James Harrison Interview 27 Aug 2025 1

All right, lovely. So, yeah, I mean, this kind of, this kind of came about just from the video I put out, I think a couple of months ago now. And you had the kind of response that made me think, I wish I thought this video, three more. If I knew somebody who knew so much more about this than me was going to comment. But yeah, I think there's some sort of really interesting discussions to be had around this and we've, I know we've sort of interacted a few times on Facebook, but like we just said, this is a kind of like first time actually sitting down and having a chat with you properly. So, yeah, I kind of, I know we talked a little bit about maybe just kind of working out exactly what it is we're saying, like using terms properly, which I'll freely admit is something that I try to do well at, but I often use the term. Actually that doesn't technically mean that. Yeah, you're right, I should probably use something else. So I think that's. Given that we're talking about chiropractic philosophy and that's such a fraught, you know, we're going to upset people this video, no matter what we say now. So that's great. But I want to upset them for the right reasons. You know, I don't know.

I think chiropractic philosophy has got a bit of a bad reputation and I think it's been polarized a little bit.

Yeah.

So it's certainly to become offended. But actually if you follow proper philosophical thought processes and thinking, nothing should be offensive at all. It's just a question of opening the mindset and just thinking, okay, I'm gonna sort of open up part of my head and just allow things to come from all directions. And there's such a great learning opportunity without having to be too offended. The offensiveness comes from the general constructs of philosophy and that is naturally offensive and challenging because it's at polar opposites to so many other things. But it's not unique to chiropractic. It's the same in medicine science. It's the same all over the place.

In the sense of like, well, if you're too attached to your own ideas, you're probably going to be offended no matter what.

Because that's it.

We have to challenge those ideas to have a useful discussion.

And look, in the chiropractic profession, we talk about dogmas and we tend to think of it as the philosophical subluxation based type of models. But there are dogmas everywhere in science, in evidence based practice, which is in itself a philosophy, incidentally. And all of these things, just bringing them together means you can learn and reflect so much more crisply. But also you can really understand the difference between what, what you are as a practitioner, who you identify as, what the profession's identity is. I think that's what was in your post that really resonated with me. You know, so many students leave and question, you know, what, what is, what am I doing? Am I just doing a thrust? Am I just talking about things? Am I just basically pleasing the GCC and making sure that I fil followed the code? Am I able to have some permission and freedom within those guidelines? Of course you want to stay within those guidelines to really rank up what we're doing and really advance and develop the profession in a way that is congruent with contemporary practice, but still nods a cap off at the past.

It's interesting you mentioned the code because that's something I, I didn't put as much focus on before, but I'm noticing more now is how. And it's funny because I saw, you know, people I graduated with, similar sort of thing, this idea of like, oh, if you're not being evidence based enough, the GCC will get you. And you know, when you actually look at the code and I've chatted to people at the gcc, some people interpret that as if I don't have a reference for everything I say to a patient or everything I do, I'm going to lose my license. In which case I would go, well, we're all going to have very short careers then. Because that doesn't leave much on the table for anyone to have a reference for each thing. And that's not been my experience at all. You know, the code seems to be quite flexible in that terms of if there's evidence, great. But most of what we do, let's be honest, there's not a lot of evidence for and whatever evidence there is, anybody could pick apart and go, well, that wasn't a big enough study or all these kinds of things. So it is funny. I think people take this idea of evidence based and the GCC being this really strict thing and they operate very defensively, I think from that a lot.

Of the time I think the viewpoint is though, is that what gets written in a code is the way that the profession is held to account. And I think new code that's coming in definitely is drafted in a way that creates confusion because, because the way that it was discussed during the consultation was, is that it was all Whether it should be evidence based or not. And actually, that was not what the arguments were about. The evidence was. The arguments were about whether it is that Sackett model of evidence, basing where you have the three stalk sides of it all, or whether it is that rigid application of, you know, if there isn't a paper, you shouldn't acknowledge it, or it needs to be of a certain standard. But right now, evidence based on evidence itself, they're discussing it about whether that actual hierarchy of evidence is actually helpful or not, or whether really good N equals one study is probably better than an RCT or not. So even that in philosophical terms, the debate continues. And yet in the current code and the way it's written, you've got two bits of drafting, so you've got the Sackett model, which is the. The definitely the energy, I think, that the GCC wants us to go down, which is to think about the evidence, to really engage with it and understand it and almost rip it to shreds and use it as a learning point to improve the standards with our patients. And the flip side is it says that there is a hierarchy as well in the definitions, that the RCT standards are really, really worthwhile to focus on, which from an educational perspective, makes really good sense. But from a practical perspective, well, as you say, it might limit practice, it might shorten the scope, it might mean that actually you can't suggest, I don't know, cold or heat in a certain scenario or think about wider public health issues.

Yeah, I have to stop treating any of my patients who aren't between 20 and 40 in male. Basically.

That's it.

Yeah, yeah.

And. And similarly, you never, ever, ever touch a neck, for example. Flip side, because most of the research is all about the negative stuff of touching a neck, whereas there are some positives that can be done from whatever technique or approach you're using. So this is where philosophy really gets frustrating because you can see all the different perspectives and you have to kind of wade your way through it. And my biggest bugbear is that we're not taught it anymore. And that conversation behind the scenes means we lose the sense of our identity, we lose the sense of how to properly analyze a paper, why we're analysing papers, which papers are important or not, and also who we are. You know, are we just basically extended physios or the same as osteopaths? Are we spinal care experts or do we do something else? Do we. Is there something bigger than we're doing and is that just restricted to public health Talking about smoking and obesity or is that actually, you know, we're thinking about wider health and well being broaden by psychosocial model. So big stuff really.

Yeah. So would you, would you say if we don't have that philosophy clear, we can't really have identity, then I think.

You'Re gonna get a fractured identity. So I think there is always, I.

Mean, as the individual, I mean obviously as the profession, but also as an individual practitioner. If I don't have a somewhat, If I don't have some idea of kind of what my philosophy is or what philosophical constructs I'm operating under. To me it's the kind of. It's the why question. Right. It's the. You could say that the science is the what and the art is the how and the philosophy is the why. That's probably a bit, you know, a bit wishy washy for it, but that's kind of how I've seen it and that's, that's what I was trying to get to in the videos. If you don't know why you're doing anything, how can you pick the right path because you don't even know what you're trying to get to?

I really agree. I think there's a phrase that, I can't remember who said it, but they said if you don't stand for something, somebody else will stand up for you. And I think that's the kind of.

Oh, I know, I'd heard it as, like if you don't stand for something, you'll fall for anything.

Oh, actually I think that works too. It's one of those things that actually you. But I think the actual answer there is not. Well, you don't have to subscribe to one set of beliefs or dogmas or viewpoints to be a great chiropractor. You can decide what you want to be and how you want to achieve and what you. And what do you want patients to see? So long as it's in line with the code, of course, and all the other bits and pieces. Great. So I think necessarily you don't have.

To pick a side kind of thing.

You don't have to. To be honest, I don't even think there are sides, if I'm honest.

Yeah, I know what you mean.

There may be sides, but the reality is I just think people talk about things using different words or terminology. People get caught up on things and there are sadly perspectives and dogmas where. Which seem to define viewpoints of the profession, which might be true in other countries, but in the uk I'm just not so sure it's quite as divisive as we make it out to be. There's a lot standardization than we perhaps led on and that, and that often means that there is a lot to play for if we actually just kind of go for it rather than worrying about, you know, I'm going to take this part of it or this part of it. So, and that's, that's in the realms of politics, which is another.

Well, I was about to say I've really noticed in the last six, seven years that certainly the, at least the UK profession, because that's the one obviously we're most familiar with, that it's kind of a microcosm of wider society and that the same political issues that we see in the profession are mirrored, you know, and it's, I think we have an incredibly polarized political system now. People want to put you into one of those two sides. And the idea is, well, if you're, if you're on side A, you believe all these things are good and all these things are bad. And then if you believe side B, that, and there's, there's not a lot of ability to go, well, I think they're right on this and that. I like, I quite like the terms left and right wing because the bird needs both wings. Like sometimes it's got a flap harder with one and sometimes flap harder with the other. But it does seem now that people want to go, were you vitalist or evidence based? And if you're evidence based, you must believe A, B, C, D, E. And if you're vitalistic you must believe the efg. And there's not really any room to go like, can I have a bit of both? It's like we're given these rather unappealing set menus and I go, I just want to order off the menu. Really.

It kind of doesn't serve. I was watching TikTok the other day of all things and, and there was a video from an American chiropractor saying, you know, I'm an evidence based chiropractor and this is how you find another evidence based chiropractor near you. And it was, the first thing it said was is go onto the website and see whether they're using the term subluxation or not. If they're using the term subluxation, they automatically cannot be evidence based. And I just thought, well, that's a load of rubbish because ultimately subluxation is jargon regardless of which way you look at it. It is I would argue as helpful as any other piece of jargon. But ultimately you can still be a really good chiropractor and evidence informed whilst using another piece of language in just the same way as you might want to break down the meaning of the traditional meaning of the term subluxation. Talk about, I don't know, these are just general words that have been used in history. So joint dysfunction, kinesio pathology, you know, whatever, they mean exactly the same thing and just the same way.

