Monday, 27 February 2012

A DOCTORS' DILEMMA

A dilemma for others too – conductors for example

Sue O'Reilly has written to tell me of an Editorial from last October's Medical Journal of Australia, a challenging item by Professor Rinaldo Bellomo on a major question facing modern medicine, knowledge-management.

This problem may loom particularly large in medicine but it cannot be ignored is less developed fields like, for example the provision of services for those with motor disorders – and conductors.

To illustrate this, I have taken the liberty of extracting a little of this Editorial, but in doing so have replaced the words 'medicine' with 'Conductive Education,' and 'doctors' with 'conductors', and I have changed a couple of associated words to fit in with this. I find that Prof. Bellomo's analysis transfers rather well –

In a world populated by rapid-diffusion media, varied cultures, widespread literacy, extraordinary means of communication and media veneration of the might of the scientific method, one might expect that the “marketplace of ideas” would be extraordinarily open, lively and free from censorship or restrictions. In such a world, one might expect that Conductive Education shine like a beacon of open-mindedness and acceptance of new ideas and that it would foster the development of challenges to operative paradigms. In such a world, dogma would fail to develop roots and could not survive. Evidence would triumph and, in its absence, both experts and the broader citizenry would hold on to healthy doubt. In such a world, one might expect that Conductive Education would shine like a beacon of open-mindedness and acceptance of new ideas and that it would foster the development of challenges to operative paradigms.

There are several potential explanations for Conductive Education's persistent love affair with dogma ... The cognitive “illusion of knowledge” also plays a role. We have to believe we know the answer and that there is only one answer, the one we have. To accept that we do not know the answer, or that other people might know the answer while we do not, is emotionally challenging and calls into question our very professional essence. Best to believe that what we think we know is actually true. As Thomas Kuhn would have it, at any time in history we operate within 'paradigms', the 'soft'(but often strongly enforced) dogmas ... We use such paradigms as totems and make challenging them a professional taboo.

Dogma probably protects patients from rogue behaviour. We need to make sure that not all treatments are allowed. Rules (dogmas) do exist for a reason ... The difficulty, however, occurs in situations where the evidence that a particular action is needed is not so clear, or, just as frequently, when the practitioner is not aware that such evidence even exists ... In such a state of permanent flux, it is a lot easier to 'stick to what you know'(received dogma) and never change until retirement. This is a problem, because while such a stance might have been justified in 1911, it seems spectacularly out of touch in 2011. Indeed, together with the obstinate adherence to such 'training school' dogma, knowledge management (knowing what one does not know and knowing what one should know) may now be one of the major challenges of Conductive Education.

Finally, in a world full of “experts”, controversy and opinion, holding on to dogma is reassuring and may well have vital functions. Yet, dogma has a dark side and its dangers may be as great as its benefits. Conductors would do well to maintain a degree of cautious skepticism for both bold new fashions and received wisdom, whether generated by the world or by the self. They would do even better to question what they do and see such questioning as an asset. It is everyone’s responsibility to find out how to ask questions systematically, find answers from searching the literature, critically appraise the literature and apply the results to practice ... Resources need to be allocated ... to make this process of questioning dogma and obtaining up-to-date high-quality evidence a ... priority. Unless this is done, dogma will continue to rule conductive hearts and minds.

I have omitted Profe. Bellomo's well-referenced, medicine-specific examples (indicated above by ellipsis … ). Readers will presumably be able to find their own though, such is the present state of knowledge-management in Conductive Eduction, they may find it harder to ensure that these are as well-referenced.

Epigraph

The epigraph to this Editorial is a quotation from Harriet Beecher Stowe's Little Foxes – 


Physicians are quite as intolerant as theologians. They never had the power of burning at the stake for medical opinions, but they certainly have shown the will.

Does that transfer too?

Reference

Bellomo, R, (2011) The dangers of dogma in medicine. Is the dogma of today the footnote of tomorrow? The Medical Journal of Australia, vol. 195, no 7, pp. 372-373.

2 comments:

  1. Hi Andrew,
    I think you are being a little harsh on CE in suggesting there are any substantive parallels between its practitioners and the overwheening arrogance of the medical profession over many, many decades in its negative, pessimistic, indeed some would say nihilistic attitude towards people with severe brain damage and brain injuries - basically just writing them off. An attitude which surely helps explain much of the medical profession's historical hostility to optimistic, positive approaches such as CE - surely?
    My reason for sending you this article is that I reckon all those of us who believe in the capacity of individuals to learn, and to develop,should celebrate any sign that there are medical professionals out there willing to concede that medical dogma - dogma such as the belief, for instance, that severe brain damage automatically prevents individuals from learning or developing - can be, and often is, a VERY dangerous and destructive thing.
    Sue xxx

    ReplyDelete
  2. Thanks for that, Sue. I have responded with a separate posting:

    http://www.conductive-world.info/2012/03/doctors-and-conductors.html

    ReplyDelete