Debate and dissent are useful in their own right. In the realm of professionals, argument should not be a pejorative. Agreeing to disagree is the start, forming the foundation of the discussion, not the end. Yielding of discourse and the parting of ways is but to avoid the required conflict of progress. Contrary to popular belief, dissent for dissent’s sake and debating just to debate are necessary to sharpen and sculpt the knowledge base and thinking in any realm. We need contrarians.

Time spent arguing is, oddly enough, almost never wasted. -Christopher Hitchens

Hang out with individuals who ask tough probing questions, not those that give you high fives and excessive praise. As Jerry Durham routinely proclaims “if you are the smartest person in the room, you are in the wrong room!” Pursue disagreement.

On the charge that debate, “nit picking,” and argument tarnish the public image of physical therapy, I must protest. Generally, Science and debate are already misunderstood in the public sphere. This problem is not unique to physical therapy that the process of progress appears contradictory and self defeating . Yet, all scientific disciplines evolve through argument. Critique, alternative explanations, and disagreement force the community at large and the individuals therein to analyze current assumptions. Theories, processes, and understanding all require frequent sharpening. Critical analysis and differing viewpoints are the wetstones of inquiry. We can simultaneously argue fiercely within our profession while advocating passionately for it. These two necessities are not mutually exclusive. Further, we must actively seek to address and engage critiques from outside our profession. Physical therapy writ large should engage other health professions and scientific disciplines.

Picture all experts as if they were mammals. Never be a spectator of unfairness or stupidity. Seek out argument and disputation for their own sake; the grave will supply plenty of time for silence. Suspect your own motives, and all excuses. -Christopher Hitchens, Letters to a Young Contrarian

The proposition of challenging and questioning our current understanding is an uncomfortable one. Cognitive dissonance involves feelings of discomfort that we usually seek to avoid. However, consistently aiming to prove ourselves and our professional assumptions wrong is not only beneficial, but necessary. Questioning is not an attack, it’s the process of refinement. The difficult task of reasoning through and critically thinking about our conclusions is a component of strong clinical reasoning. Reflection, as it is proposed, is a hallmark of clinical expertise.

Often, skepticism and critical inquiry are mistaken for antagonism, if not outright cynicism. Although, to some extent professional antagonists are likely to improve our thinking and development. The contradiction is such: disagreement is necessary and debate is fruitful in it’s own right, but constant contrarianism appears to yield little concrete action. Those who dissent by asking the tough, uncomfortable, uncommon questions should improve their counterparts as well as their own thinking. Hopefully all involved in a discussion are at least subtly affected by the exchange. But, there is more at play. The dissenting may positively affect the spectators. Seemingly fruitless and circular discussions in which neither side appears to change are of benefit to those who bear witness. Considerations to ponder, questions to investigate, and new ways of thinking become available.

There’s a small paradox here; the job of supposed intellectuals is to combat oversimplification or reductionism and to say– “well, actually, it’s more complicated than that.” At least, that’s part of the job. However, you must have noticed how often certain “complexities” are introduced as a means of obfuscation. Here it becomes necessary to ply with glee the celebrated razor of old Occam, dispose of unnecessary assumptions, and proclaim that, actually, things are less complicated than they appear. -Christopher Hitchens, Letters to a Young Contrarian

Don’t avoid dissent. Answer the question. Attempt to prove yourself wrong. Disagree and debate. Reflect. Be fierce, but respectful. Admit mistakes. Concede where indicated. Anything less, I contend, is unacceptable. Perhaps you disagree?