This is what I find really interesting with that is that like Leonard Fay who's like, to me is like sort of on the evidence based side is kind of like Granddad Cairo, like one of the, one of the original faculty members ACC very much, you know, from an evidence based perspective people would go, well, he's kind of on that side. And people don't realize that he came up with the five phase model of the vse. He was the one who developed that. He's since gone, look, it got taken and they ran with it in a direction that wasn't what I was talking about. But it's this idea of like, I tell students that and they're shocked. Like, what? Like, but how can he. It's like, no, I'm not saying that DD Palmer was exactly the same as some modern practitioner now, but there's a lot of, there's a lot of nuance in the history there and I think.

A lot of people miss that philosophical question. So I didn't interrupt you, but the big philosophical question is why are they shocked? And nobody asks that question. And that's, that's the thing that gets missed. We, we see the shock, we see the, the energy and the emotion and we just run with it as, oh, this is hard work. So let's just, let's just skew it, let's just push it to the side.

Yeah, that's where the stereotypes come from, isn't it? It's actually hard work to understand what another person believes. But if I can go, oh, you said subluxation. That allows me to not think and put you in this box with everyone else. I disagree with who all does all these things and stereotypes. I mean this is a little bit controversial, but that's, that's kind of the same thing as racism. Right. It's kind of the same route is I'm going to treat everyone in this box the same, you know, all the things we think of as terrible. It's like that's kind of what both sides are doing here. When you go, oh, if you're like that I'm going to be prejudiced against you for all this stuff and I'm going to treat you like you believe a bunch of things that I haven't even asked you about.

I definitely think it's discrimination and I think in history you see this discriminatory wish, for want of a better word in chiropractic, you know, there's straights and mixes, there's vitalists, there's mechanists or materialists. There is, there's the bca, the UCA in the UK or the mca. You know, there is this division and this desire for division and I'm not entirely sure it's very helpful because I.

Think it serves the organ more and more. I look at the, I look at the, I mean BCN you say is the, the kind of classic. I know obviously SCA and MCA to my understanding are reasonably aligned with the uca, at least more so than the bca. I don't actually know the nuances of how those three organizations relate, but it's this kind of idea if you want to put the two groups, to me, it's like, it's like two playing cards stacked against each other. It's like, well, you need the other side to be the terrible people that you paint them out so then you can go join us because we're fighting them. Like, I don't, I personally, I feel I'm not as familiar with the UCA as a BCA member, but I feel that if anything the vitalistic associations tend to have a more positive message and that there's a bit more of a this is what we stand for and this is what we want to build and this is what we want to see the profession grow into. I feel the BCA and evidence based chiropractic for quite a long time has had this problem of going, well, this is what we stand against. It's like, well I think that's wrong and that's what. And I've often made the comparison. It's a little bit like, you know, you people go through that really irritating teenage atheist phase where it's like, oh God, stupid religion, stupid like. And it's just, I think that's crap and that's crap and like you just rubbish all these things you don't like usually very simplistic understandings of those things. And if you go, what do you believe? There's no real answer. And I think the evidence based side, we have that issue. If we've defined ourselves in terms of a negative for quite, quite A while, which is kind of what I was trying to get to in that video is like, so what are you for? Like, okay, you're for not ripping patients off, you're for not being Dr. Centered, you're for not doing all these bad things. Like, okay, that's great. As I think you said in one of your comments, well, vitalism doesn't have anything to do with being unethical. Like, you can have unethical, mechanistic and vitalistics as well. But it's this, you know, I think this, this is a profession we have more, in my honest opinion, is I think the more vitalistic associations tend to at least go, well, this is what we want. Like, there's a more. I think they have a clear idea of their goal. The bca, as far as I can tell, is we'd like NHS and doctors to accept us. And I know that gets thrown at BCA quite a lot, but I can't really see what else is the positive vision we're building. And it's not something that excites BCA members, frankly.

I think it's the question of what is philosophy, because I think each of these associations have their own philosophical stamp. So as you were saying, the bca, I think they're very well respected for what they're doing in terms of pushing the evidence forward. They're trying to lobby and ensure that chiropractic has got a very, very stable basing and foundation from an identity perspective. But they want chiropractors to be seen as spinal care experts. That is definitely one philosophical sort of entrenchment. So as you said, it's all about whether we can be adopted into the NHS or not, whether the medical professions will see us as being credible enough to, or authentic enough to be part of whatever model that the medical associations and organizations want to be. Flip side on the alliance organizations in the uk, they're very much more the Chester Wilkes side of things, of, you know, chiropractic is separate and distinct and it isn't medicine. And ultimately we have our own principles, whether they realize them or not. So I will, I will acknowledge that one, that sometimes I think they talk about them and they might not necessarily know all of the philosophy, philosophical underpinnings behind the scenes, but they are essentially suggesting that they want to be seen as their own separate profession and that they want to be known for chiropractic and the identity of whatever chiropractic stands for. And certainly the associations on that side may vary a little bit in terms of their viewpoints or their thought processes or how much they will integrate with medicine or other types of healing or thought processes or all the like. But ultimately what we are looking at here is whether the chiropractic is something that can be absorbed in by medicine or whether it stands alone and it flirts with medicine as an interplay, an interdisciplinary practitioner. And ultimately I think that's for all of us to kind of take the viewpoint on. But wouldn't it be great if we actually had both and we actually had chiropractic that was. Knew what it was, stood up for what it was, could actually define itself without having to go, maybe that too, and ultimately be part of this bigger model so that you could say, you know what, this medical, this pill or potion isn't working, but let's go for chiropractic. And that to me is possible, but we have to mature and we have to get off us thought process.

Yeah, yeah, I feel like we have to. And that from what you're saying starts from, okay, a better understanding of what philosophy is and isn't and what different philosophies there are available to us. Would that be fair to say?

Yes, historically. Well, this is, this is probably deeply political. So forgive me for saying this, but it's.

Oh, we've lost everyone now because we mentioned politics, everybody.

I've been very intense already, but it's. But historically, philosophy is the thing that people control if they want to say a viewpoint, look at anything in history, world wars, battles, the thing people control of the books, what is considered as evidence or rational or reasonable or the philosophy tomes. So Hitler, for example, in his book burnings, he definitely got rid of a lot of philosophical terms. And ultimately it is about that political politics is a type of philosophy, so I'm embracing it. But ultimately it is about trying to control a narrative. It's about directing and leadership ultimately, and certainly containing philosophy, suggesting things are historical concepts just on their own merits restricts scope. But it doesn't necessarily have to be that way. So for example, I'm not saying, for example, that subluxation is a good thing to talk about because I do think it is outdated. But certainly philosophy has been removed from a lot of trainings, so it may be an educational institutions, so it may be seen. But instead you'll have an epistemology module or you'll have something about critical awareness of how to read a paper. That's all philosophy, Clinical studies, how to communicate. That's all philosophy. Even, even your very own talks that you give in terms of New grads and how they can integrate. That's philosophy.

Yeah.

This day and age, we don't dress it up as philosophy because we're a bit scared of it. So what we do is we talk about it being evidence based or scientific, but those constructs are not scientific constructs.

We're kind of going, instead of, look, here's the topic of philosophy. Here's the different, you know, philosophical concepts that are available that you can choose from. We're kind of going, don't worry about philosophy. We're going to take a couple of these things off and it's to use the menu item. You have this nice big menu. It's like, no, no, you just want burgers like that, just have a burger. And if you don't like burgers, sorry, there's no other food. Now is that. I think that's where the grads come up. I had an interesting chat the other day with Chap. I think he's been out for about three years and he'd done another degree before, so he had the benefit of a little bit more life experience, had gone through university before. So he was a bit more aware as to where he was struggling and where others were struggling. And it's one of the things he said is that we're taught, you know, evidence, evidence, evidence, like research papers for this and research papers for that. But we're really just taught, is this how to know is this a good or bad paper, you know, critically appraise it, do we put it in the useful or the useless pile? But we're not really taught. Okay, but now I have a patient comes in with a very particular set of circumstances and issues and co factors and all that. How do I. How do any of these papers that I put in my good pile help me? And also to me I'm going, well, good and bad is a very black and white way of looking at, you know, well, as you say, philosophy essentially there. And it's this kind of. They don't know how to translate this particular version of philosophy into. Yeah, but now you're dealing with real patients all the time and reality is messy and all that lovely left hemisphere models and construct stuff that allows you to absorb the knowledge, doesn't allow you to translate it into what this patient needs. And I think that's where a lot of them and, and at the same time they're going, well, you know, this is another new grad I spoke to. He said he'd worked, he worked in one very high volume, very vitalistic by the sound of it what most evidence based chiropractors was stereotype as that kind of practice. And then he let, oh no, he worked the opposite first. Very, very mechanistic. You treat them four to six times and then you discharge them. Only pain based. That's it. And then he said I need to see something else. He went to this completely different place and he said look, that higher volume place wasn't for me. But the thing I miss about that is they all knew what they were doing, they had a philosophy. He said I don't fully agree with it. And he said I think that's what was new grads is we graduate and we have no philosophy. And then to their perception because then haven't been taught that what you have is a philosophy. They're coming out and half the profession are going you need a philosophy. Here it is, this is chiropractic philosophy. And the other half are going, you don't need philosophy. And I, you know, there's problems with both sides. I suspect that the side going you don't need philosophy at all. Like I've heard some quite hard line evidence based folks say oh chiropractic philosophy. Like you don't need philosophy. Philosophy is nonsense. That's all a waste of time. Now I think that might be doing more damage to the grads than here's a particular version of philosophy and this is what it is and this is what you should have. I think being, I think having a bad model is better than no model.

