Keys to critical thinking

Last week I had the very great pleasure of teaching some critical thinking skills to postgraduate students at AUT University with my good friend Dr Barbara Gibson.  The students were physiotherapists, nurses, case managers, occupational therapists and others, and few of them, in truth, knew much about critical thinking.

So we concentrated on what is perhaps the most important, but also the hardest skill in thinking critically: questioning things that we otherwise take for granted.

Because something is taken-for-granted it is, by definition, hard to see.  They include things we unquestioningly support (like taking care of your own health, for instance); things that are custom and practice (patient assessments perhaps); popular attitudes (a dislike of cigarette smoking); and powerful ideas and influences (biomedicine).

The reason for focusing on these practices, is that they are often the least questioned aspects of our lives, and so play a very important role in silently shaping what we believe and trust.

In recent weeks we’ve seen a series of announcements about physiotherapists who have won awards for innovation (see this, this, or this, for example).  Now you would be hard pressed to find any physiotherapist prepared to critique such achievements.  They raise the profile of the profession, they celebrate excellence, and they provide a pathway for others to follow.  But does this mean that they should be immune from critical examination?

I would argue not, and that awards, acknowledgements and achievements are powerful indicators of changing conditions in healthcare, and so might be some of the first places to look, if we want to gain critical insights into where physiotherapy has been, where it is, and where it might be going.

Importantly, awards, acknowledgements and achievements can reflect shifts in attitudes and attempts to move away from traditional practices and ways of thinking.  They are themselves subtle critiques of what went before, and they can be pointers to what is to come.

So what can we glean from some of the recent awards and announcements of innovation appearing over the last year or so?  Perhaps we can see that there is:

1. A move away from ‘traditional’ physiotherapy departments and towards physiotherapy delivered remotely;
2. A much greater focus on activity and participation, and reducing the burden of illness;
3. A move away from acute treatment to long-term care;
4. An attention to intractable health problems like chronic pain and disability;
5. A desire to reduce the costs of specialist care, increase independence, and self-sufficiency;
6. A serious commitment to greater diversity of work, role sharing and devolution of old professional boundaries.

To my mind, there isn’t one of these that isn’t hugely problematic and fraught with difficulty, but it is worth remembering that they would not be winning awards and functioning at the ‘bleeding edge’ of new professional practice if they didn’t, on some level, come with some benefits.

The question is, perhaps, what is gained and what is lost in these innovations?  Whose voices are we hearing and whose are being silenced?  Which ‘truths’ are being promoted and what beliefs are being marginalised?

Being critical is therefore not so much about deciding something is necessarily good or bad, but more deliberately and purposefully asking questions about what lies beneath our everyday practice, so that the dangerously banal aspects of everyday decision-making don’t go unquestioned.