Now I’m not going to post a lot about Hippocrates himself, but I want to start todays post by quoting something that he is supposed to have said: ‘There are, in fact, two things, science and opinion; the former begets knowledge, the latter ignorance’.
Hippocrates proposed that if a new treatment was to be tried, we should use science to decide whether or not it works rather than relying on somebody’s opinion.
What makes science different? Apart from its reliance on experiments, observations, trials, argument and discussion – and its supposed adherence to objectivity – science continues to question what is accepted and assumed just in case it has got it wrong.
And this is important for us as clinicians – instead of relying on big budgets for advertising, incredible sales talk or persuasion, or even ‘received wisdom handed down the ages’ – we are encouraged, in fact required to maintain a critical eye on what we do, why we do it, and how we do it, to learn from our outcomes, and to endeavour to be objective about what occurs.
Of course this doesn’t happen nearly as wonderfully well as Hippocrates wanted, but it is an aim for us all. It means we need to know something about scientific method or how to systematically investigate our outcomes, and it means we really must know something about how to measure what we do, and some of the confounds that get in the way of being ‘objective’.
There are some hot debates about the place of objectivity in many parts of health care – especially nursing, occupational therapy, social work – areas where individual experience or constructions are important, and where the context of what happens is seen as influencing both the event under observation and the observer.
Actually if you look up constructivism in wikipedia, you are greeted by a whole page of different links (take a look!).
In some ways, hard science, such as empiricism where experiments and facts and statistics have held sway, has been given a bad name in circles where constructivism has been emphasised. I think you can be both a constructivist and an empiricist – and later this week I’ll show you why.
Why would it matter to us as health care people? Well to me it’s important to know that what I do with a person is less about me personally and all my wonderful charisma, and much more about the methods and skills I have learned. Otherwise I’m concerned that once I’m not here the world will be soooo much less able to manage and I’ll have to live forever doing what I do!!
I may joke about this, but seriously, I want to know what is working in the mix of inputs I provide to someone, so hopefully I can learn to do it more effectively, and have the results last longer.
I’m also keen to know that the effects are not temporary ‘feel good’ effects – and I don’t want to find that the effects are all about natural remission, or ‘regression to the mean’ or reducing distress, when I think it’s something completely different!
If you’re interested in some of the things that do influence treatment effects that aren’t necessarily about the treatment itself, this paper although old, and on a site that has been criticised heavily (check it out for yourself and make your own mind up), has some good information.
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