In that sense doing is actually misguided. I'm very happy to be posted on that. It's also damaging for the profession because what's actually happening is you're saying take away the leadership, take away the self awareness, take away the mastery of, of the art and just dogmatically apply a paper and that what happens essentially is you're getting people being great academics at chiropractic leaving chiropractic college and they're just not practically relevant. They, they're not horrible. And more than anything else they have to then be taught how to speak to a patient, how to talk to a patient, how to empathise. And ultimately those qualities should be taught in college. And they are certainly taught where there are more clinical based modules where you can be around patients, you know, your internal and external observations and the like. But those are snapshots of scenarios.

I think it's more an exposure than a teaching. I think it's. If you go into it and you know what you have to learn, you could go in there and Pick up a lot, but you kind of have to. No one's going to go. By the way. This is what you should really be focusing on here. It's one I get some experience.

So one of the things I learned when I was involved with the World Congress of Chiropractic Students when I was a student was the amount of access people get to philosophy around the world. And it was somebody that was being taught in South Africa told me what their impact or what their knowledge of philosophy was. And I'm going to just share it with you for a second because I think it's useful to know. So it came from this book which is the Modern Development of Principles of Principles and Practices of Chiropractic by Scott Haldeman. And this was their entire knowledge of philosophy because this was the only thing that was really given to them in their course. In this book, the only bits to do with philosophy talk about traditional philosophy being DD was a quack, they were family eccentrics. BJ apparently murdered Didi.

That still gets thrown around.

It tells that the evidence based people are people of competence. So the people who are not evidence based are incompetent by delineation. And it even suggests that the threshold of respectability and subsequent acceptability by the scientific mainline is the goal of chiropractic. So in other words, what this book is suggesting is that anything that doesn't absorb into medicine is automatically something that is incompetent or not worthy of the title of chiropractic. Now, I am not criticizing Scott Halderman. He's done so much for the profession, so I'm just going to put that out there. But what I am saying is that is very much one viewpoint that's very much more aligned traditionally with that BCA model we were talking about earlier. That is a really credible way. But there is so much richness that comes from some of the other discussions that go out there that could inform an approach and probably make that job a lot easier if that was suddenly integrated within. One of the things you mentioned was about vitalist practices being high volume. That is not always the case definition of vitalism just means it's bigger than the sum of its parts. So mechanism being contained by its parts. So. So if you were doing anything that is to do with public health, you're talking about diet, nutrition, you're talking about obesity, smoking, you're talking about a chiropractic lifestyle, as I call it, you're not being mechanist, you're being vitalist. And straight away a lot of Those practices that suddenly talk about that we are not.

Can you expand on that a little bit? Because I'm not, I'm not saying I outwardly disagree, but I think a lot of people might hear that and go, wait, wait, how is talking about lifestyle vitalism? I think there's a leap there that I, I'm still a little bit like, I think you're right, but I don't quite get how you got there.

I love that. Yes, completely. It is about definitions essentially. So the definitions. So the challenge that that philosophical discussion has is it is based not on opinions so much, although everyone thinks it is, but based on conventions. So if you've got a convention that leads you that is set up a definition, a way of working, then your thought process kind of filters underneath that. So a little bit like your definition of evidence or what's considered good evidence or bad evidence in the traditional sort of evidence based paradigm, that is the philosophical construct. So your RCT and systematic review and your controlled trials are higher than your, your case reviews, for example. The same happens within philosophy generally, regardless of whether it's chiropractic philosophy or not. And ultimately there are different definitions of what's going on. So mechanism or materialism, it's actually probably more materialism than the mechanism that we talk about in chiropractic terms is all about things being the sum of their parts. So it's the machine model, it's the MOT model. So you're going into your chiropractic clinic essentially because you've got an ache or a pain and you want to get it fixed or perhaps you want to maintain your machine behind the scenes in order to get things to chug along along the road.

Yeah, the body's just a collection of parts. We find the broken part and fix it and then job done.

So sure, like your car and your mechanist side of things, your mechanic might want to say, well, we'll do an oil change here and that might be a little bit more. But the intention is really is you're dealing with the constructs of the body. So it is all very self contained. So your brain is your powerhouse of the body and from a biological, natural perspective and everything is kind of governed from that. Now when you start to put mental health into the flat side of that, suddenly you're a little bit further out of the body and straight away that doesn't fit that model of mechanism. So it's more the mechanism. So anything that is psychosocial, it's actually not mechanist.

Well, I was going to say that that's the whole hard problem of consciousness. Right. It's like, well, we can't really explain the emergent properties here if we're dealing with complex systems. From what you're saying, it sounds like, well, we have to dip our toes in the vitalistic water at some point, unless we're going to go. Which is. And it's funny, actually, I think this is where I. I don't want to say I think it's where a lot of the academics in the profession come from, but I feel like there are a lot of people who get into chiropractic thinking. It's a materialist, mechanist job. And it is that. Find the broken part, the person's going to come in and lie down and I'm going to lift the hood on their spine, fix the broken bit, off you go. And then they really struggle in practice because it turns out most of the job is dealing with the spine's owner. And that's a completely different set of skills to being a mechanic. And it's the sort of, are you. Are you higher in empathy? Are you higher in systematizing? And not many people are high in both. So the people who are naturally great at being the spinal mechanic are probably people who would naturally be bet do well in the academic world because they're good with models and numbers and concepts and that sort of thing. And I wonder if many, not all, but many of the chiropractic researchers were people who were naturally more inclined. Yeah, this is a complete stereotype. I don't know if it's true. I imagine you find more atheistic chiropractic researchers than atheistic chiropractors. Well, I've done some research because it would lend itself to that.

Sorry, I've done some research on that. It wasn't published because it wasn't. To get this politically savvy to public.

We brought religion as well. So we're definitely going to be.

But these presumptions are well and truly documented as being debunked. And ultimately the vitalist side of things. I'll just continue. So you've got that mechanist viewpoint. Vitalist is something bigger than that mechanist side, and that's all it means, essentially. So there is a whole viewpoint of there being two concentric rings, essentially. So you've got mechanism in the center and then vitalism that encompasses that mechanism side of things. And so what I would say to what you said is that actually I don't think there is that delineation I think you can just have a greater researcher or greater student who is vitalist behind the scenes. It's just their practice includes something a little bit extra, essentially.

To be fair. I don't mean to say it should be that way. I think it's just more. My suspicion is that because of the way that we discuss the. Or don't discuss these, is that those people might naturally be pulled a bit more. The impression I have is most. The chiropractic academics that I speak to are much more inclined to. I think their view of the world is quite deterministic, materialistic. And I think that the, the clinicians. And it's probably. I don't know how significant this is, but I think. What am I trying to say? I think if you naturally have a vitalistic worldview and you naturally sort of are open to and appreciate the whole is great in some of its parts. I think those people, for whatever reason, are less inclined to get involved in research as a career and leave clinical practice than. But I. I've made that up. So that could be nonsense.

I mean, I would say it's harder to do it because your lens is different. So if you think there are. It's like speaking. It's like behind a mechanist talking to somebody about quantum science, you're never going to get an agreement there because quantum's just kind of way out there in comparison. You can't control anything. Whereas science has its constructs and philosophical constructs. Behind the philosophy of science is it's all about measuring one thing, a hypothesis or a null hypothesis, and seeing whether that is true or whether it's not true. That, incidentally, is also philosophical. But it is, but it essentially, that's what science is about. It's about getting that snapshot viewpoint. So I would agree that you're probably more likely going to get those people who view the world that, that they want to ask a question and get a specific answer through perhaps an algorithm or, or something like that. Whereas if you're more vitalist, you're going to see that there's more spurs off, there's more gray. There's more things that might not necessarily be tangible or quantifiable for that matter, but there's still qualitative studies out there that can be still quantified and there are still qualitative ways of, of contributing to it. So I wouldn't necessarily say that all. I know you didn't say this, but I wouldn't necessarily say that all researchers had to be on that mechanism oh, yeah, Yeah.

