Certainty is Fragile

Cycles and Pendulums provide apt metaphors for the steady swing of Physical Therapy (along with the rest of Healthcare and Medicine) toward a seeming certainty of data-driven science. Which point in this arc we presently occupy is debatable and difficult to specify with strong convictions. The present, however, will influence the future; and developing an approximate sense of our present location definitely helps. As Howard Marks wrote (Nov 20, 2001) [pdf],

In my opinion, the key to dealing with the future lies in knowing where you are, even if can’t know precisely where you’re going.

Evidenced Based Practice is gaining momentum; as it should! Data-driven and Research-driven potential propels the pendulum from a haze of “traditional” patient care into the shining light of stark evidence. Social media spheres continuously pepper the digital landscape with phrases similar to “…the fall of postural, structural, biomechanical models…” and “Manual therapy, pretty much debunked…” The pendulum swings with unwavering certainty – riding the latest “in vogue” explanatory model. A model. A model of the way things work. A model representing our latest approximation of reality. Reality is too beautiful and complex for complete representation by the most complex models. Science evolves (as it should!); and models change. Kathryn Schulz said it well in The Pessimistic Meta-induction from the History of Science:

Because so many scientific theories from bygone eras have turned out to be wrong, we must assume that most of today’s theories will eventually prove incorrect as well.

Good Scientists understand this. They recognize that they are part of a long process of approximation. They know they are constructing models rather than revealing reality. They are comfortable working under conditions of uncertainty – not just the local uncertainty of “Will this data bear out my hypothesis?” but the sweeping uncertainty of simultaneously pursuing and being cut off from absolute truth.

… all of our theories are fundamentally provisional and quite possibly wrong.

Extreme confidence and unshakable convictions have their drawbacks. Howard Marks again (Aug 5, 2013) [pdf],

When people conclude that all the merit is on either the positive or negative side of the argument, they reach extreme conviction regarding their view of the future and become certain they know what to do. But all-good or all-bad attitudes area rarely right, since there area invariably valid points on both sides and they mustn’t be ignored. Mark Twain said, “It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.” Most of the time, limits on confidence are more desirable that cocksureness. Overconfidence in one’s judgement is very dangerous.

The pendulum will eventually slow before stopping and changing course. While the particulars of the pendular swing may be difficult to understand, maintaining a nimble and adaptive stance might be more fruitful than the current zeitgeist suggests.


P.S. – This post was born out the following email (made public at request of the recipient):

Hi Kyle,

As I read through your post one concept reared itself repeatedly: the concept of fragility. As I’m sure you know, science progresses on uncertainty. Certainty requires just one piece of “anti-evidence” to knock it off it’s throne. Certainty is non-adaptive; it’s ways are set in stone, and new information is either excluded based on contemporary certainties or included based on ideas that rhyme. Healthcare is both a social science and a business. Social sciences constantly swing on a pendulum of “physics envy,” and Physical Therapy is on the same pendulum. Medicine has repeatedly evidenced the pitfalls of staunch “scientism” and we would do well to allow for shades of grey is what is becoming a very black and white delineation.

Here’s an interesting fact: history shows “facts” can (and often do) change; especially in medicine! Avoid ideology; move beyond Dualism.

Applying terms such as “Snake Oil” and “pseudoscience” invite sharp reaction. It’s not my preference to promote/provoke change via prickly blog-posts; perhaps that’s part of your style. I have no intention to change your style, but an adaptive stance would benefit everyone.

“Financially motivate” is a bit of a straw-man. Isn’t financial motivation an inherent part of every business? No finance, no business.

I’m incredible excited to see such passionate fire within our profession; just don’t turn into the arsonist who burned down his own house.

