Level of Proof for Forums

There were issues behind and reasons for the way things have been handled there. In general terms i would urge caution when talking of "unsubstantiated charges" if not aware of all the facts.

For your information, a trolling is the process of leaving deliberatly inflammatory posts with the purpose of derailing constructive debate.

However how "the other" site is moderated has no bearing on the question of what posts are allowed / acceptable / appropriate on Pod arena. They are two entirely separate entities with different posters and different administrators. I fail to see the relevance and i wonder why you bring it up! If you have an issue with the way the other forum is run i suggest you either A: take it up with the forum administrator or B: avoid the other site altogether. As Kevin has alluded, cyberspace is full of choice, if you don't like something, don't use it!

Are we now speaking of the moderation here or there? If there i refer you to my earlier answer, it has no relevance to the present debate. If here then i refer you to the moderator of this site to answer for himself.

Kindest regards
Robert

 

Robert,

My words are plain and I am sure that you well understand. And yes, I am aware of the facts.

You say
"For your information, a trolling is the process of leaving deliberatly inflammatory posts with the purpose of derailing constructive debate."

Certainly the actions taken there have 'derailed constructive debate'.

However, I agree that your reported "issues behind and reasons for the way things have been handled there" on another forum should not be dissected on this forum.

My point remains, that genuine posters (on any forum) are certain to be discouraged by the presence of any established clique who seem to be able flout the rules that are otherwise applied to everyone else. It is, in my opinion, part of moderation to ensure that such issues do not arise. Familiarity is not professionality.

 

Wow- a lot of repsonses to this question.
That is what makes this "Podiatry Arena" so valuable. Different people, from different places, expressing themselves in different ways. Some contributions based on academia, research, and some contributions based on practice experience.
I suppose I'd contribute the same advice I have in the past, while in the Army, when having the honor of meeting practitioners from around the world- "enjoy everyone's opinions and contributions, don't take anything too personally, then listen to the Americans..."
(Just kidding, of course)
-John

 

I don't think the moderators here demonstrate any bias in the way this site is managed and having been a moderator elsewhere, I applaud the ongoing work of the Podiatry Arena team. Can you point us to an example of disparity?

By established clique, do you mean people who contribute regularly? Perhaps those of us who make this site "work" by writing here, should all stop writing for a while and let the "lurkers" take over and have their say?

"And the meek shall inherit the Arena"

 

Well I am a potential lurker. I recently joined this site because:

a) I am an FHP and want to learn more, although I am more than happy working at grass roots level
b) I can often find the answer to a question from the extensive forums on offer.
c) I thought this to be a more professional site than others that are available where postings are more about bitching and bickering.

What I want from this site is information, knowledge, shared experience (with reference where appropriate).

I do not want to have to seive through personal neuroses and other hang ups which could be better dealt with in therapy. Keep it professional please.

 

Good point itchy, and thanks for posting. It's nice to have the lurkers come out of hiding every now and then to express their opinions as to what they think will serve them best for this forum. Voices can't be heard if they are always silent!

 

I think moderators can work with other ways then deleting posts and shutting down threads. It might be more effective to contact posters outside the thread via email to warn them that they are going close to the edge of the rules and need to tone down their responses.

In academia there is always going to be tension between teaching theory and teaching experience. Both are vital to creating good podiatrists but different people place different levels of importance on clinical skills vs theoretical knowledge. You would expect that the same dynamic would exist on Podiatry Arena.

Those more in the theory camp may argue that without evidence based medicine our clinical practice must always be questionable.

Those in the experience camp could say that theory is just theory not proof and that most of the research conducted is not relevant or valid to actual clinical practices.

What would be ideal is for both camps to accept the critical need of experience and theory equally.

I can remember back to the first few months of being a podiatrist. It felt like I had learned as much in that time as I had over the four years of the degree. The clinical experience was what brought me up to speed. However I wonder how well I would have done without the years of learning the theory behind me.

 

Just want to throw into this debate that, just as there are levels of reliability of evidence recognised in academia, there are also shades of opinion.

This can be illustrated by looking at the profession of Law. A 'learned opinion' of a Judge or QC carries more weight than the opinion of a solicitor (there may be language problems with this for our American cousins - tomato/tomato. A 'solicitor' in Britain is a lawyer - not a prostitute. Some will say that there is no difference!