I mean, and this is something I have to watch against because I'm. Are you familiar with Ian McGilchrist mastering his emissary? Done a lot on. On hemisphericity. And again, this gets in hot water because people misunderstand left hemisphere, hemisphere. But I'm somebody who's naturally very sort of left hemispherically strong. I like models, I like concepts, I like algorithms. You know, my brain is very good at this or that. It's not very good at both end. And that served me really, really well. But the thing that allowed me to grow as a chiropractor more than anything else was to try to go, okay, that's helpful somehow. But this right hemisphere, both and idea of like you say, there's shades of gray. Sometimes something can be. It can be elements of both. Started my mentor, the only mentor I've stuck with for more than 12 months, Rob Pape, who I'm still mentors me now, eight years later. He's completely. That we kind of joke between us. We have one functioning brain because he is all right hemisphere. And actually talking to me helped him learn to kind of like, categorize and build a bit of a framework around some of his concepts because he'd not had someone go, what's the rule? Is it this or that? Does it go this way or that way? But my tendency is still to pull things back into yes or no, that more kind of binary mode of thinking. So, yeah, that part of me wants to say, well, researchers are like this and clinicians are like that. Which obviously is way too oversimplified from.

A philosophical perspective, though. And I'm hoping people who might still be with this as writing notes, guides through this is questioning what's behind that. So if you're aware of that enough to get a coach that does the opposite, then that's really. Philosophically. That's like, one of the best.

It was a happy accident. It was only. It was after I stumbled across Ema Gilchrist off. I'm like, this is why you've helped me and frustrated me more than. We just ended up chatting. Kind of fell into oversight. I'd love to say that, yes, I identified a flaw in my thinking. I really didn't. He was just patient enough to stick with me. I was stubborn enough to not give up, even though it was frustrating.

That's brilliant, though, because it challenges your viewpoints and your thinking. But you then speak through that. Recognize what you see life as. Your prejudices, your biases, your dogmas. Everyone's Got them. So you have to kind of just kind of work out where they are. And as a result of all of that, you can then make more strategic decisions or you can frame things in a different way. So if you naturally like an algorithm, I hate algorithms with fashion. But if that you've got an actual algorithm behind the scenes, then you can map something out, an algorithm and you're taking from whatever content it is, you'll note it down differently to say, I would. I'm always amazed by people who could do mind maps in lectures. There was somebody who's always sat next to me and in my chiropractic lectures who do a mind map. I would go home and I wouldn't be able to remember a thing from that. But it's just how different people are tuned differently.

And to me a mind map is not hierarchical enough. I'm like, that's too right brain. No, I want a list, I want heading, subheading, subheadings.

Do you know what? For me. So I trained originally as a lawyer and the research and the evidential perspective on law is pretty much the opposite to science. And for me that was the bit where when I was training as a chiropractor, I went, wow, this doesn't fit. And I had this huge dichotomy and this sort of paradigm disruption between me as a lawyer where viewpoints of judges are considered the top of evidence.

So the case study is the thing that sets the precedent, that sets how it's. Yeah.

And then you've got your case studies and your judges comments at the top and then actually the case that it's very different. And this is the thing that got me interested in philosophy because before then I was sort of thinking, why would I want to know about it all? But because actually between the two of those there is a gray area and that's the medical legal world where actually they merge. And ultimately what the GCC has been savvy at doing this year is with its new code is it's starting to sort of merge that and getting people to think about where the code meets the research for chiropractic and how that integrates. But that's a dangerous area for an organization that doesn't necessarily recognize philosophy because there's going to have to be philosophical discussions to navigate through that. And sadly that's going to end up in the fitness to practice hearing side of things, rather than an academic side in the Royal College or the like, which is messy. But that, that's the way it goes. But it, but it is Interesting how philosophies can differ and those perspectives differ. So I normally come at things from a relatively logical perspective. To start off with, that's the old lawyer in me. And then the chiropractic me, since I've discovered what I am philosophically and my identity and how it works is a little bit more. Well, I'm going to use the word intense, I used that earlier, and it's quite passionate. But between the two, you see those different hierarchies, and ultimately the RCT doesn't really sit as highly. So you're in a. You're in a case or fitness to practice case, and the RCT actually doesn't mean as much as what the end result is. It's a very different setup. But from a clinical perspective, your RCT or your study that's, that's peer reviewed is actually quite high. And so there are different lenses for different purposes and different viewpoints. And sometimes we just, as a profession, in my opinion, just go, you're vitalist, you're seeing too many patients.

You're doing. We all, we, we, whether we know it or not, we're all, we all graduate with a certain lens. And then it's, oh, well, these people seem to have the same lens I do, so I guess they're my people. And everyone else must have the only other lens you could have because it must be black or white. And then I guess so, you know, I'm trying to think in terms of what would, what would help the profession, us as individuals, what could we do to help profession? And it seems like just appreciating there's different lenses out there is probably a good start. You don't even have to change your lens. But just going, oh, there's other. It's like, you know, I've only ever eaten burgers to continue the menu metaphor. It's like, you know, it's possible to have fried chicken. I mean, it's possible to have a salad, but if you're raised on burgers, you wouldn't go near a salad. But it's okay. There's other. It's a bit like, oh, people do things differently in different cultures. And it doesn't necessarily mean we have to immediately judge, is one better or worse, or do I now do that? But it's that kind of, oh, yeah, over there. That might make sense, even if it doesn't make sense within my lens. Or it's. Or maybe it's something that could make sense but isn't naturally something for me to spot with this lens.

I'd agree with that completely. The other thing that I'm going to say, one of my reflections on the last couple of months. So I'm currently Studying A, an MSc in Healthcare Leadership and I'm lucky enough to be on calls with people from different healthcare perspectives every week across the world. And I said a phrase that was beaten down in my last seminar, which I thought I would bring to this call, because I said, well, chiropractic is really fragmented. You've got four different associations in the uk, all talking different stories. And the person shot me down instantly and said, oh, wow, you have it easy. And I thought, okay, you're what now? Then he talks about surgeons all having different viewpoints, all having different ways of doing things, all having different ways of, of, of working with it. So many different associations and other bits and pieces about different types of surgery. And I, I ate my words in a huge way. And I do think there are professions that are more fragmented than ours, that are handling things a whole lot better than we are as a profession. And that is me saying that about chiropractors with so much love and appreciation. But actually, I think we, we deserve to sort of be shaken a little bit.

Thank God we only have four associations. I'm not sure you'd ever find a chiropractor who said that, but since I've.

Had that seminar, I've really appreciated actually, yeah, we don't need a fifth and we could get a sixth or seventh.

Because I've, I had this sort of, this narrative in my head that, you know, I've shared quite freely before in the, I've, I've kind of seen. It's like, maybe this is less true in the uk, but having hung around a lot of American chiropractors, chiropractic certainly used to, and I think this is true to a slightly lesser degree in the uk. It used to attract slightly weird people like it, it wasn't a, it wasn't an obvious career choice. Well, I was weird in that my, I was raised by chiropractors, so I was always going to be weird. So I was the only 5 year old any teacher of mine had ever met who said, I want to be a chiropractor, grow up, but it's usually something people kind of stumble into. And if you're very much like a normal mainstream person, you probably wouldn't have considered it. So it tended to attract slightly wackier people, but it also tended to attract people who kind of want to go off and do their own thing. That they're not looking at work. They don't want to work in a big organization. No, I want to do my thing and be my own boss and be in charge of myself. And that. That's changed. This is a whole separate discussion. But I do think that's changing with younger practitioners now. Very, very different. And I think as clinic owners and mentors, most of us are not prepared for that. But it was this idea of, like, oh, yeah, we all kind of want to do our own thing. And the problem. One of the. One of the mistakes I think we tend to make, and maybe this is less true than I thought, is that most people look at a problem in the profession and go, I know what we need to do to fix that. I'm going to start my own thing. And I kind of, like, often find myself going, like, we have. Wouldn't it be better to take a thing that already exists and try and steer it a bit more, that it's gonna be slower and harder and you won't get all the credit and you won't get to be in control. But, you know, like, people talking about, we need to set up a new mentorship scheme. I'm like, we have the prt. Like, I'm biased as anything because I'm on the council for it. But I will freely admit there are many ways we could improve it. There's multiple things that don't work as well as they should it, and it's hard to fix those things. But I go, wouldn't it be nice if you got involved with this and helped us to fix it? I mean, that's one of my biases. But why do we, you know, I think many of you, we try to recreate everything from scratch all the time. Instead of going, look, I know it's not a wheel, but a hexagon kind of spins a bit. Maybe just chisel off one of the corners with it. So that's better than trying to reinvent the wheel.

Let's just pick up on prt, as I'm a PRT trainer and, okay, we'll.

Both get in trouble with Marcel then.

That's good, I'm sure. But I will just say this much. It's philosophy. It's clinical skill training. It's working out who you are, how you can be patient, centered. It's about making sure that you know how to read a paper. It's about standing with you whilst you're having those scary moments. Science is not going to do that. Philosophy and art will. And that's where you. That's what PRT is about. But we don't dress it as such. But actually that's where that real stuff is. How can I talk to my patient? How can I make it patient centric? Am I actually being patient centric enough? These are really valuable questions. And some of those things that I've had this year whilst mentoring PRT students is, is that that voyage that happens throughout the course of a year from going from a college perspective where everything is almost given to you? I know it's not given to them, but it's. But it's sort of artificial in respect. Yeah. Oh, rubbish. Walk into the clinic, what do I do? And there is that scrabbling around behind the scenes of figuring out, okay, what's the, what's the public perception that I want to give? What's professional, what's going on behind the scenes and paddling away that nobody needs to see? And what am I reflecting behind the scenes and going, actually that could have been so much better than that. And that is so valuable. But that whole exercise of reflection, reflection in itself, the GCC makes us do it every year. Guess what? It is philosophy we don't want to.

