Episode 1: Nobody Knows Shit

[MUSIC] Hi, colleagues. Welcome to Evidence and Argument, a podcast for Speech Language Pathologists, audiologists, and the scientists who support them. This is a podcast where you'll come with questions and leave with more of them, a podcast by two people who love thinking and lively debate, but hate beating around the bush and baseless claims. Welcome to Episode 1, Nobody Knows Shit. [MUSIC] So, Ian S.S., tell me a little bit about who you are, what you know, and what you don't know. All right. Well, I would describe myself as a free thinking and fiercely independent extrovert, and I enjoy rich intellectual debates with others, which is why I'm excited about this podcast. I value my freedom. I value learning. I'm intensely curious about what makes other people behave the way they do. I love to ask questions. I do not like rules for the sake of having them. Boredom is among the worst things that can happen to me. I'm especially bored by people who share all the same values that I do, because then my scope of thinking becomes limited. I just don't have opportunities to test these bizarre theories that are floating around my head. And I'm comfortable with shedding inherited ideas, even when those ideas are socially acceptable. Perhaps the listening audience will eventually pick up on those moments. Let's see, other demographics that have been applied to me. When I say that I mean, we live in a world where people like to give you labels, and so I might draw from them intermittently, but they don't define me one. I'm black, two. I'm Canadian. I'm female. My family's background is Jamaican. I'm in my mid 40s. I have a PhD. My area of academic expertise is swallowing. And my two most defining characteristics are confidence and fearlessness. I love that. And I've loved kind of like getting to know you and finding the places in which we intersect and have common backgrounds and experiences and personality traits, and also the points at which like we're a little bit different. Did you want to talk at all about like past jobs you've had? I feel like a lot of times people are like, where have you worked? What have you done? Like tell me where you've been. Yeah. So my undergrad degree is from the University of South Florida. My master's is from Howard University. My PhD is this weird hybrid thing where it's conferred by Howard University, but I did all of my research through a intramural research award at the National Institutes of Health. I was in NINDS, which stands for National Institute of Neurological Disorders and Stroke. And then I went on to do my postdoctoral work at the University of Wisconsin-Madison. I was on faculty at Johns Hopkins School of Medicine for eight years. And then I was on faculty at the University of Florida for four years. And the University of Iowa for one year. So those are that sort of my lineage in terms of academics. I think it's broad in that it's extended long, right? And I went from schools of medicines, historically black university, predominantly white universities. But it's not particularly broad in terms of topic. It's speech pathology all the way through, it's swallowing all the way through. And so that's why these kinds of podcasts to me are so interesting because I get to talk about things other than swallowing. And being in all these different settings have helped me to learn how to have these kinds of debates. That's awesome. When I think of you, I think of you as like a swallowing expert. Like that's like one of the labels that I give you. Yeah, that's about right. But you know, when I think about you, I don't think about any particular topic that is that granular. And so I think that's what's most interesting about you. So I maybe let the listening audience know more about you. Yeah, so Meredith Harold, I'll go backwards from you. I'll start with kind of my career and where I've been and stuff. I got my PhD pretty young at the University of Kansas. I was one of those students, which a lot of people don't know you can do this, but you can go straight into a PhD program right after your undergraduate. You don't necessarily have to go through a master's in speech pathology first. And so that's what I did. I worked in research labs a lot as an undergrad. And so I kind of got exposed to science really quickly in my career. And so I was in my PhD program. I was uncertain whether or not I wanted to continue on in academia for a variety of reasons. But basically just wanted to kind of hit pause on the fast track. And what I mean by the fast track is that traditional path of get your PhD, then do a postdoc, then apply for a, you know, tender track position, start applying for grants, you know, all that stuff. And so I decided to go become a school based SLP. Like I said, I was at the University of Kansas. I moved to Kansas City, which is 30 minutes from where I did my degree and worked as a school based SLP for what I thought would be like maybe a year, maybe two years and ended up being over five years. And so I basically just found that once I got into being a clinician, I liked it. And it felt like rapid learning in the same way that most of my PhD felt like I felt like, oh, holy moly, there's this whole world of stuff that I know nothing about. And now I get to, you know, explore it. So I ended up staying after about five or six years. And then I got to miss academia because I love being at universities like I love it. And so I applied for a faculty position took that in Kansas City at Rockhurst University. But right before I took my faculty position, I started the informed SLP. It basically started as me blogging about our fields research and has now turned into like an in depth database covering our fields research each month. And what I thought was just going to be like a little hobby project ended up turning into something that became my career. And so I ended up leaving the university and doing my business full time. So now for the past year and a half, maybe I've been doing it full time. I've been doing it, you know, alongside other things for several years now. But basically, I've kind of bobbed around different corners of our field like I've spent a little time feeling what it feels like to be a scientist or a professor. I've spent a little bit of time feeling what it feels like to be a clinician and spend time feeling what it feels like to be a full time business owner. And I really, very much think of myself as a generalist and that I'm not as good as a scientist as you are. I'm not as good of a clinician as somebody who's been working, you know, full time for eight, 10 plus years is. I mean, if I were to sit down next to an SLP right now and we had like a goal right off or something like that, they would kick my butt, right? Yeah, like a goal right