Best Wishes & I look forward to more of your work,


Find me on Twitter @Cinema_Air

“Regret Minimization Framework” by Jeff Bezos

Making major life-altering decisions is inherently daunting. Jeff Bezos, Amazon’s founder and CEO, provides a brilliant filter that simplifies the decision – A “Regret Minimization Framework.” (video at bottom of post) This is simply beautiful:

I went to my boss and said to him, “You know, I’m going to go do this crazy thing and I’m going to start this company selling books online.” This was something that I had already been talking to him about in a sort of more general context, but then he said, “Let’s go on a walk.” And, we went on a two hour walk in Central Park in New York City and the conclusion of that was this. He said, “You know, this actually sounds like a really good idea to me, but it sounds like it would be a better idea for somebody who didn’t already have a good job.” He convinced me to think about it for 48 hours before making a final decision.

So, I went away and was trying to find the right framework in which to make that kind of big decision. I had already talked to my wife about this, and she was very supportive and said, “Look, you know you can count me in 100 percent, whatever you want to do.” It’s true she had married this fairly stable guy in a stable career path, and now he wanted to go do this crazy thing, but she was 100 percent supportive. So, it really was a decision that I had to make for myself, and the framework I found which made the decision incredibly easy was what I called — which only a nerd would call — a “regret minimization framework.”

So, I wanted to project myself forward to age 80 and say, “Okay, now I’m looking back on my life. I want to have minimized the number of regrets I have.” I knew that when I was 80 I was not going to regret having tried this. I was not going to regret trying to participate in this thing called the Internet that I thought was going to be a really big deal. I knew that if I failed I wouldn’t regret that, but I knew the one thing I might regret is not ever having tried. I knew that that would haunt me every day, and so, when I thought about it that way it was an incredibly easy decision. And, I think that’s very good.

If you can project yourself out to age 80 and sort of think, “What will I think at that time?” it gets you away from some of the daily pieces of confusion. You know, I left this Wall Street firm in the middle of the year. When you do that, you walk away from your annual bonus. That’s the kind of thing that in the short-term can confuse you, but if you think about the long-term then you can really make good life decisions that you won’t regret later.

Sources: Academy of Acheivement and Bijan Sabet

Find me on Twitter @Cinema_Air

Why You Need Rituals

Quotes from Twyla Tharp’s The Creative Habit: Learn It and Use It For Life:

“Creativity is a habit, and the best creativity is a result of good work habits.”

“The routine is as much a part of the creative process as the lightning bolt of inspiration, maybe more.”

“Over time, as the daily routines become second nature, discipline morphs into habit.”

Many creative individuals have daily rituals. These rituals may be so routine its practice goes unrealized and its significance lost. According to Twyla Tharp, rituals play an important role in the creative process.

“It’s vital to establish some rituals – automatic but decisive patterns of behavior – at the beginning of the creative process, when you are most at peril of turning back, chickening out, giving up, or going the wrong way.”

She lists reasons why establishing rituals into your creative process is so vital:

It “has a transforming effect on the activity”
It “eliminates the question, Why am I doing this?”
It “erases the question of whether or not I like it.”

What’s needed to develop a daily ritual? More Twlya Tharp:

“The only criterion is this: Make it easy on yourself… It should make you want to be there, and once you find it, stick with it. To get the creative habit, you need a working environment that’s habit-forming.”

This begs the question: How do you create new habits? Enter Charles Duhigg, author of The Power of Habit: Why We Do What We Do in Life and Business,

“This is how new habits are created: by putting together a cue, a routine, and a reward, and then cultivating a craving that drives the loop.”

An example of a daily ritual turned habit:                                                                           1. Cue – Waking up                                                                                                       2. Routine – Boil water, grind coffee, make the coffee with hand press, pour coffee in mug 3. Reward – the Taste                                                                                                         4. The Craving – Improved Performance through the day

Thought Experiment 1: What are your daily rituals? Is your daily habit automatic? What is it about that habit that you truly enjoy? Does it make your day better? Make a list of your daily and/or weekly cravings; leverage your cravings to develop new habits. Odds of success improve when you work together, so make it a team effort.

Thought Experiment 2: Rituals also exist in the working world, embedding themselves into work-place culture. Seek to identify routines at your work-place.

The Power of Habit: Why We Do What We Do in Life and Business and The Creative Habit: Learn It and Use It For Life are simultaneously informative and practical.

Find me on Twitter @Cinema_Air