It's funny because the, the opinions I've often seen from the more vitalistic practitioners out there who don't like the RCC is they go, well, there's no philosophy. It's, it's, it's BCA disguise. It's BCA pretending to be apolitical or something. I'm like, you might not agree on the, all the philosophy that goes in there. And I agree it's certainly, I'm sure from a more vitalistic perspective, the RCC does look fairly anemic. And there's probably, we, from what you're saying, we could probably do with more of that discussion. But at the same time, I know some pretty vitalistic chiropractors who are heavily involved with the RCC as well. But it's that you. One thing you mentioned there as well. Do you. So you've talked about how there's these different philosophical constructs we can use and we're trying to mentor a new graduate in this example and help them find out sort of who they are on their identity and whether they're being patient centered. If they're being patient centered enough. Would you say patient centered care is a philosophy?

I think it's a practice style, but it is a philosophy in the respect of who would you define as a patient? And that question is.

I knew you'd instantly go deeper than I was Prepared for with that answer.

Sorry. And the reason why I love it. Nobody wants me to talk philosophy. You've asked me to talk philosophy. I'm loving it. This is 15 years of oppression here. So I'm loving is really good. But who is a patient? I'm a patient. You're a patient. Everybody's a patient. And so actually it's about what our lenses again in terms of who are we and.

All right, sorry, rewind on that. How is everybody a patient?

Yeah. So when you have an illness, you're.

Oh. And that we all get ill at some point. Okay.

And your perspectives at that point. So I was ill a couple of weeks ago and guess what I did? I did the thing that I really hate that my patients for doing. I went onto Google, I put my symptoms in there. I was like, this is what I need to work out. I know what I think it is, but I still put it into that. I put it into chat GPT as well. I'm really embarrassed to admit that, but that's what came up. I was going to die, you know, all the other bits and pieces. And then I stopped and I thought, I've moaned about so many of my patients doing just that. And that's because patient centered care is about being understanding of your patients and understanding it from their lens. I don't think I was actually as patient centered before that experience. Now I realize that they're feeling vigilante behind the scenes. They want to be looking in terms of their health and wellbeing. They want to be the person making the decisions and firing in the shots and we need to be supporting them.

And it's the thing they can do right now. Like you're not, you're not in front of a doctor. So it's 11pm at night and I'm worried. All I can do right now is get on Google or I'm just going to sit here and go, well, better wait till the morning and hope I can see someone.

A brilliant video to watch to back what I'm saying up Here is a TEDx talk about meets E Patient Dave. If you put that into YouTube. Meet e patient Dave Patient Dave and you'll get it up. It's a TEDx talk and it is a brilliant little video. It's about 25, 26 minutes long, so it is definitely worth a cup of tea with. But it is a brilliant thing and I found that after my experience and it really opened my eyes in terms of what we think patient care is, you know, but actually the lens that Most of us go with patient care is not patient centered. It's what we think the patient wants rather than what the patient actually wants.

Yeah, I've often called this patient centered light where it's sort of. Oh, right. So like ever, you know, the three stalls. Right. And it's funny, patient goals and values always last. Nobody ever lists that before they list evidence and experience. But we go, okay, so then there's the patient centered bit. So I'm going to basically use my clever brain and I'm going to assess things and ask them questions and I'll find out about their life and their goals and you know, their kids names and all this stuff. And then I'm going to put that into my brain and I'm going to decide. Right. Based on that, I assume I know what the patient wants and if I was them, I would want this. So I've now got to convince them to do the steps to get them there. But while I do it, I'm gonna be nice and friendly and I'm not gonna outwardly force them and I'm not gonna deliberately over treat them and I'm gonna remember their kids names and talk about. And this will get you back to tennis too. Remember you like tennis. And it's kind of, it's still this sort of paternalistic, slightly like well intentioned, but patronizing mindset of I've decided where you should go and my job is now to convince you to do that. And I think that's what I've spoken to many experienced chiropractors. When you spell it out, they're like, yeah, that's me. It's that lip service to patient centered. But you don't seem to get the philosophical underpinnings to it.

But then again, flip side, because I'm all about flip sides. I wouldn't want to cast any shade or aspersion or blame to those people that feel that way. Because if you look at it in terms of what's in the code, we have to be evidence based. And the third pin of that chair that you were talking about is, is the, the wills and the needs and the wishes of your patient. So you can view that from a non philosophical bent as well as a philosophical bent and think of that as being evidence based and actually being pretty reasonable behind the scenes. You're just viewing that as being a little bit more accommodating to how you view or look at the research or apply the research.

Yeah, I don't. Let me think this room. I'm struggling to compute that A little bit. I don't know. I feel like it's. People talk about this funnel model of evidence based care, which I don't, I don't fully get into how that's different to stall and this sort of thing. But to me, the patient centered part is, okay, who's in the driver's seat? Like who has what role here and how are you working together with the patient? I think the ones. Because I think you don't have to be evidence based to be not patient centered in that. And I don't, I don't think either side has a claim to that at all. To me, it's about are you acting as a, as a guide, somebody to help them work out what they want to help them get there, or are you acting as someone who's in charge and kind of driving the bus? And then how you approach your, you know, your approach to science and your approach to the research of that in your experience will all inform that. But to me that all comes second to have you really understood the patient? And is it a transaction relationship where you give me money and I give you treatment? Is it a parental relationship where my job is to kind of make sure you go down the right path and I know better than you and this is for your own good, or is it one where you're just, you're two equals and you're trying to find out as much as you can about where they want to go and what's stopping them and then give them the info they need to make that choice themselves as to where they go. But I don't know. I don't, I don't see, I don't see evidence based or vitalism or anything that those terms don't to me kind of have a claim on that decision at all. They're sort of, they're important distinctions and decisions. And like we said, I don't think they're mutually. What's the word? I don't think they're really the loggerheads people say they are. But the patient centered part, to me it's, it's something that to me comes before that. And I get it. And I don't judge people who do do patient centered light. Because I did that for years, because that's what I thought it was because that's, I learned that at uni. I learned it when it was a new cool thing. All be patient centered before everybody and their mother said they're patient centered. But the, the way it's, the way it's been taught. I don't think people really get the, the deep personal growth you often has to go through as a practitioner to be able to be more patient centered. And it's, it's still a journey. I don't think it's a, oh, I believe this now. So off I go.

I was unusually quiet there, but because that was brilliant philosophical exploration because you went all the way around it, you followed a full sort of cycle there in terms of working.

Oh, I feel I talked all the way around it without saying something.

But I'm sad to say people have called philosophy torture in the past. But ultimately it is one of those things where you really do evaluate it from different perspectives and there is nothing there that I don't think you could argue rationally with a whole host of different viewpoints and proponents. Yeah, it's definitely. I agree at least in terms of that thought process and, and I think it's the way that which you view it and the way that which the lens you apply it. But I think going to sort of evidence basing itself in terms of what Sackett wrote about, I think that was very much about defining what evidence base was. It was very much more of a this is our stake in the sand type of thing as opposed to the practical relevance of it. And I love that you, you, you took it to practical relevance. But actually that's where the. I don't think there is that algorithm, forgive me for saying it, those words that kind of identifies that clearly. But maybe there should be and maybe that's the output here is actually we start to figure out and work out what that output looks like. But I don't think that there is the best bits that I've seen on.

The terms of you can you link a pathway between evidence based philosophy and patient centered care?

There's definitely bits that link over. I think the work of Jeremy Herrick definitely does all of that sort of stuff. But it's. And, but I think it's, it's one of those things that you have to make it your own to some degree, you know, third leg of, of the definition of evidence basing to that patient side of things. It's as much about relationship building and, and resilience essentially to the model of science and putting it through some pretty intellectual rigor behind the scenes while sitting in front of the person talking to them with a notepad and pen and going what do I do? It's so ultimately that's what it's what it's about. And you might make decisions that aren't that clever. And you might reflect on them later on and think could have done that in a different way. But that's a learning objective. That's that in a really negative side. That could be a candor, near miss type of scenario if it's really bad. But, but that behind the scenes thinking through how do you relate with that study and how does it relate to the patient? And what does that patient in front of you, what are their values, what are their assumptions? How does, how does that impact on what they want? You know, if you've got a patient in front of you that doesn't want 100 sessions, I don't think anybody wants 100 sessions.

Then why are you going to do a chiropractor?

Usually you know, that's it straight away, that's practitioner focused. That's not all practice focus or money focused or whatever. That's not patient focused. Patient focused is saying, look, I think you need a course of care. I don't really know how many sessions you need, but this is what I'm going to suggest right now. Blur, but let's break it into chunks and let's reassess it, let's figure it. That's all patient friendly stuff regardless of what you say. I digress there, but it's, but it's, but I think, I think it is the philosophy in its application. But you're right in holding me to account that it's probably not just a philosophy, that patient centered side of things.