off. I'm like, how could you quickly compare, you know, clinical skill set, you know, like I understand the business world, especially more and more every day within our niche, but like I'm not as good of a business owner as somebody who's done it much longer with a much larger business. And so I think the most valuable thing about me is that I have a little bit of insight and just enough to be dangerous, kind of in all the different corners of our field, but it's tough to because I don't necessarily consider myself an expert in one particular area of our field. And a lot of times, you know, people will be like asking me to do, you know, talks and things like that. And they think that I'll be able to give talks on anything in our field. And I'm like, oh, no, no, I can tell you to go to, but like it, it's not me, you know. I would say the things that define me personally like as a human being is like you, I'm a very curious person. I find people's responses to things fascinating and I feel like something that I've learned over the course of my career, which I'm still very much at the beginning of is that people's responses to things and their interactions with each other and how we kind of all work is like a human network has a major impact on what happens in our field. And so I spend a lot of time watching that and paying attention to it and trying to learn from people around me and learn from people's behaviors around me because holy moly people are the biggest barrier between what we want for our field and our clients and, you know, some of the things that happen. And that people get in the way of people understanding people, right. And I think that we're in a very interesting time with all these statements coming out about denouncing race and gender inequality with all of the writing that's happening. And that this first podcast long before we knew that any of this would be happening was called nobody knows shit. I think everybody's really realizing now holy shit, I know shit. Yeah, I mean, you'll be having a conversation with somebody who's been a colleague forever and you realize that actually when they put on that hat, I don't even recognize that person anymore. And these are the conversations I've been having with a lot of people I've known for decades. This conversation we're going to be having I think hopefully we'll cut to some of those issues about how do we get comfortable saying things we don't know. It's now a very different conversation because admitting things you don't know requires you to be uncomfortable both in your profession and in your world with your colleagues. So this is really exciting now. Yeah, yeah, it is isn't it weird how you can like learn lessons in one context and then some like event happens and you're like, oh, look at all the parallels. Yeah. And this is a skill that we hopefully can cultivate that we can then transition to different parallels. Sure. When we first talked about doing this podcast, really it just started with a shared interest in clinical problem solving and understanding and application of our fields research. So E and S and I both spend a lot of time problem solving the use of evidence in our field. And we wanted to see what would happen if the two of us started dumping our concerns, observations, questions and evidence into a podcast where we could think on it together and invite you all to think with us. So I'm really excited about this too because it should be an opportunity for growth across the course of the podcast and the episodes that we kind of try to tackle. Because E and S and I both know each other but not that well. So I predict that some of the things that we bring to the table will allow us to challenge each other's thinking and get listeners to challenge their own thinking as well. All right, so let's start tackling some questions. Today we're going to be talking about thinking and expertise because in my own work on social media and with my business, I've observed that what people want most from me is to tell them the answer. So to tell them if something is either evidence or lined or not, like to give them either the green light or the red light so that they can just go ahead with their business, right? Which is helpful in a pinch because it is a time saver when you can have someone else answer a question quickly for you and just tell you what to do. But if you rely on it too much, it keeps you stuck in the mud where you're never able to figure some of these things out on your own. And when I've talked with you, E and S, you definitely like to start a lot of your courses with the reality check that relying on someone else to constantly give you the thumbs up or thumbs down just won't work long term and really doesn't serve you well. So we kind of talked to us about what's framed your thinking on that and what you like to kind of talk to people about when it comes to starting with thinking. So this is something that I'm really, really passionate about and I didn't know I was passionate about it until I started giving a lot of talks. It started with my dissertation topic, which was on electrical stimulation and swallowing. And when it came out, it was very controversial. I didn't realize quite how controversial it was, but the people who wanted to know about it, they simply wanted me to tell them if they should use East and or not. They didn't want to know about what it was. They were like, tell me yes or no. And I was like, that's kind of like you just coming up to me and saying, should I take Tylenol? I'd be like, for what? Under what's, I mean, it's just such a broad, but if somebody walks up to you and says, should I use Tylenol? It tells you how much they don't know about medicine, about their own body, about there's so many questions to ask. So after many years of this, I realized this reminds me, this I just call it baby bird thinking. At some point in the learning process, you have some book or source or tutorial or experience or something to feed you concrete, basic information. At this early stage of learning, it's okay to just take a textbook and just get whatever the basics are. But then in order to go beyond that, you actually have to forage and just digest your own stuff. But baby bird thinking means that you never move past the point where you are now, like, I get to get the foundations, but I need to go and get the research myself. I need to read it myself. I need to ingest it and digest it myself. And then from there, I can ask questions as opposed to being like, can you please get everything and just tell me what I need to know. Just regurgitate everything your brain back into my stomach. Now there's, again, there's some of that that you just need to have with experts who just have this wealth of knowledge that you, they can point in the