In Defense of Experience
Last week I found myself in the position of defending experienced therapists, specifically those who have been practicing 15 years or more. I was talking to a newer graduate, SB. He was finding fault with therapists who have been practicing awhile but haven't kept up with trends arising from internet access such as evidence based medicine (EBM). EBM is a topic for another day. SB was complaining about another therapist. This therapist told him she didn't see why she should find new techniques when the ones she currently used were effective.
Before I go further, I need to point out that SB missed the whole point of EBM. By definition, EBM is practicing medicine based on evidence. To be simplistic, research is considered the source of evidence. However, if a treatment is effective, and has been effective, that is a form of evidence. One of the tenets of EBM is clinical judgment, a part of which comes from experience.
To continue with SB, he couldn't believe this therapist didn't want to rush to the internet and research new treatments. I'm paraphrasing what he said to me-that everyone knows about Goggle. Look it up there. Before he makes that statement, SB needs to take a few things into consideration. While SB grew up with computers, they are something new to my generation. Many people aren't comfortable using them. There are people who don't own a computer. I don't know if SB has ever done a Goggle search for PT related topics, but Goggle isn't a good choice. It pulls up consumer oriented Web sites. That isn't the kind of search he wants to do.
If someone wants to research PT topics, access to a database is needed. The APTA offers this through Open Door and Hooked on Evidence, but membership is required. Access is also available to someone taking university level courses. The average PT has neither. Young or old, if you don't have database access, research is difficult.
SB also needed to understand that our generation grew up in a different environment. We were educated differently. We were taught to think differently. I made it a point to research continuing education opportunities before I wrote this. I didn't see one course for EBM. Nor did I see any educational opportunities on explaining how to search a database. This is a skill I recently learned. There is more to it than simply typing in a subject.
Finally, I need to point out to SB that for every article that says one thing, another can be found that says the opposite. A skillful researcher can massage data to say anything. Not all articles are written equally or based on equal science. If SB has an article that supports his opinion, he can say he has evidence on his side. I can say the same thing if I have an article that says the opposite. One good random control study discounts 10 poorly done studies.
I told SB to be less judgmental. He needs to respect experience for what it is. In my 20 plus years I've learned what is effective and what isn't by trying it. The therapist he spoke to may have done the same thing. Maybe next time SB could offer to help with a search. Then he could help solve the problem instead of contributing to it.