No, no. I'm curious because to me I've treated it having not had a discussion like this before and I'm learning a lot from here as well and not fully appreciating the nuances of what a philosophy is and isn't. And I didn't get this discussion. Chiropractic philosophy was a historical concept when I was training as well as far as how we were educated. It's something that to me is kind of. Well, it's, it's the, it's a set of, of principles and beliefs that kind of guide, they're kind of the boundaries for me in how I practice in the, the first thing if do I do this or not? The first thing it has to go through is like, well, is it patient centered or not? Because if it's not, frankly I don't care. Within that you could go, oh, but is that more vitalistic or is that more materialistic or is the more evidence based, ascribing to the literature and more relying on, you know, there's all these other interesting nuances there but the kind of outer boundaries, like if it's not patient centered, it's out of bounds to me. So the way I operate in the way I practice, it's kind of everything else is nested within that. But I don't think that means that all these philosophies belong inside patient centered care and the kind of related to that. One of the things you said earlier was we were talking about, you know, different philosophies being different lenses and you should explore different ones and, you know, see which ones work for you. And like we said, don't just automatically just subscribe to what you think your tribe says you should do. But then you did kind of go like, and is that, you said a couple of things. But is that patient centered or is that patient centered enough? And there's this kind of assumption that, you know, all my biases say is true, that being patient centered is good and not being patient centered is bad. But then we're kind of saying all these other philosophies, it's like, well, there's pros and cons and, you know, we don't, I don't think you just want to sit here and work out which one's better. Like, that's a, that's a silly question there. But we kind of take us for granted that patient centered is better. And I guess I'm wondering, can we get, can we pry that up at all? Is there any, am I making any assumptions with that that we could challenge? Because it's, it doesn't seem to be a philosophy, like just a philosophy in the same with the others or if you see what I mean.

I think it is a question you can, you can rip to shreds because patient centered has only been better since the 80s. And if you think about the development of time before the 80s, all the way since the beginning of medicine, even when it was just a route. Here's, here's a thing. It wasn't patient centered. It was patriarchal. So actually, I think it's quite pioneering patient centered care, if you really think about it, there are chiropractors in practice who predates patient centered care. That's crazy to think of it in that respect. But, but there are. And ultimately it's. And, and they definitely looked after their patients.

I'm not saying, you know, everyone before us was terrible.

Yeah, but you know what I mean, it's one of those things. And you can, you can really extrapolate that. But sure, there are circumstances I can think of from a philosophical perspective where you Just think, no, just, just do this. And you can't necessarily say that in this day and age because we've built that construct. But actually there may be that circumstance for. For example.

Well, I'm thinking surgery. I'm thinking if, you know somebody's on the table after a car crash, it's like, I'm not going to take the time to find out would they prefer I use metal work in there or I casting. It's like, we don't have time for patient values here. They're bleeding out. Like that's. I think we're quite fortunate in chiropractic. We don't deal with life and death emergency situations more than maybe a couple of times in a career that's really medical emergency, we've got to do that. But, yeah, I do. Then I look at surgery and go, well, maybe, maybe that has to be a little bit paternalistic. You can't be asking the patient, all right, do you think I should go like around the peritoneum here, or do you want to. I think that was there. What do you want to do?

Patient centered care means you have to consent for it. And now you've got a whole host of things. So a surgeon cuts open a body, finds a cancer there, but it wasn't part of the initial mandate. They can't chop that cancer out, but they've got your body open. It's going to be a whole other visit with tens of thousand pounds worth of expenses to redo all of that. But they have to seal it back up. If they've not asked the consent and got that little tick box to say, if we find something, do you mind if we just take it away at the same time?

Do you mean medical legally here or do you mean ethically or like in reality?

I love that question. It's both. Okay, so medical legally, but also ethically. And ethics is a part of philosophy. So you've got that surgeon that's potentially, you know, take that cancer out, take a bit too much out, the patient dies. You've got a whole question there in terms of law, ethics, values, who consented what, and suddenly you've got a huge philosophical.

But a cancer is one thing where you could stitch them back up, bring them around, ask the question. I mean, you're not going to go right back in again, but you know, that's, that's not an emergency in terms of if we don't do this in the next, you know, two hours, this person's going to die. But there are situations where somebody you Know, like I said, car accident or something like that, you don't have time to go and ask the patient what to do. And they said, you kind of so patient centered care to me is like, well, you're respecting the fact the patient is in the driver's seat and you're the educated, informed, compassionate navigator and together you're on this journey. But because the patient always has the chance at any moment to opt out or say no or to ask questions as soon as you administer an anesthetic or the surgeon's in charge. So to that degree, I think once the anesthetic's been administered, can you be. And most patients would go, no, if you find something awful that's about to kill me, you don't have to wake me up to get my permission. And is it automatically unethical for them to make that decision for them?

These are questions and ultimately they change.

I love that answer.

They are questions. I'm not the one.

I might steal that for my next seminar.

Actually. These are, that's a loyally answer, isn't it? But they, but we went through a whole period where giving first aid to somebody, people were more fearful about giving first aid so people would walk away from. And that was because of. You had to turn the rings, you had to make sure that you weren't breaking ribs, otherwise you might have a claim against you. I'm so happy to say that the last first aid course I went on, they said, no, don't bother with that, the rules have changed, we're protecting you for doing first aid. I love that. But the reality is, is that there's still that fear and people will still walk on because of the ethical dilemma of if I touch that person suddenly I'm opening myself up to liability, for example. And you get these stupid scenarios that come up and you think again, that's.

That'S, to me, that's a, that's a legal issue. They're not doing it because they're worried about will this person think I was ethically wrong? They're going, no, it's ethically right to try and save their life. I just don't want to get sued for it. So I don't. Is that a question of ethics? That seems like a question of law.

What do you think law is based on?

Well, ideally ethics. I think it depends. We could all point to law.

It's the philosophy of law and that, that's where ethics sits in.

I'm not going to debate somebody with legal training on this at all. For sure.

This is this is, this, this is the craziness and this is, this is my point and why I'm so avidly happy to be on this call, is that we actually really askew philosophy and chiropractic, where actually it has a really centered place and it's, it's everywhere in other professions. It's just, for some reason we've decided that we need to just get rid of it because we get. Well, historically, things were not necessarily as clear as they could be, or not as professional as they could be, or they align themselves to things that actually we should be slightly embarrassed about, perhaps, or perhaps we had sandwich boards and other behaviors or big elephants and all the other bits, but the reality, and we don't identify with that, but actually philosophy itself, it's kind of a friend, it's kind of part of what we're doing. And I think by stopping that conversation, we actually minimize a lot of what's great in our profession. But also that links us all up together and, and also our understanding about chiropractic and its integration with other healthcare professionals too. Because there are so much that can be said by comparing philosophies and having that conversation with other professions as well as with our own. But it's, it's, it's getting into those conversations by acknowledging that philosophy isn't a weaker limb of education, but a strong limb that might actually raise more questions than answers, frustratingly, as we've discovered on this call. But it, but actually it's really relevant to work out, really, how far do we go with this? Where are our boundaries and what is the most exciting things for us that we want to focus on to develop the profession versus just keeping the status quo or, or echoing one person's paradigm because we are so varied and it should integrate everybody and people should get that belly fire, you know, people should go into practice and go, I've got this patient, they've got something. I have no idea what to do, but I'm going to give it my best shot rather than what can I.

Do, what can't Let me just bounce back to the GP in case the GCC come after me.

That's sad.

And it's defensive practice, isn't it? And I think that's, that's, I mean, I see it the number of times somebody is pasted in, like a Facebook group or something. Oh, I've just got this email. It sounds suspicious. I think it might be Simon Singh in his good thinking lot. And I'm reading the email that just reads that somebody's asking for help. Like, they just happen to be asking for help about asthma or something that you're not completely confident saying, yes, we can treat that and ASA approve of that. And the number of times, the number of comments below where people just go like, oh, yeah, I got that. I just ignore them. So that's, that could be like, it might be somebody trying to trick you. But you know what, guys? It's not actually that hard to not let them trick you. Just don't say, yes, I can cure asthma. Like, if you already know what you should and shouldn't say, and if, if someone's coming after you, trying to trip you up and get you in trouble, the gcc, it's like, well, for that to happen, you've either got to make a mistake or you've just not got to know the code really to do that. But that's, that's like. I've had this with quite a few my patients the last few years. I've. I've helped them find like a counselor or a psychotherapist, and I haven't recommended them, but I've gone, look, here's the BACP website, here's how you can kind of browse it. And this is a process I found works for myself and others where you can go, have a look, see who's got a friendly face, read a bit more about them, like, just a little quick way to find somebody who might be a good fit for you. And I've had several patients come back to the point where I actually adapted and I started saying, by the way, message a few, don't be upset when half of them don't get back to you, because I don't know what it is. But mental health professionals, at least there's a good few who just don't seem to. Maybe they're not. I usually say to patients, they might just not be that good with tech. I don't get what it is. But I had several patients come back and say, yeah, I messaged like two or three people. None of them got back to me. And they're like, that was quite tough because I had to really put myself out there saying, I'm struggling with my mental health. Could you help me? And for someone to not even acknowledge and not even say, sorry, I'm full, they felt quite an okay. That's a little different to chiropractic. But I think there's lots of patients who've just been flat out ignored because the practitioner, sorry, I've gotten a soapbox about this because the Practitioner was too scared about getting in trouble for saying something they weren't even going to say. Like, it's just defensive practice. It really annoys me.