Therefore, I venture that the opinion of a senior teaching clinician with a relevant background and a wealth of 'at the skin-face' experience ought, in the grand scheme of things, to carry a bit more weight than a passing comment from someone who does not even practise in the same area of the profession. I sometimes get the impression that some posters on this site have very little respect for others hard-earned and legitimate standpoints. We can't all be academics, but we all share a common interest - albeit from different perpectives.

 

:good:

Good point well made! The empiricism vs inductive evidence debate has run before and will run again here and elsewhere!

This is where it gets sticky though isn't it! When people disagree on the grounds of inductive EBM there is oppertunity for a rational debate. How, though, can people constructively debate when the justification for the viewpoint is "in my experiance" when they have experianced different things?

And how to we weigh the value of somebodies "hard earned and legitimate standpoints" when we know few details of that persons "credentials". Many posters choose to post anonymously (which, of course, is fair enough). We cannot give credance to somebodies experiance if we cannot verify that experiance! All we have is their word for it. An anon poster could be someone of the experiance and skill of Simon Spooner or Dave Smith... or it could be a pod student boasting and rehashing other peoples views. Or, indeed, a practitioner who has worked so long alone with nobody to challenge their ways of working that they think themselves to be a more effective clinician than they truly are! Or even a member of the lay public with a "googledegree".

And even if somebody DOES tell us who they are and DOES offer some background to their experiance and we DO beleive them can we still always give their experiance credit?

Consider this. Two Podiatrists. Both are widely published in Japma and elsewhere. Both have made innovative orthotic designs / variations which challenged the status quo are used widely across the globe. Both hold the title of Professor. Both have a "following" of other professionals who use their techniques to great success (we are told). Both have 20 + years of experiance treating patients and both report that their methods have been widely successful (in their experiance).

One is Kevin Kirby. The other Brian Rothbart. . The difference is that Prof Kirby can offer solid deductive evidence for his methods. Prof Rothbart cannot. Evidence is what sets them apart.

Now consider this. Prof Brian debates his techniques with a 3rd year undergrad. On the strength of experiance one must consider Prof B to be the superior. Yet would he be?

Some / many posters come with a financial ax to grind. Can we give weight to their experiance when they have a declared (or otherwise) vested interest?

Everybody practices methods which work "in their experiance", otherwise they would change those methods. But when those methods vary so widely and are often so diametrically opposed how can we, as onlookers, weigh the value of this experiance?

When we discuss in the context of theory, deductive or inductive evidence, we play on a level playing field. We discuss facts not people. It does not matter if the poster is the lowelyest undergrad or Prof Kirby or indeed an anon. The value of their words can be judge on merit. When we discuss in the context of experiance a "senior" member with more experiance can use that to justify their position over a less experianced EVEN IF they happen to be wrong.

I once heard tell of an American graduate, a DPM who dared to disagree with none less than the Founders of biomechanics as we knew it! With little experiance he challenged the widely accepted status quo. A good job for all of us that that debate was not based on the experiance or perceived status of the participants!

Kind regards
Robert

 

If someone with experience says that based on their experience, something works - well - you've only got to try it to prove it.

I suspect that this argument is coloured to some extent by the possibility that some academics have little hands-on experience that they can trade with. How can this be balanced by the experience of a clinician with some academic ability but no strong academic inclination? Has the clinician wasted his time? Is he a waste of time? Or does he actually do the job? Shall we ask a patient?

In any other walk of life experience counts - and in my opinion it should!

 

Sorry bro, i cooked and ate my therapist.:butcher: Pod arena is all i have (sniff):empathy:

Seriously though. I appreciate your desire for the facts, the pure facts and nothing but the facts. But i think it is worth repeating that the people who give of their time so freely to offer you this wealth of experiance and information are not beholden to you or anybody to do so in a format pleasing to you.

And speaking purely for myself, if Simon (for eg) wants to spend 3/4 s of a post flaming me to a cinder or telling me about how his was bitten by a dog as a child and now won't eat kebabs from dodgy vans and 1/4 of the post sharing his huge expertise i would consider the other 3/4 a very small price to pay indeed!

Gaaaaaahhhhhhhhh!:craig:

Firstly i'm not sure that experimenting with something on a patient because some bloke on a forum told you it works is ethical! Secondly, trying something and having it work is scarcely proof!