right direction, but hopefully not for the foundations. And hopefully you find yourself asking that question too much and realize, I could forage a little myself. So that's sort of where all of that started. When you start to talk to people about the need for, you know, thinking for yourself and for, you know, forcing yourself to kind of like go through that pathway of discovery, how do you think we get people to do that who aren't doing it yet or aren't doing it regularly now, like what's the starting point or what's the starting point for, you know, some of the newest people in our field. Mm-hmm. It's a good question. So there's two answers that I can think of. One is that in the beginning of my courses, one course is called critical thinking in disavage and management. And I remember when that was the first thing that somebody said to me about that was like, are you sure people aren't going to be offended at that title? I thought, what? And they're like, well, it's telling them they're not thinking critically. And I was like, oh, it hadn't occurred to me that the title itself might be offensive. And so we did some talks and we said, hey, this is how a swallow works blah, blah, blah. While we got a lot of positive feedback, we also got some people who'd say, I didn't think it was nice for you to highlight the fact that we don't really understand swallowing. Then we realized we have to start this course in a very intentional ways, what I want to say, to say, look, as a field, there have been published and unpublished criticisms about where we are in managing disvagia. I had to set the stage to say, a lot of people don't know a lot of things. And it's starting to show up in literature and online. And in order to tackle this, we all need to be able to point the fingers at ourselves, myself included and say, how can we learn? So I usually start by saying, you guys should all know that when I graduated with my master's, I knew nothing about swallowing. And I only learned it because it's going to get a PhD in it. And I thought, for crying out a lot, I have to know something. So I read and read and read. And I went to meetings and I asked and asked and asked and I did all these things that you shouldn't have to do. You really should have gotten this in your program. But the fact is this is where we are. And you didn't and you're treating disvagia. So let's all be okay with saying I didn't get all the information. I'm here because I'd like to get it. And then the evaluations changed to, oh my gosh, instead of saying she made me feel dumb, it's a whole more like, we have a shortfall. We need to fill this gap. I need to take responsibility and go and do the reading. And I can't blame this on anybody else anymore. And so that's one place that I go to. So those are practicing clinicians who may not have been prepared properly. But the other place is the students who are currently not being trained to think for themselves. Right? So the problem that I notice now is students already want you to tell them from the very beginning what the answer is. The process of discovery is not quite as popular in many clinical programs as perhaps they are in philosophy. We need to admit that we actually might have difficulty all defining disvagia perfectly or defining many of the speech and language issues the same way. Like one person is calling at this and one person is calling at that. That's the process of discovery. It doesn't mean that you have failed because you can't define it. If in fact you discover that the definition itself means that you have to know more about the process. And that's not the way that you're talking about. And that's the way that you're talking about the way that you're talking about. And that's the way that you're talking about. And that's the way that you're talking about the way that you're talking about the way that you're talking about. Thank you for correcting me and too. Why didn't I know that? It's the wrong response to have, I think. And then what ends up happening, if you don't go through this process, you end up being strong and wrong. You know, that's kind of the issue that we kind of have right now. Yeah, there's so much self preservation going on where people are so afraid to say, you know, I don't know. And it takes a lot of self reflection and it takes a lot of like being okay with admitting, not knowing to start to get comfortable with that. The explanation for it, like who the hell knows, you know, like we don't, we definitely don't have the expertise to make a definitive statement on like why it's like that and why the world's like that and why people are like that. But it probably comes from a lot of different reasons, at least some of it has to come from others setting examples for us and, you know, emotional maturity, whether or not it's valued to say, I don't know. And for some of us, you know, even just being in different places in our lives or different settings or different cultures, I think, makes a difference like for example, I remember when I went from being a doc student full time being in like the science work. And like the science world full time and making that transition over to becoming a clinician talking about thinking and questioning each other and having like debates that aren't meant to result in somebody being right or wrong, but are instead meant to like uncover all of our, you know, like gaps so that we can come to, you know, clarity and understanding. I feel like that was a lot easier when I was among doc students than when I was among fellow clinicians, but I don't think that it has anything whatsoever to do with like a different skill set or different capabilities for self reflection or anything of the sort. scientists and Peter. our just as biased as everybody else, but I think that it has to do a little bit with what we're tasked with doing on a daily basis. So like a scientist, we're tasked with uncovering information and things being unknown literally pays scientists bills. You know what I mean? Where like our job is to ask questions, debate, dig deeper, uncover things that we were maybe wrong about so that we can get closer and closer to an understanding of things that we wanna understand. Clinical reality isn't like that. You don't get, you know, the ability to debate things and spend a ton of time researching things and quite frankly spend a ton of time thinking on things because you're put into a situation where you're seeing clients back to back to back to back and it's not as valued or supported to be like, okay, let's stop and let's spend some time thinking on this deeply. It's like no, you need to make a decision for this client who's in front of you right now. - Well, not only that may also add that if in the clinical world somebody's come back for 20 visits and