First post - a clinical epistemology

For someone as opinionated as myself it is quite surprising that it has taken this long for me to start blogging. In my courses I often go on tangents to draw connections between seemingly diverse topics to what we are learning about in the class. These blogs will in large part be based on those tangents. So if you are a current or past student and you enjoyed those tangents, you may enjoy these posts. I have been a physical therapist for 20 years now and have been thinking about the topics I will post about during those 20 years. I have practiced in a variety of locations, educated students at UMass Lowell and through guest lectures at a variety of institutions, educated practicing therapists across the country, earned an ScD in ergonomics with an epidemiology minor, have taken several mathematics and philosophy courses for personal enrichment, and read too many books - to the point where I sometimes spend too much time thinking and not enough time doing….

When I entered the profession it was a time of heightened awareness of the need for evidential support for clinical decisions. I believed it back then, and I continue to believe that today. As I have learned in the past 20 years, this is much easier said than done. In a 2005 letter to the editor of PTJ I attempted to provide a reason for this difficulty. Simply stated, if evidence is considered the results of a controlled trial, or even a well formulated systematic review, it is overly unidimensional (dare I say simplistic in a variation sense) when compared to the immense complexity faced by a clinician when making a clinical decision. Since 2005 I continue to believe that there is a mountain of complexity to climb when developing an evidence based practice, but with the right clinical epistemology it is possible. With the right use of causal reasoning, theoretical models and inference it is attainable.

I am going to try to put out a few blogs a week on this topic - eventually moving towards concrete examples by taking published studies as cases. I hope to contribute to a broader dialectic of what clinical epistemology is, how various forms of evidence contribute to it and how knowledge, not evidence, guides decision-making in practice.

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