and try and learn from them. Once we can do this, it signifies that we are acting in good faith; we want to actually progress the debate forward and come to conclusions that are mutually agreeable.

We want to avoid straw-manning our opponents by mischaracterizing their views or distorting their argument in a way that makes it easier to argue against. Instead, we ought to be steel-manning our opponents: we want to not only understand their case, but argue against the strongest possible version of it. If we present an unobjectionable summary of our opponents’ position, it makes it easier to point out the problems with their argument and ultimately reach common ground. Many of the concerns regarding my article were legitimate, but some people missed the mark when they attempted to make their case. People commented on the article without reading it, and discussed my points without citing any evidence or providing any actual arguments. It seems that many people did not understand the points I was making, and I found I was directly quoting myself in response to their points. We all need to think critically about what we believe and why, and do the same for out debate opponents. We don’t want to be in the position Sean Hannity found himself when talking to Christopher Hitchens:

https://www.youtube.com/watch?v=UPsZtZ1itq0

If we can follow Rapoport’s rules, argue in good faith, and try to reach common understanding, debate and discussion will improve and the profession will be better off.

Seeking Truth

I originally thought this blog should be a resource for new graduates to help navigate the complicated clinical world. As I developed my content, I think it morphed into something more than that. At its most basic level, I just want to think out loud and in public about what I do and why I do it. I want to get as close to the truth as I can, and try to always be less wrong than yesterday. As I learned from my first “popular” writing endeavor, not everyone is ready for a hard conversation. When you challenge long-held assumptions, respectfully criticize approaches, or suggest we abandon antiquated ideas, people get uncomfortable. While I understand peoples’ general reactions, we need to have these public discussions. Our profession has its fair share of problems, and the first order of business needs to be getting comfortable with being uncomfortable.

References

Dennett, D. C. (2014). Intuition pumps and other tools for thinking.

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