people's physicians still can't figure out the problem is, it better be a goddamn mystery by the time you do. It better be the most complicated hidden thing. It better not be, you mean your appendix broke that burst this whole time? Whereas in the other world, we take the clinical realities that someone shows up, has a question that's answered immediately by the physician. If that ever happens in the science world, you are not believe. You're like, I figured out the brain. People are like, oh my God, that's garbage. Right. They have their daggers ready to poke all the hole. So scientists set up their questions so they can answer them. And in fact, you don't get a grant. If you don't set up the question so perfectly that the likelihood that you're gonna get an answer is if it's very low or questionable, you're not getting the grant. But in the clinical world, they don't get to decide, I'm gonna cherry pick the patients for whom I can diagnose the problem. Any hole comers come in and you have to decide, is this even in my realm of, if this is my specialty and when we're referring out, if it's in my specialty, do I have the capability to do it, do I have the instrumentation to do it? You can't say, I'm not gonna work with you because I just don't feel like answering that question today. Right. You didn't set me up to answer that question properly. Right, right. Like my school principal or my sped administrator would have like had me by, they would have been like, what the heck is wrong with you if I was like, sorry, I can't do this, sorry, I can't do that. Sorry, I can't do this. Can you please only give me children between the ages of three and five with speech sound disorders? I can't do anything else. They would have been like, yeah, right. Get it together and figure it out. But what you've said now to me is why we're having this podcast. Evidence and argument in CSD means, we have a very broad area to cover. But what makes evidence and argument in CSD particularly interesting versus evidence and argument in ocular movement? I'm just guessing that there aren't a bunch of ocular movement people who are also dealing with the mouth and they're also dealing with skin and they're also dealing with the nose and they're also dealing with respiration. In our field, it is so broad that it means that your example where you said you can't tell your supervisor, can you just please make sure you only ever refer me, children between three and five who are having trouble with tongue trust. Thanks very much. That's not gonna work. You're gonna get a kid who comes in with cerebral palsy in the school system and you're like, whoa, whoa, whoa. I didn't have a feeding class. I didn't have a swollen class. I don't know anything about this. Most of my kids are like this and they're like, right, but you're the SLP. Where the reverse can be true. Not so much in the medical setting. Are we getting like kids walking in with, you know, speech issues? That just doesn't happen. But certainly in the other realm is asher starting to note these things. So this is why nobody knows shit. And the capacity to say what you don't know foraging and not being a baby bird, being okay to know yourself and why you might not be a self-motivated seeker of knowledge is so important in our field because our patients come from a wide range of backgrounds and all of those skillsets that we talked about allow us to be effective and to be somewhat happy with our job. I can see why people get frustrated and go for crying out loud. I get why they're coming in this door, but why am I not even prepared enough to know how to do a PubMed search in this other area? Yeah. I think that's one of the most under-acknowledged things in our field is how much a lot of us are responsible for. Some positions are worse than others, meaning like, I would imagine that it's probably a little bit easier if you work like in a voice clinic or I shouldn't say easier. It's not easier. The task of a specialist who works in a voice clinic and only does voice stuff is probably going to be afforded more opportunity to quickly become an expert at their topic than someone who works in a setting where they have a huge range of ages, a huge range of disorders, and they're going to feel incompetent a lot of the times. When I was in SLP, how many times am I going to say this today and today is podcast? I was surprised at how incredibly incompetent I felt on a daily basis year after year, and I had a PhD when I went in, which was also kind of funny too because my colleagues they thought that because I had a PhD, I knew all the things about all the things. And so when I first met my new colleagues, they would try to come to me with questions and I'd be like, I don't know, are you kidding me? I just got out of like a four-year stent of literally only studying infant babbling and absolutely nothing else. Like, I can't answer any of your questions, but over time, and I think that that's one of like the toughest places to be in, is your first one, two, three years in clinical practice where you feel nothing but like overwhelmed and terrible at everything. But it gets better over time as and if you start to make time for slowly but surely becoming increasingly competent at little things. - And being willing to acknowledge that you came into this profession thinking you were gonna be like Maria Von Trapp from Sound of Music and all the kids were gonna be homogeneous and all have the same issues. They all saying they all host war, whatever. You are Mrs. Garrett from Facts of Life. You got Tudy, you got Blair, you got Joe, you got Nanle, you all have different backgrounds, different races, different ages. That's who we are speech pathologists. We're Mrs. Garrett, we need to figure that crap out bit by bit. I always tell the people who are just starting to kind of get to the point either because they're new to the field or because they've decided to task themselves with getting better about knowing more about various topics in our field. I always tell them that I feel like the easiest way to tackle it sometimes is to stay just a little bit up to date about everything, but then to systematically go deep into various topics one by one rather than thinking you have to know them all at once. So basically setting yourself a goal where you're like, okay, this year I'm gonna focus on AAC and I'm gonna get to the point where by the end of this year, I don't have a panic attack because I get a kid on my caseload who has a device and I have no idea what to do. And I can tackle AAC this year. And then next year I can tackle fluency. And the year after that I can tackle this. And just to start to be comfortable with knowing that maybe for some of the kids on your caseload, you're not giving rock star therapy, but you're doing the