But I was going to flip it because I'm flipping everything in this car. What about when you call up and. And you say, oh, don't go to that clinic because they're subluxation based, don't go to that clinic because they're mechanist. It's just as confusing. Those are jargons and nobody knows what it means in the patient side. And in just the same way as you think, I've actually spent 10 years with this back pain and I want somebody to help me to get into it and support it.

And what you've basically put barriers in front of that and gone, here's the places not to go. That doesn't help somebody go, where do I like? It might narrow it down a bit, but it's still.

Yeah, but using your example, wouldn't it be great if you could have a scenario where you could identify and communicate with that person regardless of their tech ability so that you can do that behind the scenes for that patient to just go, here you go, slot in, this is the person it is. Here you go. Without having any compensation, any issues back thrown at you from a regulator, say if you've done something wrong or whatever. It would be brilliant to have a mechanism of open dialogue so that you can be properly patient centered. But that will only ever happen if we identify as who we are and recognize what other professions are recognized as and their identity and work out our piece within the bigger picture.

Can I, can I just clarify there? You talking about the ability for me as a practitioner to liaise with another practitioner on behalf of my patient and go, right, I've spoken to them, they're available, I'll put you in touch.

No, thank you for the clarity question. I think.

I wasn't sure if that's what you.

Meant or something interdisciplinary care we should be doing anyway, it's part of it. So. So yeah, certainly in terms of just picking up the call, but in order to, to break down those barriers and think bigger in terms of the professions and how they link together. That's what I was talking about. About. But yeah, you're right, I'm an everyday practice. Sure. You know, we've, we've got a circumstance in our area at the moment where most places that accept X rays, for example, don't really want a chiropractic referral. So even though you've gone through additional IRMA training or whatever, they just, they just won't accept it. Or if they do, they will very much look over at it and give the bare minimal, because they're worried about what they need to do on their side. So that. That can sometimes give a position of risk or a position of where actually, professionally, you're feeling like you're under the. The. The back foot, where actually you just want to do what's in the best interest of the patient. It would be brilliant to have a way that the professions can properly talk to each other to. And I mean that not just simply philosophically, of course, it's in order to. To really ensure that there are firm links, more than just rely on A and E and gps to funnel through, because that's just clogging systems up and thinking broader in terms of what we need.

As a professional, I've just realized, as he said, that basically our ability to get somebody into the medical system when they need it, the two access points we have are the two that are the most overloaded and the two that the most. Like the NHS is going, please stop wasting their time. It's like you've only given us gps. And A and E, that's our two endpoints and they're the ones that are so overwhelmed.

Really don't want to pick on the GCC with my next comment, but. Forgive me, forgive me, Nick Jones, but the whole writing letters to a GP a suggestion, I'm so glad it didn't go through, but can you imagine what we would have done to the GPS if that had gone through, for example, in that respect, when would we ever get an X ray referral? They'll just ignore us. And ultimately, this is where sometimes it's. It's knowing what we need to fight the battles on, to fight the right battles at the right time so we can advance and develop the profession. That all comes, you know, and I'm going to say, I mean, from philosophy and working out what it is that we need to be doing in the right perspective of it all. And it goes on. We all think of it, but we might not recognize it. And I think we need to think it through and work out. So on that respect, I don't think we're being as patient centered, going back and hopping back a bit as we could be because we're not asking the right questions. We're thinking about writing a letter for every time a patient comes in, rather than increasing that access to a phlebotomist. Whatever is required.

Yeah. So I'm thinking I'M aware that this ran over quite a bit already. I assume you're good for time. I'm.

As I said, it's been 15 years since somebody has asked me to talk on it, and I'm really happy.

Well, I mean, I think there'll definitely be, at least on my part, some reflections on this and then probably a part two at some point. Now I've thought about this. I have even more questions, but I guess to sort of like not quite put a bow on this, but to sort of wrap it up a little bit. And this is probably exactly the kind of question, well, let's find out. You're now benevolent dictator James Harrison can basically get the profession to do what he wants. What would. What do you think that we. What would be your first kind of steps to go? This would. This is how we're going to advance the profession, both for the patient's benefit, for the profession's benefit for us as individual practitioners. What change would you most like to see, other than discussing philosophy more? I guess that's probably. That's step zero before we get to step one.

I'm trying to do it in one word for you. So let me just. So the reality is, is that I wouldn't want it just to be my viewpoint. That's the thing.

No, that's. That's where I thought. This is probably the wrong question to.

Ask you, but the word I would actually say on the back of that would be integration. Now, the word integration is very polarizing and it can mean different things. Integration. Now, I don't necessarily mean. I've not completely worked this out, my viewpoint on this, so please note, whether we integrate in the nhs, for example, I think that's a separate viewpoint from what I'm talking about, but certainly integrating with each other, having that general respect for each other, we need not to be saying in meetings and conferences that there are parts of the profession that do us harm or there is a side of the profession that's the evil side of the profession. I've heard those on conferences over the last two years. Anything else, and ultimately that doesn't help. So I think that integration, that respect, that openness, transparency and respect for everybody within the profession would be the thing that I think would be the most amazing transformation in our profession, because what that will then mean, essentially is that people can do what they do best, that they're regulated, surely those things, but they actually can learn, tolerate, respect each other, rather than forever going into a meeting and going. I don't know whether that. Chris Gets me or my are you one of them?

Kind of thing.

Are you one of them? Yeah, it's, that is such a shame and I don't like using the word shame very often but it is, but it is, it is really sad that so much good quality mature conversation cannot happen because of a delineation of vitalistic mechanist for example or whatever which has been going on for over a century and we haven't stopped it. So we just need to acknowledge that it gets put to bed essentially that's something that if you want to identify, you can identify like we're talking about discrimination but if you don't, that's, that's cool too. Let's just get on with the proper stuff rather than working out where we are.

Yeah. The kind of fight it's, it's funny you reminded me of years ago at was at a seminar, it was hosted BY Another, this U.S. american coach and he, I, I gave a little talk with it and he was generally more vitalistic and most, but not all the people there were more vitalistic. And there was one particular part about like discovering patients underlying goals and values that he'd asked me to speak on and I was talking about that and I said look, I'm coming at this from my more evidence based background here. There was one point I said, I said something along the lines of like just bear in mind for those of you who don't see yourself as treating pain, like bear in mind pain is a stressor. So that is going to be a psychological stress on the system. So if you completely ignore pain you're actually potentially ignoring one of the contributors to the subluxation. So I'm just going to put that out there and let you do that what you want. And then at the, we all went out for dinner that night and there was somebody there who had a rather formulaic model of care that was like no, no, no. The evidence says everybody should have twice a week for eight weeks because that's what you need to do to get the spine to adapt and then they should do this and had only been in practice well you know, a few years less than me but not a lot. But we were chatting and it was really clear to me especially where I was at the time which was a fair bit less nuanced, even more left hemisphere than I am now. Um, we were chatting quite a bit and there was somebody else there who was more kind of similar to me in terms of evidence based but quite black or what I know that's just nonsense like which is quite dismissive. And I was trying to get under like, like, so what's the, what the studies you're referring to. Okay, like, so what did they show in the study? I wasn't trying to be combative, it was more, I want to work out how you reach this conclusion because to me I don't really get at the time, how did you get there from the evidence, based on what I thought it was. And she messaged me a little bit later going, you know, that whole pain is a stressor. She's like, I need to really think about that. I'd never thought about that. And that's actually made me think maybe I need to be a bit more flexible here. And she'd said, you know, the only reason I listened to you is because you listened to me afterwards and that, you know, asking those questions. She's like, I could tell you were curious that other person, whatever had written me off. And it was that even if you go, oh well, I'm right and other people are wrong, like that could have easily gone the other way as well. But even if you want to assume that your philosophy is the correct one, if you can't talk to people with respect, like you're saying, if you can't have that into intra professional integration, well you can't get your message out there. Like if you call half the profession evil bastards, well that means half the profession is never going to listen to you and your point of view won't ever reach them.

And we have enough of a problem. My personal viewpoint here, with people outside of the profession purporting to be in the profession, doing stuff that we wouldn't be grateful to do in our practices. So if we want a common scapegoat, I think there's one ready made there as opposed to one that's internal. And I think, yeah, it is time for that. Just wanted to pick up one thing. I know time's short, but it's.

One.