At the risk of being academic i've seen studies for back pain with a placebo rate of 44%! You could try strapping cabbage to their knees and a good proportion will get better! Its scarcely proof!

Sorry, are we still speaking of the "academics" on this forum? Ask Kevin, Dave, Eric or Simon how much experiance they have! I suspect they have plenty to "trade with!" Who are these inexperianced academics of whom you speak?

Regards
Robert

 

So, man with hole in foot sits in chair.....

"I'm sorry, I can't fix that for you. I have no idea what to do because nobody has written a paper on what you've got. I understand that someone in Australia is conducting a trial that might be relevant, but he won't be able to write it up 'til next August, and then he has to get it published. Can you come back?"

or

"Gee, that's nasty! I'll clean it up for you and put a dressing on to help it to heal. And we'll make something to keep your weight off so that you can get about....."

Put yourself in the place of the patient. Which operator would you choose???

 

If I were the pt with the `hole in foot`, I would want to be treated by a clinician who would apply both EBM and experience in their assessment and tx along with high standard practical clinical skills. For the final year clinical exam, we had to justify and record why we used the dressing of choice for each pt. This required knowledge of up do date evidence on efficacy and contraindication of debridement agents/techniques and antimicrobial dressings appropriate for each individual pt.

For example; the decision to use Lyofoam, Allevyn or Biatain would be influenced (amongst other factors) by the categorisation of the ulcer following assessment for low, medium or heavy exudate. I would not be pleased if the clinician cleaned it up with an oxidizing solution such as hydrogen peroxide (I`ve seen it happen) and then apply a Biatain dressing because they had not kept up date with best practice.


Cheers,
Bel

 

LOL. Moved on from who the inexperianced academics were then. Fair enough!

Is this not something of a straw man? Do you actually beleive that any of the people you refer to as academics here would decline to carry out treatment unless there is a direct inductive trial? Surely not! And in your example i would think the academic would be able to refer to studies on which dressings perform well on that type of wound and on the benefits of offloading!

The situation you portray is a caracature, a clinician who ONLY has academic experiance and ONLY operates on the basis of inductive EBM. Again i say, know you of any such?

As Bel states, i would wish my podiatrist to be conversant in the relevant and up to date research AND experianced in the use of the treatments.

Interesting choice of topic actually. We have quite a few reps come visit where i work bringing their dressings to sell. Most hand out glossy pamphlets containing clinical trials on their product. Some are of good quality, most are not. More than any other area i have seen (save perhaps drugs) we see here the cold blooded manipulation of statistics and experimental protocol. A better exercise in critical analysis one could not hope to find!

It will come as no surprise to most that when these reps come visit it is my assigned role to analyse and question their research. However when it comes time for me to cover the acute alcer clinic (which is not my favorite!) i will admit that when in doubt i generally ask one of the colleagues whose opinion on these matters i respect rather than bring out my research file!

However this is the nub. Those colleagues whose opinions i respect have earned that respect. They are not necessarily the most experianced or the most studied or the most qualified. They are those whose WORK i admire.

I don't know how to extrapolate that to a forum. How to judge the quality of somebodies work when you have never met them and know nothing of them, not even their name! How would i know that the person whose advice i was considering was not, to put it bluntly, an ass?

Great debate this btw!

Regards
Robert

 

Belinda

I think you would not like to spend time with me treating wounds.

Contrary to popular (mis)conception, I splash liberal amounts of H2O2 and povidone iodine around on manya wound...

Just goes to show how EBM and clinical management don't always gel.

(I work in a subtropical region with high humidity and significant wound colonisation issues - just in case you were getting anxious).

LL

 

I've now held a driving license for many years. I drive a vehicle every day.

Question: If I had to sit my driving test again tomorrow, would I pass?

The following is a model of learning: http://www.businessballs.com/consciouscompetencelearningmodel.htm
The theory being we start at level 1 and end up at level 4, the problem is, without staying on top of current theory or "academia" (BTW look up all the definitions of this!) and without regularly honing our clinical skills we can end up back at level 1 and be blissfully unaware. Which is the more dangerous to the patient, the unconscious incompetent or the conscious incompetent?

Question: how do you find out that you are unconsciously incompetent?