best you possibly can because you've allowed yourself to know what you need to know in order to be able to take this get onto your caseload and make it work and then slowly but surely get better at the other stuff. - Well, what you're saying makes me say, you are clearly an expert on how to be a really good generalist. That's what a lot of people need to hear, but let me ask you this on the topic of experts is one, can we rely on experts? Should we rely on experts? And how are we supposed to know who the experts are? Because truly your level of questioning and what you've been talking about is you're an expert at telling them to go figure out how to get information and that's great. But mostly the experts they're asking are topic specific. I have a patient with a trache who, that is very specific and they'll ask someone who has some expertise in traits or they'll just post it on Facebook and pray to God that somebody tells them that they're not occlude the guy's trache so he dies, right? - Yeah, either any of those. So you have the people who know who the experts are and they know, let me ask this person who works for past senior or they'll say, I actually don't even know who the experts are, that's how bad I am. So I'm just gonna put this out there and see, I'm just gonna pick up what everybody puts down. So what do you think about this idea of expertise is? - Yeah, so the concept of expertise, I think we could spend a lot of time talking about this. And I have some kind of notes on stuff that I wanted to go through specifically on that today too. But first, I think that we need to start with a general definition of what an expert is, right? So that you can category is someone roughly into the category of like expert and non-expert. And experts are people who have had the opportunity to learn very deeply about a topic, you know, and there's not going to be some checkbox where it's like, oh, you've gone through X number of years and X number of hours learning about this, you are therefore an expert now. But the general characteristic is an extreme amount of time on something. So I think the thing that's kind of tricky about our field is a lot of times those people are scientists because scientists job, they're literally paid to go very deeply into a specific topic and it's their daily work, you know what I mean? Like they get the privilege of being able to dive deep into things. And so a common profile for someone who has, expertise oftentimes is someone with a, you know, PhD in our field who has tons of expertise on one specific topic because they've spent years and years and years and have been paid to do it. But that doesn't necessarily mean that experts need to have PhDs in our field. There's also a lot of clinicians in our field who I would consider super important experts because they happen to have either chosen a path or just been in a path where they had not only the time because sometimes the time is a little bit of a privilege, right? Like were you in a situation where you had the time to put the effort into learning deeply about something, but also the interest to dive deep into these topics, right? So you need to kind of look at somebody and, you know, evaluate have they been able to manage learning very deeply about a topic. So that's like criteria one, right? How do you know that somebody's not an expert, I guess. You're telling me how you know somebody is an expert. How do you know somebody's not an expert? Well, experts know what's known about a topic, right? Then I'm going to steal your words because you've talked to me about this before. They know what cannot be known and they know what they don't know. If you're looking at someone and trying to look for like warning signs of whether or not they're basically like pulling your leg or just like really good bullshitter. Yeah, they think they know that they think they know when they don't mean on experts. Yeah, yeah, well meaning on experts. You essentially yourself and it's not going to be foolproof. It's not going to be foolproof. People are going to trick you. You're going to go down a path with someone where you listen to them and then you start to find holes in their arguments and you're like, maybe I shouldn't have listened to that person, you know, but you essentially just need to like look for warning signs that they can't answer your questions or they aren't willing to say they don't know or they aren't willing to discuss kind of the unknown. It's just tricky too because sometimes this is like a little bit of a personality trait. I know some people who I would consider to be experts but who don't respond very well to people debating with them. And so it's like, well, you know, frankly, I would count you as an expert, but you're not a good expert because you have an expert in dissemination of your own knowledge, which is because scientists in here are like are known to be poor at disseminating knowledge that they have in their little heads. I'm going to pat myself on the back here. I'm good at that. I'm good at saying, all right, guys, this is what's complicated and help help, let me help you understand it. But there's something that you said that I thought was really, really interesting about this whole idea of expertise. And they heard of the five wise, let me just start with that. Yeah, tell them to me. I do that. Somebody says something just a blank statement to answer your question. You say, hey, Mr. So-and-so, what's the best letter of the alphabet? Well, a letter N. The very next question should be why? Uh-huh. Well, because N is neither M nor is it, oh, why does that matter? Well, because we know that M and O are blah, blah, blah. Well, why M and O? If they can get to five levels of reasonable, that makes sense. It not only lets you know that you're learning as you go, but it lets you know they thought of it. They know what's out there. That's why people say if they can't get past five wise when they answer your question dead pan, then you should start questioning the extent to which they have that knowledge. I love that. That's really good. That five wise things, genius. I have absolutely love that because that's almost one that you could like stick with and just go with and it always works. I should be able to go down the five wise in my own head, right? Yeah, absolutely. I mean, it won't be nothing's foolproof. It won't be perfectly foolproof because like if somebody, I can imagine, you know, like myself, like if somebody did that to me on social media, on my best days and in the best situations, I would engage with them all the way until the end. But sometimes have you ever heard of sea lioning? No. So sea lioning everybody at home, Google it. Google it when we get off of this too because you'll find it really amusing. Like the animal? Yes. Like