Guest Post by Dr Neil Langridge, Consultant Physiotherapist NHS.
I recently had the privilege of attending and presenting at a conference overseas, meeting numerous Physiotherapists from multinational backgrounds. They were keen to collaborate, learn, develop and discuss. They were fantastic in their ability to listen, debate, and be critical in a professional way that made knowledge translation and critical review a pleasure rather than a trial. On my return it made me consider the UK Physiotherapy professions’ approach to building on knowledge, and how especially through social media we conduct discussions which inherently are on an international stage. It made me really consider how these are subsequently digested and the impressions our words, and approaches to professional development are viewed.
We work in an ever-evolving profession. Whether you are a new graduate or near retirement, the process of change is continuous. Over time this has happened at different speeds and has been influenced by “movements”, beliefs, individuals, social need, politics,… this list can go on. National development of new models of care has led the profession into different ways of working across many disciplines with a view of supporting patients and colleagues to deliver new and better ways of managing numerous and diverse patient populations.
The responsibility of the profession is to be ready to help, support and hold an offer that allows other professions to realise that offer with us and utilise the skill sets we have. In engaging with other professional groups, national bodies and internationally we as a profession have to ensure the offer is credible and we are seen as credible partners. There are many ways to present as credible colleagues, and one way is how we critically evaluate our practice and subsequently translate that into new ways of working. As part of the panel discussing responsibility at the up-coming 3Rs event I felt it pertinent to consider my views on this subject and I thought I would share one element, which is professional communication with anyone that is interested.
What has really alerted me of late around this in trying to gauge a sense of where we are as a profession, and how we possibly are seen externally and internally is the responses within Social Media inclusive of discussions, blogs and statements. I have always been comfortable in countering arguments, putting myself into situations where I am likely to be confronted by strong opinions and beliefs, and therefore I have always supported anyone’s right to offer an opinion and to stand by it if it is not illegal, immoral or unethical.
What I have come to realise is that some professional discussions seem to be led by emotion when it comes to challenging outdated practice or beliefs. These emotions seem to be led at times by anger, antagonism, and the under-mining of others, overall the context is very confrontational. I believe passionately that we have a responsibility to challenge internally and be critical of what we do and this freedom of speech is critical to the change process.
But, how does freedom of speech interlink with professional dialogue? They are not separate, but should be viewed as a contextual choice dependent on the social situation. This should be tacit without the need for explicit rules and as such should be a natural evolutionas a professional in practice. This is a question that seems to come up regularly, and is generally answered with a retorts such as; you choose to take offence and swearing in professional discussions is positive practice. It seems if you are thought of as being “outdated” then that means others have a right to “call people out” and we should all welcome that because that is the right thing to do for our profession. So let’s consider that in the context of a wider world view. Medical colleagues, national bodies, international groups and professional colleagues, all would wish for best practice, critical thinking and the progression of healthcare for patients, and they would wish to discuss this, learn from each other and share knowledge. How do you think they would wish to do that? Are we offering the right environment, the best external view of our profession and the atmosphere that encourages discussion?
I believe we need to seriously consider the inter-relationships of professional dialogue and behavior and the rights to expression. Perhaps it is worth reflecting on the virtual professional learning communities you are involved in? One of these is Twitter, and as such it is worth considering what the value of this is to you as a clinician. These types of professional learning communities have been described as;
“A group of people sharing and interrogating their practice in an on-going reflective, collaborative, inclusive, learning orientated, growth-promoting way”.
I believe that Social media provides this really well, however are the discussions you see or are involved in “growth-promoting and learning orientated”? What I also believe is that as well as having a professional responsibility to critically drive change from within the profession, we also have a responsibility to not be so aggressive in that mission of practice evaluation that it actually stifles behavioral change and in fact implodes on itself because it is led by emotion rather the cognitive empowerment of the profession.
It is easy to create an emotional response, be angry, confrontational, be threatening; making people think requires more than that; it requires clarity, reasoning, giving individuals the freedom themselves to consider their positioning in a non-threatened way and most importantly, their freedom of professional dialogue. Angry responses limits others and so does not encourage change, in my opinion those that angrily, aggressively sound the horn create an uncompromising environment that can only, ultimately limit some of the change behaviors that those that shout are championing for. It seems to me ironic that some of those pushing for change do so in a manner that actually drives the opposite.
Through communication we construct our own social realities and these then shape how we communicate, this can make a circle and this can become a vicious circle, bouncing around the same arguments, with the same outcomes and no effective change occurring. So, let’s consider a change?
Tannen (1998) speaks of “argument culture” expressing concern that confrontational communication can be counter-productive and self-perpetuating. It limits deep engagement and “Stimulates ritualised opposition that reinforces antagonism, this preventing the collective exploration of underlying complexities. These exchanges tend to escalate, polarising participants…in other words, the argument cultures impedes dialogic conversations, and creates the perfect stage for the performance of entrenched monologues”. The diagram I have put together below I hope gives my blog some pictorial interpretation. If you were a patient listening to your clinician who were about to assess you discuss their profession, where in the diagram below would you expect/hope those clinicians to sit?
In the end using direct opposition tactics to achieve change may work for social movements, but in professional practice, identity and development I would propose that confrontational attitudes, attacking approaches and undermining manners only provide opposition and not a vehicle for change. I am an advocate for change, development, critical review and challenge but not at the expense of our professional courtesy. The professional arguments we have need to be built on credible dialogue, a willingness to explore and debate and provide a context that encourages the communication, not suppresses it. With this in mind I believe it is always worth considering the next interaction, the next discussion, the next blog etc and be analytical and critical in a way that encourages professional dialogue and always considers how our external/international colleagues may view the work of the profession, the future may rest on the words we all write, and emotional responses we control.
1 Stoll et al (2006) Professional Learning Communities: A review of the literature. Journal of Educational Change. 7 (4) 221-15.
2 Tannen D (1998): The argument culture. Changing the way we argue and debate, London: Virago Press.
3 Kerry R (2017) “Physio will eat itself” https://rogerkerry.wordpress.com/2017/04/24/physio-will-eat-itself/
Dr Neil Langridge, Consultant Physiotherapist NHS.