I was having a conversation with my partner about the difference between dialogue and debate the other day. We had gotten into a debate (fight) about Bonnie Henry, the Provincial Health Officer for BC. I like her and her approach and he doesn’t.

The convo was not pleasant or going in any kind of pleasant direction so we paused and took a big step out – into a convo about our convo. 

So often we can be tripped into a debate by our ego. We have attached a sense of safety, connection, or belonging to being right. We have interpreted someone else’s difference of opinion as a threat. 

When this happens, debate occurs. Each person is committed to their opinion. They are relentlessly defending it, and trying to convince the other to agree.

There is no openness to learning. No compassion, nor vulnerability. There is also no learning.  No reflection or evolution. 

When we debate, our attachment and protection of our opinion closes us off from all potential to grow, learn, and connect with each other. 

Dialogue on the other hand, as Freire beautifully (and densely) articulates in Pedagogy of the Oppressed, is about openness and connection.

When we dialogue, we listen. We are reflective, we expand our consciousness beyond the ideas we have already attached to, and we can learn and grow with the other, whether we agree or not. 

Debate limits us, while dialogue expands us. 

When we educate patients, from our position of power and through our expertise we so often presume to know best, and are attached to our own opinion.

Often, this is the case, that’s the nature of the interaction.

But if we educate through debate, with attachment to our own agenda, with the intention of changing the other (even through a soft approach like motivational interviewing) we ourselves remain closed.

When we model closure, we invite it in the other.

If we enter into dialogue with our patients, particularly when it comes to pain education and changing long-held maladaptive beliefs, if we remain open to their experience and our own perception changing, they can remain open to this too. 

On a deeper level, entering into dialogue can invite greater understanding of each other and ourselves. 

When Lukas and I came out of our fiery Bonnie Henry debate, we realized that I was pretty attached to her as I had so little feminine leadership culturally I was unwilling to look at the mistakes she’s made and went flying to her defense. Whereas Lukas with a small business battling with many last-minute changes in policy was so frustrated with the poor planning he experienced he couldn’t look at the big picture and was generalizing his own experience.

It was our different experiences of the same thing that gave us our different opinions, and when we dialogued about it, we both learned, and we knew and understood each other better. 

When we are open with our patients, and open to our own mind being changed by them as we are in trying to change theirs, we are better physio’s as we aren’t stuck in a rut and blinded by preconceived ideas. 

Tips for staying in dialogue:

• Listen 
• Stay compassionate to the other and interested in the depths of where their insight comes from 
• Understand before offering any new insight
• Get comfortable with having different experiences and opinions with others and know that you can still be close and connected 
• If you start to defend, catch yourself. Pause and take a breath.
• If you start to convince, catch yourself. Pause and take a breath. 

For applying to patient education:

• Obviously, there’s an element of teaching here, where you are hoping to elicit a thinking or behavior change 
• But all the above still applies
• Balance education with check-ins to see if it fits for the other or not, and explore why not if it doesn’t.
• Remain curious and open, and willing to be wrong and adapt to their perspective
• Let the process of change take as long as it needs to, it’s their timeline, not yours 
• Be transparent about what’s happening – why are you having this dialogue – explain your clinical reasoning and the research and get consent for the dialogue – as it IS a treatment approach!