the animal. It's a social media strategy that people will use to wear out and break down someone else. So say you've got like a climate expert, right? And say they're sharing information from recent science on Twitter and they're like, oh, people need to know this. This will be helpful in them understanding climate change or whatever. And then you get people coming in sea lioning, which is the persistent questioning for more evidence and why and explain it to me and cite this and cite that and more evidence and more evidence purely for the purpose of breaking someone down so that they either get frustrated and angry and it makes them look bad or to simply just like annoy the shit out of them and waste their time. So like on the one hand, like the wise thing, I love it. But like I can imagine if somebody was doing that to me on social media, in my best days and in the best situations, I would stick with them. Like I would stick with them all the way until the end and you know, answer their wise all the way until the end. But if I get a feeling that they're doing it just to frustrate me, I might exit the conversation and pull out, you know what I mean? People can't be experts in everything. And I think that that's another warning sign that I see around me a lot is when someone always has an answer for absolutely everything. A lot of times that's not humanly possible, right? And to like have the time to genuinely have deep expertise in everything. And if they don't ever like refer out to someone else or say, I don't know or admit that they might not know the answer to it, I feel like I see that as a warning sign. So I think what you're saying is you have to differentiate people who have deep knowledge on a topic versus who will win Jeopardy. Yes. Because winning Jeopardy, I can't tell you how many times I've seen on Facebook, there was a question about the highly bone. You must believe that the biggest champion there, if I said, why isn't that the highway bone is positioned there? Right. She's not going to be able to tell me. So that's that's trivia pursuits versus expertise, right? Right. Or surface knowledge. Right. You know what I see a lot of too on social media and in academia and everything is people trying to say that someone else can't have expertise in something because they're profiting off of it. Yeah. Yeah. Yeah. As I'm like running through my head, all the arguments that I've seen colleagues and you know within our field make about things. And I think that we could talk about that as related to expertise just for a few minutes. I mean, obviously money is a really deep topic, but I think that it's worth bringing up because I see it bring up by other brought up by others a lot where they'll essentially say because this person is profiting off of it. Therefore they cannot be trusted whatsoever. And I think that there's like a vein of truth in it, but you can swing too far either direction too. And being around kind of like my my science colleagues, I feel like in the world of academia, they tend to associate money with being a conflict of interest far and above anything else. When in reality, there's a lot of things that can be conflicts of interest, you know, because people are going to protect power. They're going to protect reputation. They're going to protect all sorts of things, right? The culture of science has a little bit of bias toward considering money as dirty and considering money not being involved as righteous, you know what I mean. But they don't want to admit that the way that they get money is just telepoticular story to a grant panel in such a way where maybe your pilot data could go a different way depending on the way you discuss it. And you will probably be the bigger quote expert if you're in a swallowing world where you know you're talking to two one or two people on the whole panel that actually know about swallowing. And you can, you know, you can generalize in other areas, in other people who don't really know what aren't going to argue with you. So there are things as you said that scientists do that bias a conversation toward this will work. These pilot data are promising blah blah blah. Or they'll simply say these pilot data are promising because and put a very complicated sentence after that they know they're very tired end of day reviewers are going to go, God, I have to look up those five papers. All right, you have to just give them a little leeway here that they know what they're talking about. And something else you said about this idea of money is the first thing we have to remember is just because somebody has expertise really deep knowledge on something, it doesn't mean that that particular something is, you know, is really relevant. If somebody is like, there's probably a guy in the planet who knows everything about buttons. Buttons buttons buttons. So yeah, he sells buttons too, but okay, you get you get to profit on buttons because it's really not that big a deal. Like, no, there's not a whole dynasty that's going down because this guy was a monopoly on buttons, right? Right. However, what we do know is when the stakes are high and let's say there's a device that's being sold and there's controversy, we know the people who have course selling these devices know both sides. They just represent one side. So it's not a question of what they know, it's what they're willing to share. And that's where your job as a clinician to know the sides. So you'll know that this person's an expert, but boy, they also an expert at only telling you at this side. And so I'm going to poke a little bit around on this negative data or not so positive data and see the extent to which they're willing to talk about it. Oh, you do know that study. Well, why didn't you mention it? And tell me I mentioned it. Uh-huh. Yeah, 100%. And I can give you a warning sign when everything would crumble for someone if they were wrong or couldn't give you the whole picture. Like, you have to kind of, I almost think, look for that more so than money is look for would everything kind of fall apart for this. person in terms of like their career and their well-being and everything. If by poking holes in it, it would destroy it all. Or they know that they're getting money for it and they're upfront and very, very balanced and saying, "Yeah, we don't actually know that about our device. We're still trying to figure it out." Then they're going to get your money even more. He's like, "Okay, these people are working on it." 100%. And aside, do you see that in academic culture, kind of like a hesitancy to ever allow money to be involved? I feel like that's something that's almost. It's almost like new rich and old rich, right? For a new money, old money. Old money is NIH grant money. So I was going to put like a new