 

Robert,

There are good clinicians whom you have not so far met who properly deserve your respect. Does the fact that you have not yourself observerved them working put them beneath your respect?

There are very few clinicians now, that practise the medicine of the early 20th century. Almost all treatments have some sort of history or credibility.

I could turn your argument by observing that much of the research done is ineffective, non-conclusive, and raises as many questions as it solves. I have read papers that were little better than comics, poorly conducted and badly written up. The researchers have wasted their own time in doing it and have caused me to waste my time in reading it.

Much of the so-called research is little better than any individual with a thirst for information could get from the Internet with a Google search. Many 'literature reviews' and 'meta-analyses' add little or nothing to an appreciation of what is known.

Many papers (the better stuff) are often only available for a fee. Those in private practice do not always have the advantage of an Athens account or institutional access agreement. This puts the 'evidence' out of reach for many.

I must also point out that if a treatment proved efficacious last year - because it worked - it will also work this year. I'm with Lucky on this one. H2O2 has its uses - certainly in minor wound control. Those dealing with non-healing wounds in the acute situation have a different problem, and employ a different solution.

As for driving abilities, which would you prefer, because most of us will fit most of the time into one or other of Simon's options-
* someone who did the right thing (from gained experience) just a fraction late, or
* someone who did the wrong thing (from inexperience) but with dazzling speed and electronic accuracy?
Which is the more dangerous?

Of course, what started this EBM concern is a particular paper - the one that speaks of "...the judicious application of the best evidence from research, backed by best clinical practice..." (Sackett 1996). The author made his stance clear, as I did in post 15 of this thread. Polarisation is not my intention, quite the contrary. What I try to advocate to the practitioner is to be aware of new thinking and use what you can of it in the clinics, where you consider it appropriate. This does not mean throw out all that is not new. There is such a thing as time-proven. It's a bit like experience.

 

From your post 15:

This is not true, any clinician can be directly involved in research if they choose to. The reality is that there are many clinicians who choose not to be directly involved in research.

 

Certainly we have clinicians that post to this academic forum that have done no research, have published no papers, have never taught in podiatry school/podiatry seminars, but still manage to write intelligent and thought-provoking posts to this forum and many of us enjoy reading their postings. However, if you are a clinician that has never done any research, never published any papers, never taught in a podiatry school/podiatry seminars and only see patients in your clinic, you will not normally be viewed as an expert by those individuals that have written papers, taught in podiatry schools/podiatry seminars, and have done research, even though you may be viewed as an expert by the lay public. This is simply human nature....people tend to have more respect for those individuals who have accomplished as much or more than they have, and tend to not have any special regard for those that have accomplished less than they have in their field of expertise.

This doesn't mean that these clinicians with fewer credentials don't have important things to say. However, what it does mean is that when a discussion comes up on a subject in an academic forum such as Podiatry Arena, the individual with more credentials, more research, more published papers, and more lectures on the subject will have far more respect from their colleagues than the clinician that has no special recognition on the subject being discussed.

The lesson from this is that if you are a clinician that has not published papers, not done research, and not lectured at podiatry school/seminars on the subject being discussed and want to get the recognition you feel you deserve on an academic forum such as Podiatry Arena, then I would suggest you, first of all, make the effort and take the time to write very intelligent postings that have good spelling and grammar and excellent content. I would also suggest that you read as many articles as you can about the subject that you are discussing and reference these articles within your postings. Then, if you still feel like you are not getting the recognition and respect that you deserve, I suggest that you get up off your seat and start doing research, start giving lectures and start writing papers for publication....all it takes is a long-term commitment, hard work, great sacrifice and little to no financial reward for the countless number of hours that are necessary to accomplish these types of academic pursuits.

 

Don't we just know it.

 

As individuals they are worthy of my respect unless they have done something which causes them to lose it. In terms of their views an expertise, i'm afraid that respect must be earned somehow.

As Kevin said, there are many ways to earn that respect.

For eg, do you consider my views on reconditioning antique clocks worthy of respect? How can you know? I might have spent the last 20 years putting them together or i might not know my spindle from my sprockett. Would you then take your clock apart on my assurance that i could tell you how to put it together? I think you'd be unwise to do so.

Erm... ah. Whoops. I'm sticky on at least the middle two of those (if not more)!

Regards
Robert