Time for a less cut-and-dried approach? - Veterinary Practice
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Time for a less cut-and-dried approach?

Dr DAVID WILLIAMS describes how after two years of study into research methods in teaching and learning, he is finding that a ‘positivist’ approach to everything can be fraught with problems

I HAVE a confession to make. For the last 25 years I’ve lived life as a “logical positivist”. “What on earth,” you may ask, “is a ‘logical positivist’ when it’s at home?”

I’m just finishing a Masters in Education in the Faculty of Education here in Cambridge. Positivists argue that all authoritative knowledge comes from logical inferences gained from our experiences.

August Compte started it all off. He was a French philosopher born in 1798 and suggested that as we can chart the fall of an apple to the ground from a tree by employing the physical laws of gravity, so we can follow the developments of society with specific laws of social science.

Now you have to understand what sort of society Compte was born into. What else started in 1789? The French Revolution of course. It might be said that Compte developed this positive philosophy in an attempt to remedy the social malaise of the French Revolution. Well at least that’s what Wikipedia says so it must be right, mustn’t it?

“Ah!” says Compte. “Not so fast: where is the absolute evidence for that?” But where is the absolute evidence for much of what we assume as being true, what we base much of our lives on?

Indeed, while having an evidence base might be central to defining an optimal therapeutic regime to tackle a particular disease, can we truly have an evidence base for much of what we want to know when it comes to people’s attitudes and opinions?

Compte would argue that the only things we can really know are those we can measure. And as scientists we can evaluate and influence the world around us as a separate entity from ourselves as observers. That was my unquestioned assumption through my veterinary training and the science I’ve worked in since then. Up, that is, to the point when I encountered educationalists with quite a different view of life!

One of the first lectures in my Masters course changed that view completely in the space of an hour. Oh that my lectures in ophthalmology and animal welfare had such a profound influence!

The lecturer displayed his first PowerPoint image of the protestors sitting on the steps of St Paul’s cathedral during the Occupy London demonstration. “How could we work out how many people are wearing blue here?” he asked.

Do you remember being at school, in a new class, when nobody wanted to be the first to put up their hand to answer a question? Well we Masters students were just the same, all reticent, shy and retiring. Except that this has never been a description of me!

So I answered, “Count the number of people wearing blue, count all the people and divide one by the other,” – a no-brainer for sure! “OK,” said the lecturer, handing me his laser pointer, “Have a go.” So I started.

“Blue, blue, not blue, not blue…” “Just a moment,” said another student. “That one you said was not blue – why did you say that?” I thought the protestor was wearing a black top but the other student thought it was dark blue. “And just a moment,” said another. “You’re only looking at what’s on the outside – what if that one with a red coat there is wearing blue underwear?”

I had to admit it wasn’t as easy as I first thought. “And now,” said the lecturer, “how do we work out who sitting there is happy?” OK – I had got the message. Trying to assess people’s views, their attitudes and opinions might be a good deal more complicated than measuring a dog’s tear production with a Schirmer tear test, something I did every day.

And now, after two years of study into research methods in teaching and learning, particularly asking students about their education and how we could improve it, I see that a positivist approach to such enquiries is fraught with problems.

One of my fellow students on the Masters course is evaluating attitudes to bullying among school children. She was aiming to interview the bullies and the bullied. From outside there is a clear divide. But the bullies often don’t at all see themselves as that.

What we might see as their jibing and jeering is to them merely jesting. They treat their friends the same way: it’s just that their friends accept this as friendly rivalry, not persecution. And maybe that disconnect between how they see it and how those who feel bullied see it is a big part of the problem, for those children in that school at least. But it may not be the same with other children in other educational establishments.

Perhaps we can’t generalise from one example to all by developing a logical set of rules to apply to all situations. That is what the positivist scientist does when looking at use of antibiotics or development of a diagnostic test. Instead, maybe the “interpretivist” (for maybe that is what I’ve morphed into when dealing with sociological situations) looks at situations in a slightly less cut-and-dried manner.

How might this work out in veterinary practice? Surely here things are more black and white. Let’s go back to an instance I unfortunately know better than I’d like to. The enucleation.

Here’s an end-stage glaucomatous eye that I’m removing. This is the vet school so we are all dressed up in masks and gowns with gloves and in a sterile theatre. Surely here I shouldn’t need to give antibiotics perioperatively, should I? And yet last year I had a dog that managed to rub its eye before the incision had healed, introduced bacteria into the orbit and we had a huge job on our hands resolving that problem.

So although logically we shouldn’t need to use antibiotics, the evidence base I have, even if it’s only n=1, is pushing me towards being “better safe than sorry”.

Maybe that is where the art and science of veterinary medicine meet. Perhaps I shouldn’t be a logical positivist all the time!

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