To Mark Eliason, David Perry, Nora Amabella C. Macatol and mailbase group
Thank you for your excellent arguments. There are so many issues raised by
your messages it would be impossible to address them all. There are some
inevitable misunderstandings however that I feel we should clarify before
going on.
You wrote that clinical competence and capable communication are not
mutually exclusive and that you cannot be a good clinician without being a
good communicator. This I would agree with. However in the context of
this argument I feel we are confusing communication with subjectivity and
hence 'qualitative' paradigms, and subsequently clinical competence with
objectivity and 'quantitative' paradigms.
I make no bones about the fact that I am an advocate of qualitative
methodologies, and I often feel they are misrepresented in physical
therapy. They are perceivd as soft, artistic, and un-scientific. By
linking them with 'communication skills' 'being nice' etc. we risk
perpetuating this view.
Take for instance the following example: When a clinician takes a blood
gas sample and records the findings they are represented in an quantitative
form. The clinician must observe them and in an objective fashion analyse
what they mean. HOWEVER it is their subjective skills that then allow
them to put them into context for the patient. Some patients can look okay
with a PaO2 of 9kPa, others can be very unwell. They need to take into
account the patient's appearance, speech, breathing pattern, etc. before
deciding on therapy. These are surely high skill, subkjective judgements
that rate above the level of subjectively being 'nice'.
The implication is always that subjectivity lacks rigour.
The formula that Mark puts forward of data collection / formulation of
theory / check observations against theory, are procedural but I wouldn't
go as far as to say they were 'scientific'. That's like saying putting the
oven on, washing your hands and mixing ingredients makes you a good cook !
David wrote that 'clinical expertise in a vacuum leaves a lot lacking' - I
couldn't agree more, but then I wasn't arguing this. I was saying that
clinical competence is seen as a 'detached science' and that the ability to
communicate is essential for good practice. However just because it is
less easily quantified it should not be considered less scientific, and
valued less as a rigorous discipline.
Dave Nicholls
[log in to unmask]
Sheffield Hallam University
England
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