Of the philosophical challenges I had when I was a student was that this viewpoint that if you wanted to have a more vitalist perspective, you couldn't be pain centered. And I think what you just sort of said kind of brought that up in my head. And I think it's good to sort of just acknowledge that pain is not just simply a stressor, it is also, well, it is a symptom of a dysfunction going on within the body or some form of pathway that's not working the way that it perhaps should. We know it's mental construct. I won't Go all that out, but it's pain is the start of most care plans. Most people come to us in pain. So this idea that some people might have that a vitalist practice will get lots of people just coming in willy nilly and not in pain, it's unrealistic. Straight from the outside. Yeah.

I've heard people brag about it. I've not actually seen anything to back up. A lot of the time that you have a completely asymptomatic patient base. I don't. I'm not convinced.

Majority of our patients in my patient practice space, I'm happy to say are asymptomatic. I really love it. But they come in.

Sorry, that's what I mean. They don't come in asymptomatic. Like. Yeah, hopefully once they're in care, the majority do get that way.

All came in initially. I'm loving that we were agreeing on this. We all came in initially with something that was griping them, that motivated them to. To cross the threshold and say, look, I need help.

Yeah.

Regardless of whether it's pain or not, that's still pain or dysfunction or something that brought them that. Unless they've had some care before and they've gone. Actually, I've been adjusted since birth and I just kind of want to continue my care. Love that. But it is.

Yeah. I have one reason, like, oh, great, you get it. We can just get down to it.

Let's just get on with it after the initial consultation. But yeah, it's. But most practices have a system or they should have a system, I'd say of handling that patient from start, middle and end of whatever their care is. And they should have checks and balances along the way and underpins all of what I'm saying here.

Yeah, sorry.

Philosophers do it in different ways. They see it in different perspectives, but it's essentially all the same stuff. But if you're saying, I think you said two sessions, eight for eight weeks, that in my head, that, well, that's. That's a lot of sessions from a starting point and a starting game. But you probably do want to reanalyze something a little bit before then there's a check in the balance because that's a lot of sessions. That's a lot of. I always compare it to the journey in. Because I always think I get really annoyed going to the gym. I have to go in the car and go back, for example. That's the thing that stops me going from the gym. I always think, what's the stop thing that Stops me from going to have an adjustment. It's getting in the car, going in. So I want to have fewer appointments as possible rather than thinking about, I.

Think people, I think practitioners really don't get that. We think that the thing patients are giving up is their money. It's like so often it's the time I had, I had a chap who was a very straightforward and you know, he, he came in back pain and we got him better, we got him stronger. He's coming for maintenance and his sessions were a little quicker than average. So I book on a 15 minute basis. He, he would be in and out in 10 minutes. He really didn't need that much. And he said to me, I love coming here. I love that I can be in and out in 10 minutes. Last place I went to is half an hour here. I can just nip in on my lunch break. And it was 20 minutes of his time. And that to him was worth so much more than whatever different fees were or things like that. And it's, yeah, it could be an hour or two out of somebody's day to come and see you twice about philosophy, isn't it?

It's about what value you put on the care that you give. And I can hear really good arguments from both sides of that coin from the hour long session because we're spending the time listening to you and everything and we're having a good natter and a cup of tea along the same, at the same time. And the five minute session where actually everything's quite slick and you've got loads of CAs behind the scenes and, and everything's kind of working but the chiropractor just delivers the adjustment after all the questions being done by somebody else and they've checked it. Well, I understand that as a model because you're getting the same quality to the patient side of things. Or it might be a shorter appointment, as you were saying, like 10 minutes or whatever. You can argue all of those perspectives. I don't think that it is valuable to sort of identify or pick faults in any one of those from my perspective on this call anyway, certainly.

But I know, I think it's good that we have. I think the problem is we all, it's funny, I think that we pretty much every chiropractor agrees that there is a good time to do it. They just disagree on what that time is. And pretty much everybody agrees that high volume care is, you know, 50% of what they spend with somebody. So if I treat for 15 minutes, if I see four an hour. As soon as you say eight an hour I would go, well that's high volume. So no, no, I'm only eight an hour, 16 an hour. Like we all have this, this idea of I'm the normal standard, good one and whatever's above and below is a little bit weird. And I completely, I have no problem with high volume care. I have no problem with a practitioner delivering 60 adjustments an hour to 60 patients an hour. As long as it's very clear to patients this is what you're getting for that, this is what I can do. And for the patients that, that isn't enough for or you know, they can't help or need other things that those things are taken care of. I don't have a problem with that. I don't think that has to be unethical. As long it's like flying business cars versus flying easyjet. Like nobody really goes, one's less ethical than the other.

I think you bring the question of ethics into it, which is quite interesting. So that's a philosophical explanation I'd suggest, but gonna pick up on something different, if I may. I think the key thing there is also intention and energy. If you're seeing 60 people in an hour, for example, a minute session, for example, I don't know who you are. You can be the most amazing adjuster in the world, but you are not in clear intention for those minutes that you're doing.

No, that's fair. That's fair. I think you have to kind of put it as you're coming into getting a, you're getting the back cracking experience. I'm going to push on you to.

Something, an automaton at that point. You're just literally just pushing down and doing the thing.

Yeah, that's, that's more, that's more adjustment as a service versus adjustment as an outcome. I guess it's not really healthcare at that point. It's like I want to have a nice, it's like sitting in a massage.

Chair for 10 minutes but dare I say it, questions. Because I'm firing questions off today. Amongst other things, it seems. What's patient centered? If people are looking at the, the videos and seeing that they're getting their backs cracked and their necks pulled and all this type of stuff and that's what they want. Are we being patient centered by withdrawing them from that. Yeah, philosophical question. I'm going to suggest we need to be above it myself, but that's my, my bias.

Oh yeah. I accidentally painted myself as in defense of high volume care. I couldn't work that way and none of my patients would want that. But I could see a way it could be offered well for what it is. And I don't think that anyone who does that is automatically Dr. Centered.

I'd say it's about logistics and I'd say with the GCC code the way that it is written, you just have to make sure the constructs are still ticked behind the scenes because you don't want to find yourself in, in any scenario where you're against the GCC code. You know, I've been an expert witness on a couple of cases and I have to say the process is as horrible for chiropractors and patients as the outcome, regardless of what it is. And it's best to, well, avoid it being above the code. So regardless of what.

Let me rewind 16 hour and say 12 an hour, you reach a point where it's like this is just can't be a good standard.

But yeah, you know what I, I went to, I sampled lots of different clinics over the years because I'm nosy and I like to see what other clinics do. And, and I went into a, it was an open plan, very high volume practice and as a patient I loved it because I saw so many people. It was a bit like my opticians. I went in, I saw loads of people in the thing, had a conversation with everybody. But actually the time I had with a chiropractor was just the tiny little bit of it. And I reflected on the end of that that actually I was quite sad from a chiropractic perspective because I wanted the chiropractic to be the big thing. That was my bias essentially. Actually the adjustment was the smallest thing in their business model.

It's a social community hub where you get a quick crack along the.

Yeah. And I, and I was a bit like, oh, I feel a bit. Oh, it's completely different to the way that I practice because I am probably one of those people that takes a lot longer and I definitely waffle a little bit more. But it's, but it's one of those things that actually. Yeah, I reflected on that and thought it was a really good experience. I loved it. But I was there for longer than my sessions in my clinic when I was a lot.

Yeah, I think many of us look at Hyvin and go, oh, so they just walk in and walk out. It's like, no, no, no, no, no. There's a, there's a whole journey thing through that practice each time, which I think they're doing A lot of things that many people who don't practice that way could probably learn from. I haven't seen many, but the ones I've seen, it's like, okay, you've, you've thought, you thought your patient journey through on each visit quite well.

But I really like going to those clinics and as a student, I like doing that. I was encouraged to with the college I went to, but I think they all do it now in terms of going to other clinics and seeing it. I've seen what other practices do. Go to a variety of different practices, different styles. From your presumption about what they do and see what they see, what the similarities are. And you'll find that there are loads of similarities. Just one or two differences or different pictures or whatever. And that aesthetics, that feel you get when you come into the clinic, well, that's a philosophy in itself. And how the practitioner communicates, that's a philosophy. The way that they deal with their practice members or their patients and they suggest what care they should have or what role the patient plays in terms of their conversation. Are they saying what saw today, how was it since last time? Or how well do you feel? Or what scale of prom or prem are they using? All of these are really exciting differences in our profession. But what you should do in your practice is the one that resonates with you most, that still fits the code and that gives you your practice identity, but it also gives the profession more of a sense of confidence. And that's what I think at the moment the profession is lacking. It's the confidence and that, the integration back, back on that point as well, because it's all a little bit lost right now. I mean, the GCC is working out how to develop the profession right now. It's asking that question right now as we speak. It's asking and asking for surveys. What do you think we should be doing in terms of developing the profession? Well, I think we've come up with a few already on this call.

Definitely. I think that's a great place to wrap it up, actually. The perfect place to end.

It's been really a huge pleasure to.

Talk to you and you. Yeah, it's so nice to finally have a proper. Well, a proper, proper conversation as well. But yeah, I think we should stew on this a little bit. I think I've got some stuff to mull over for sure. And then, I know, maybe do a part two sometime.

Sounds good.

Here we go.

Thank you so much, Chris.

Lovely. Thanks again, James. See you soon. Bye.

Bye.