Conversations with my Physio: Part Two

Another interesting conversation with my Physio today. (Dear Physio, should you, by some freak of the internet, stumble across this blog, I do hope you don’t mind our interactions being scrutinised. It’s not personal, I promise).

She mentioned that she is thinking of doing a course in accupuncture for Physios. I expressed surprise at accupuncture being available on the NHS, especially within a hospital clinic, since hospitals are traditionally particularly the domain of bio-medical types of healthcare (for an introduction to this, you could go further and do a lot worse than Unit 2 of K101. Alas, this isn’t available on Open Learn, but the fuller but older version of this material from K100 is). We ended up having a conversation about the evidence-bases of conventional and alternative therapies.

(picture nicked, appropriately enough, from the NHS choices website introduction to accupunture)

Perhaps because of her previous framing of anatomy as the central knowledge of physiotherapy, I had been thinking of the discipline as quite bio-medically oriented and positivist. But she characterised it as the soft, holistic end of medicine because they don’t prescribe drugs and do things like physical manipulations. She talked about the way she feels things in her hands when she is treating someone and how hard that is to write up in her notes.

We talked about the legendary finding (i.e. neither she nor I knew the source, but we’d both heard of this piece of reserach. A quick look at Cochrane just now doesn’t find it either) that treating scar tissue with high doses of ultrasound works equally well whether the ultrasound machine is plugged in or not. Her point was that it’s impossible to properly test this sort of thing because she would never prescribe ultrasound on its own, she would always accompany it with physical manipulations, exercises etc. I recognise this as the argument that evidence-based healthcare is incompatible with the ethics of offering patients the best care. (I’m not sure that she’s correct that it couldn’t be done ethically, but I’m interested that that’s her perception of how evidence-based healthcare doesn’t work in practice).

One day, I really ought to write something proper about evidence-based care. I keep returning to it as an overarching issue, but I get daunted by how quickly it gets into epistemology and ontology.  In the meantime, here are links to the two most accessible articles on some of the problems of evidence-based care that I have found (and at a much more introductory level, there’s my material in K101, Unit 19, section 3. This was new for K101, so unfortunately there’s nothing similar in the K100 material on Open Learn). Note to self – at least do something with the swathes that were cut from earlier drafts because it was (correctly) judged to be too difficult for Level 1.

A chapter by Miles Little in a book, available on Googlebooks

An article in the BMJ, (I think that’s open access). It also features in abbreviated form as a chapter in the K101 Reader (because I chose it)

LGBT history month: Milton Keynes events

A couple of events for LGBT history month in Milton Keynes:

An event at Bletchley Park celebrating Alan Turing (famous gay geek, murdered by the medico-legal system (I caricature)):

Actually, I’m not sure this one is part of LGBT history month – it’s in January (just) and I suppose not really historical. But it’s LGBT and in my town, so I shall link to it anyway: LGBT general assembly

Imagining Futures: Seminar announcement

The Centre for Ageing and Biographical Studies at The Open University and the Centre for Policy on Ageing invite you to the 13^th seminar in the Representation of Older People in Ageing Research series  on Thursday, 11 February 2010

IMAGINING FUTURES

At the Centre for Policy on Ageing, 19-23 Ironmonger Row, London EC1V 3QP, from 10.30 to 4.30

Fee of  £30 (£25 for registered students) payable to Centre for Policy on Ageing, refreshments and sandwich lunch included.

Email Angela Clark  aclark@cpa.org.uk  to reserve a place and request a booking form or access programme/form at http://www.cpa.org.uk/events/events.html

‘Imagining Futures’ will look at methodological issues in asking people to imagine the future and their own ageing. Speakers will address issues such as:

• What research methods can be used to help people think about the future?
• How has the future been conceptualised and articulated in research targeted at older people?
• Is it possible to move people beyond stereotyped and negative expectations of their own ageing and of later life?
• Do particular types of research methods affect how people tend to envisage the future and their own older age?
• What are the ethical issues in asking people to think about their own ageing?

The aim of the day is to explore both practical and theoretical issues in asking people to think about their own ageing, in order to improve practice in both research and practice/policy contexts. Seminar participants will be invited to share their views and experiences throughout the day. The seminar will be of relevance to practitioners, policy makers, academics and students.

