One of the inescapable realities of modern life, or should that be post-modern life, is that we have all become skeptical of authority figures that want to tell us that they know the answers, and that we should follow them compliantly, passively and unquestioningly.
There once was a time when people genuinely believed that the church, judges, the police, school teachers, parents, doctors and other authority figures genuinely knew best, but our trust in these authorities has been eroded by scandals, self interest and injurious practices.
And while some of us yearn for a simpler time when the world was black and white, we can’t erase the image of child abuse by Catholic priests, medical malpractice and institutional racism in organisations like the police.
The Internet has helped destabilise the power base of traditional authority figures, and it has done this by taking away their ability to claim privilege over the kinds of knowledge that are deemed to represent the truth. But what we have believed to be true has always shifted, so it was always the ability to be the ‘broker’ of truth that really mattered in society. So when the power of the brokers (the doctors, judges, teachers, etc.) began to dissipate rapidly with the advent of the Internet, it opened up a space for new truths to emerge.
Physiotherapists have become quite obsessive about objective evaluation of their practice and demonstrating that their claims about assessment and treatment efficacy are ’true.’ But it is questionable whether many people outside of the profession really care.
As Miles et al have pointed out in their scathing editorial on evidence-based medicine, there is no evidence that the implementation of EBM has improved the health and wellbeing of a single patient (Miles, 2008). Add to this the fact that our current methods of assessing the efficacy of our practice (i.e. that represented by the hierarchy of evidence), suggests that there isn’t much to physiotherapy that can be trusted. (Look, for instance, at this neat summary of the most influential physiotherapy research studies of the last 15 years here, and count up how many studies brought about change because physiotherapy was shown to be ineffective).
The things that we take to be true may seem on the surface to be black and white, but they rarely are. Even the idea of truth is shifting. Thus any search for absolutes is futile. The idea of a single, all encompassing truth that we can all subscribe to is a fantasy, and today’s (post)modern world only indicates more strongly that we are more eager than ever to see truth as fluid, contextual and personal. This has radical implications for physiotherapy, but it seems physiotherapists are finding it difficult to let go of past truths that meant something in the 20th century, but may be increasingly ossifying today.
Miles, A., Loughlin, M., & Polychronis, A. (2008). Evidence-based healthcare, clinical knowledge and the rise of personalised medicine. Journal of Evaluation in Clinical Practice, 14(5), 621-49. doi:10.1111/j.1365-2753.2008.01094.x