blood money. Right. Because you know that money is in industry, at least in the swallowing world. Yes. And people don't want you to take new money even though we all know that you can be completely biased and get a grant. And grant reviews sometimes are arguments because everybody knows that that person likes this theory and that theory's old. Now, the theory's not spending not necessarily something you can buy, but it's the theory that leads them down a path of success in their career. And God forbid that theory was garbage this whole time. Nobody's citing anymore their papers and there are other papers have been on this theory. So there's still sort of that sense of what does this mean for me if I'm willing to not say the other side of the argument. And it might not translate into something that stockholders might may or not invest in, but clinicians may or may not invest in that particular technique because you are the person you supposed to lead them down this path about this device or this technique or this training opportunity or this rating scale that they have to pay for the training for. And because you're not willing to say, "Whoa, whoa, whoa, actually these two criteria should come out." Oh, but then what would it mean for the people who already bought it? When those things get in the way we're just as bad as the industry partners that we sometimes like to look down on because they're new money and say, "Well, so and so just wants to sell more devices." Yeah, I see it, but we cloak it in academia and this ivory tower privilege that, well, we're working on ideas over here. Ideas that pay. Ain't nobody working on no damn idea that don't pay. Let's be real. Yeah, yeah, nobody is working for free. That's another thing that I'll see sometimes as I'll be like, "Oh, but disinformation must be pure because they're giving it away for free." And I'm like, like, dig a little deeper and see that there's some time. Either you get what you pay for or they're doing it in order to uphold like a power structure, essentially. But speaking of that, can I ask you something that will take us a little bit further down the road, which is we're talking about scientists a lot, but there's something that you said when we're talking before that I think was so key. And that is that we need to let clinicians know that they too can be experts. Yes. This is so important as we, gosh, my time flies, but as we sort of round out this conversation, which is I sometimes end up being in a process where we started out saying, "What do you do when somebody says, "Should I do this?" Or people come to you and they say, "You have the evidence. Tell me if I should do this or not." And usually I'm able to take the conversation in a road where I say, "You actually have the answer to that question." And here's why. And here's an example that I'll let you go because you really are the person who's been working on trying to get clinicians to be experts. I'll have somebody say something to me like, "I'll use this example. What are your thoughts on using electrical stimulation in stroke?" Or something like that. Just something really general. And I'll say, "Well, how long have you been working with the stroke population?" Oh, God, I've been working with them for like 10 years. Oh, cool. How long have you been using Eastern? Well, I was trained seven years I've been using for them. Oh, so you have a lot of data. You have a lot of data and exactly how it's being used and what the outcomes are and to kind of look at you like, "But you're the scientist. You are the holder of the data." I'm like, no, no, no, no. I do know how much, how many billions of dollars it would actually cost for me to get seven years of data on one very specific population with only that device with the same clinician so I can get rid of some of those biases and variability and actually publish it. And that would cost so much money. You have the data. You just don't know what to do with it. So I need to help you to become an expert at what you're doing so you can answer your own questions. And then as a team of clinicians, you guys can answer together. And as an institution, you guys can answer questions. You have the data. You have streams and streams of data. So while it might not be in in a sort of a high level experiment that scientists do with all these theories and plays and grant money and IRB, you are collecting data. And so tell me more about how you might be, and this is just me talking off the cuff to someone who raises their hand in a course. But what you do is a little bit more systematic. And so how do you think we can help clinicians to realize that they too can be experts? I think that there's actual learning opportunities that everybody needs to go through. But I also think there's cultural things that we need to change within our field. I think that there's a hierarchy in our field where like when you go to conferences, you know, like Ashina or a big national convention, where too often there's PhDs on the stage and clinicians in the audience listening and no actual like dialogue that happens where the scientists can learn from the clinicians as well as the clinicians learning from the scientists. It's also I think there's also a lot of bias within our field of devaluing the expertise of clinicians for what it is. It's harder for our fields clinicians to present at ash even if they wanted to. Like that's the real shitty thing about it too is like even if you go around and you're like, you know, telling clinicians like you have expertise like share it with us, you know, come get presentations and stuff like that. And then they try and then they can't get through because they haven't learned like the culture of what you need to say in order to get your presentation accepted and all that type of stuff. And may I add, if you are this ivory tower person and you are the expert and you go to the microphone and you say anything that's even slightly negative to help fine tune them, it can be seen as bullying. And so on the other hand, that interaction is both sacred and difficult, right? Yeah. And then our politics and religion and you're just like it's hard to be able to have those conversations. So the culture about these groups being up here and these groups being down there is really what's driving this difficulty and conversation as you said. Yes. Yes. 100%. And I honestly think that a lot of things could be corrected on our field by breaking down that hierarchy. Like I think that that breaking down that hierarchy is a precursor to things being a little bit better because difficult conversations will never be easy. It's not like it's, you know, going to automatically be easy. But in order to have a productive conversation, you need to trust the other person. You need to trust that