Abstracts

Researching the future with older people: experiences with ‘The Oldest Generation’

Professor Joanna Bornat and Dr Bill Bytheway

‘The Oldest Generation’, one of seven projects in the Timescapes programme, has been researching the everyday lives of 12 people over the age of 75. Our methods are qualitative and longitudinal. We have used life history interviews, followed by a second interview eighteen months later, and diaries covering the intervening period. While time past and time being experienced was built into data collection we realised that the future was a missing feature. In this paper we reflect on some of the reasons why the future was not included in our research design and then go on to discuss how we re-focused our attention, by direct and indirect means. In so doing we came to recognise the extent to which future time is immanent in talk and how in research with older people, the social meanings of time have a complexity which challenges assumptions of finitude.

Future matters for ageing research

Professor Barbara Adam

The futurity of action is a challenging domain for social inquiry; it necessitates an openness to rethink the subject matter of sociology, its epistemology and its methodology. For ageing research the difficulty is intensified. To gain some anchorage points for study, the paper outlines past and present approaches to the future, maps the complexities involved, identifies some of the sensitive issues associated with studying approaches to the future in older people, and seeks to identify some openings for investigation.

‘Erm, I don’t know… It’s not something that I really think about’: facing the fear in research on ageing

Dr Cassandra Phoenix

Over the last decade I have been inviting people to tell me stories about their perceptions and experiences of ageing. This has involved speaking with the young, and old, about their past, present and anticipated future body-selves. My ‘qualitative tool kit’ has included life history interviews, longitudinal interviews, the use of biographical objects, ethnography, focus groups and more recently, visual methods. With a particular interest in narrative research, I have interpreted these stories using multiple forms of analyses to explore the ‘hows’, and ‘whats’ of storytelling, identity construction through the use of big and small stories, and the ways in which such ageing identities are contextually situated through examining ‘where’, ‘when’, and by ‘who’ cultural context is produced. Central to all of this has been the notion of ‘facing a fear’ – for the participants, and indeed myself as a researcher.

I use this presentation as a welcomed opportunity to reflect upon, and share with the audience what has worked well… what less so… and how I have attempted to negotiate some of the issues that have arisen throughout this journey.

To see ourselves as others see us

The other day a Physiotherapist asked me what I lectured in. I replied ‘Health and Social Care’ and she responded:

“We did 13 weeks on health and social care in my degree. We had to write an essay about treating everyone equally. I was, like, ‘I’ve got to memorise every muscle in the body, I haven’t got time for this. I promise I will treat everyone equally, just let me get on with this’.”

I was very amused by her perception of what constitutes the discipline of health and social care and it made me think about how I would characterise it.

I’m starting here from the assumption that, as for all academic disciplines, the main way you can distinguish it from other disciplines is the way practitioners (academics, researchers, students) describe themselves, and reference the literature, debates and issues that everyone else references. Or put, more positively, the academic discipline of health and social care is a discourse community. So what are the major feature of the discourse community called ‘health and social care?’

I recognise the focus on equality as a key concern, although I’m disappointed that she seemed to have no perception that there is anything systematic or difficult about inequality. I’d hope that students of health and social care come away with some understanding of the ways it’s not just about being nice to people.

I think I’d say that understanding the major features of the current provision of health and social care, including the history from which it arises (as overviewed in Block 6 of K101), is important. So things like the (somewhat arbitrary) division between health and social care; the historic privileging of health, and especially hospital based, care over secondary health care and especially social care; the implications of the changes in funding systems; the loss of trust in professionals and the increased demand for input from service users [1]; the evidence-based practice movement and its limitations. What else?

A focus on particular client groups, such as people with learning difficulties, older people or mental health service users is common, and is often the route by which people move into the study of health and social care more generally, but I’m not sure that’s essential. You would need detailed study of the particular issues affecting those groups to study Learning Difficulty or Gerontology or Mental Health Issues, but I don’t think it’s core to Health and Social Care.

I don’t think I’d say there are distinctive research methods or methodologies for health and social care, although participative/user-controlled/action/change-oriented types of research are more common than in many other fields. Likewise, there aren’t distinctive epistomological or theoretical starting points, although vaguely constructionist approaches seem particularly common.

What else?

I was also amused and discouraged in equal measure by her privileging of the concrete and physical (‘every muscle in the body’) over the wiffly-waffly interpersonal stuff. It reminded me of the privileging of the quantitative over the qualitative, which is one of my major beefs with the evidence-based practice movement.

[1] Not failing already, deliberately using this term here, since the policy generally still does.