Saturday, March 19, 2011

What's my motivation?

The class I have been struggling with is going from bad to worse: I am learning my limitations.

I do not personally have any real attraction to the geeky side of research, whether it be learning how to measure abstract things like pain, or even learning ABOUT the geeky side of pain research, such as learning what a criterion concurrent validity is compared to a convergent construct validity. Never have had. I simply have no hooks built in my brain, that could grab that information to work with it, even if I wanted to. Never went there. Never did that. Never was attracted. So, right now I'm asking myself how and why I ended up in this situation.

Ooh. The pain. I do not like finding out I do not have a nimble enough mind to even process the information let alone mentally manipulate the information let alone do assignments and exams about it. I feel trapped like a rabbit with one foot in a steel claw. I want to get out of here. If I make a move I just hurt myself and go nowhere.

So, I ask myself, why did I sign up for this?
I think I wanted to know about all of it, but I didn't really want to have to learn how to do it.

The instructor insists that this is the right way to learn to manage pain patients, and she may well be right, but managing pain patients this way is not really and never will be my focus.

I had an enormously long email conversation with her, and slowly, it has emerged as to what my focus might really be... It certainly differs from the one she has.  There is a certain clash of perspectives. In the end, all I am is a human primate social groomer who is always inquisitive about learning anything that will help me do my human primate social grooming better or more effectively by being able to explain. Furthermore, I'm convinced that having the story in the right ball park is also important, in the clinican mind and the patient mind.

Basically, to me, this boils down to being at least on the right kind of tissue, at least conceptually, i.e., somewhere in the nervous system, when discussing pain problems.

She is teaching a class on how to administer tests to patients to figure out what kind of pain they have. To do that, there are dimensions of testing one must learn about before administering.

It gets even more dicey than that. Here is the really scary part, from my point of view. The impression she gives me is that she would love to turn the whole PT profession into people like her. She has huge judgment against any use of pain science for information value only. She seems to want it to stay pure and unsullied, to boldly go into all the shades of grey, to measure them, to develop new conceptual tools that will calculate one colour of grey against another and measure them precisely in such neutral light that back in the sunshine one can still be confident that the scale one uses to gauge the grey shade one is looking for will still correctly identify it, even when its context has changed.

She said "nothing in research is black and white. Everything is grey. Clinicians want black and white all the time, but there isn't anything black and white." (Um, yeah... we already knew that, but we have to make decisions, and the best decisions are made when we can access the best information. Hello? Withholding information isn't helpful! And just because it will never be perfect or because it's only provisional or because it's still just a theory doesn't mean that it isn't closer than what we were working with before! LIFE IS A VERB, not a NOUN!)

She was discomfited at the very idea of pain research being distributed by people who are a lot less close up to it than she, who knows all about how many shades of grey there are and still may be. (Um, sorry, that started a couple decades ago. There was no spigot in place, so somebody built one. The amount of information that had piled up around pain, that was not getting into the minds of clinicians, was threatening to burst the dam and flood the profession far below. Some people thought it better to build some ways to drain some of it out to use to grow new food for thought. Um, so the profession could remain relevant on the ground and in the clinic and be more congruent with how science looks from there.)

She was discomfited by the idea that people were selling pain information to clinicians in workshops for money. (Um, you should see some of the other JUNK being sold - at least this is useful stuff, not JUNK!)

Everything in brackets, italicized, bolded and exclaimed, is my own emotional frustration with everything she expressed frustration about.

I can see her point - she loves the geeky side, and doesn't like to see any situation develop which could possibly misrepresent the careful effort she makes on behalf of the profession. I get it. I do. I think it boils down to intrinsic academic reluctance to take a stand or make a decision. I think some of that gets trained into people. Some of it is probably a character trait. It's good..., I mean, if we didn't have that, we'd have no science at all - all we'd have would be religion (and that would not be a good thing).  She says she is against dogma, so, another point for her.

On the other hand, we have a profession full of clinicians who need better information about what it is we do and better stories with which to line our minds such that we can slide the better information out to patients. And the stories better be scientifically congruent with the information and congruent with the delivery by the profession to clinicians and by clinicians to each other and by clinicians to patients, or else the profession ends up anachronistic, or worse, deceiving the public.
EXAMPLE: I do not see any point in keeping clinicians in the dark about the nervous system and how it works. We aren't children. We shouldn't still be going around talking about something called "pain" as coming from muscles or bones or joints. It doesn't. Pain is something the brain makes out of raw data coming up from the body, but only if it has a "mind" to. It loves to tell itself stories. It can invent pain without sufficient information or even any information coming up from the body. (And no, don't go using that to blame patients for having pain. It's not them making it up. It's their brain, and they are trapped inside that brain, feeling the pain story, perceiving it even as their brain projects it.)

Anyway, here I still am, lying here with my little rabbit foot in the trap. I could chew the foot off, and would still have three feet left to run away on. I'd rather not lose a foot. Don't like making sacrifices.

There is a part of me (an ego part probably) freaked out about failing this class. After scoring an A (!) in the first class, which was all about learning what's going on in the nervous system. Learning the stories about what's going on in the nervous system. That's what I love learning about. Those stories are the ones I can explain to patients. That kind of thing I am definitely motivated to learn. This abstract, dry dull measurement stuff, not so much. I don't want some poor mark on my (pathetically irrelevant in any case) academic record. At least this ego part doesn't. It thinks people could come along and use it to judge me later. Now I remember why I hated going to university even though I loved learning information.

So, I'm forced to consider my options. Cognitive dissonance is so frickin' painful. Ow, my foot!

Lacking natural motivation for learning geeky methodological verificatory statisticality, I could force myself and could probably learn the material, but it would take me a lot longer than the time frame of 13 weeks. Even if I apply myself diligently 24/7 to nothing but the material (which I HAVE BEEN doing), I'm still going to lose. I don't know how to even begin to tackle the assignment, "Critical evaluation of a measure specific related to pain management". It's due at the end of March. No matter what I do, I'm convinced at this point that I'm gonna lose. I'm a dead woman.

From March 18, News Research UPDATES: How to Make Practical Sense of Pain Research


frederic_wellens said...


Hang in there rabbit! Just play dead and when the hunter opens the trap : Run ! rabbit run!

Anonymous said...

Hi Diane,

" I don't know how to even begin to tackle the assignment, "Critical evaluation of a measure specific related to pain management". "

I hate that feeling. Let's try to get you started then. By "measure", are they referring to something like the Roland Morris Disability Questionnaire?

Jon Newman

Diane Jacobs said...

@Fred, Ha! I plan to run as hard as I can as soon as possible. :)

Anonymous said...

You, of all people, CAN do this! I can feel your pain - but know also the value of geeky stuff like the things your tutor is discussing. I love this geeky stuff as well as the 'how-do-I-apply-this-to-the-people-I-see' stuff. Let me know how I can help OK? I would love to help you as much as you've helped me!

Diane Jacobs said...

Bronnie! I really appreciate your offer. Thank you! I'd love your input, but don't want to impose, drag you away from your Christchurch clean-up efforts.
I'll email you the outline.