you're all on the same level. You're all in it together. Nobody's the boss of anybody. Nobody's going to embarrass anybody. Nobody devalue is going to devalue someone else, but that everybody has something, you know, uniquely valuable to contribute. And once that, you know, kind of like lack of hierarchy and trust is in place, I think that I think that it would help a lot. I think that it would help a whole lot. And that's that's, I think that's a good place to sort of wrap up. I learned so much from clinicians from giving talks for years and years and years and years. I understand what the issues are, but they don't understand us. Yeah. They don't really understand. I mean, I've had conversations where they actually think that we get paid to get our papers published. But when they paid at $36 to pay for the paper, they're like, Dr. Humbers, rich man, he must be getting, nah, nah, we paid him with them things in there. Yeah, remember that whole thing about 20 minutes? It's like crazy. Right. And so they don't realize how much money goes into just getting it in there. And you have fees. You have a lot of, and time is money, right? For us, and you do all this work, and sometimes it doesn't get published. So there's, there's a lot there that I think the explanation needs to go both ways. So I will so look forward to future topics or conversations where clinicians can just be like, dude, like tell me what's really going on there? What is this like? What is that like? Because the more they understand our world, which just again, seems like this perfect situation, they don't realize our constraints and that the fact that there's no incentive for me to ever help clinicians in my career. There is a real incentive for me to help any clinicians actually perform better swallowing therapy or assess better. I'm incentivized by putting up papers that get cited by other scientists, which is why I write for scientists. When I do these talks, these gigs on weekends and evenings, yeah, I can fill my CV with more talks, but you can't have 500 talks and no papers and no grants. There's a hierarchy on your CV of what matters most. It's grants, then papers, then talks. Yeah. So those kinds of things are just foreign ideas, right? Where is productivity in their world for us as I got? Can you imagine? 90% productivity. Good Lord. I said, five hours, having tea with that duo over there. Just talk an idea that didn't produce anything. Yeah. Yeah. I know the podcast is supposed to be sharing information, but I want to brainstorm with you right now too. And so I'm just going to insert it. We should have a, we should have an episode that specifically is common things. Clinicians don't know about what it's like to be a scientist and common things that scientists don't know what it's what clinicians, you know, what it feels like to be a clinician. Yeah. Definitely not. So we can probably sort of wrap it up at about this point. But, you know, one thing that we want to make sure to emphasize before we close this episode is we've given you all a whole lot of things to think about, but really absolutely no solutions. Like this episode wasn't solutions oriented. This episode will mostly just leave you thinking like, oh holy shit, awesome. So now what do I do, right? But you know, the process of seeking information isn't easy and the process of, you know, gradually shaping your practice over time so that you can feel increasingly valuable to your clients isn't easy. There's a lot of barriers in place there. And over the course of this podcast, we're going to have some episodes that make you feel like, oh, yeah, these are action items. Like, now I can go do this. Now I understand how to do XYZ. I'm ready to do it. I'm going to, you know, knock this out at some point within the next couple of weeks and make it happen. Other episodes are going to make you feel more like all we're doing is presenting more questions. But if you can just kind of get comfortable with that with us, I think that it'll be an opportunity for all of us to kind of figure out where we can go and identify some solutions. Yeah. And I want to say something about that. Then I'll move on to the actually how this podcast really ended up happening, which is everything you said about improving your practice is something that scientists had to do. I'll not forget when I was a junior scientist and not even junior scientists. I was in semester one. I didn't know what the hell I was doing at the NIH. And my dissertation advisor was Chrissy Luddlow and she just answered a question in a way where I was like, oh my god, this woman has so much knowledge. And I just said to the person next to me, I just wanted to download everything she has into my brain. And now in retrospect, I'm like, thank God that didn't happen. Because it's the process of acquiring the information that made it real for me. I knew when I asked that person, I knew when the light bulbs happened and they worked for me. They're just not encyclopedia things. I go back to to reference. The story, the network of how I gained this knowledge is relevant. And I knew I knew something when my students said that to me within the last five years, they asked me a simple question and I gave them 15 years worth of information. And they were just like, I just want to take your brain and download it into mine. I'm like, I made it. I made it. And so when I saw your post on Facebook where you were talking, it was your Facebook group is called clinical research for SLPs. And it's not mine. It's run by a bunch of people, but yeah. Well, I remember you posted cross posted because there was this really interesting discussion. And it was about this idea that sometimes people get in trouble for calling out misinformation because of the legal battles associated with it. You mentioned when they're pseudo science. And there's you know, some there, this knowledge is now enveloped into some kind of incorporation or those stock shareholders care about this versus just, you know, buttons, as I said before. You have to tread very carefully. If you are a person who's of knowledge who knows, gosh, they're really misrepresenting that about speaking out. And there were like 500 comments on it. So I remember my comment was, let's do a podcast on this. And that was like a month ago. And then you're like, yep, let's do it. We're going to talk about why we don't know nothing and why the process of not going from not knowing things to knowing something is actually what life is. That's what learning is. And we have to just sort of be okay with that. So that's why we're here. We're so excited that you guys have decided to spend an hour with us as we talk about why nobody knows it. All right. Well, thank you so much. And we'll see you all next time. We'll see you next time. [MUSIC]