The art of conversation almost seems lost these days. Demand for rapid responses and digital dialect has seen a disheartening change in the way people communicate with each other. We see the weakening of potential bonds that may have developed over a cup of coffee rather than what has been conducted through poorly punctuated e-mails or text messages.

However, there is a great importance in reducing how this transpires into your clinic or treating room.

A new patient form can be a marvelous clinical system that helps provide patient personal communication details and previous medical histories, however, with those past experiences and labelled conditions there also comes the unfortunate tailing of pre-conceived ideologies which can skew professional rationalism.
The identification of underlining conditions is necessary in the ruling in and ruling out of particular ailments that may be present however, it is also important to be aware that the existence of those conditions does not always correlate to that which is being presented. This ideal is an important factor for not only the practitioner to be accustom too, but should also be educated to the attending patient so they too are aware of any impact pre-existing conditions may have on their current issue – you can never over educate a patient, as long as it is done correctly.

Too better understand this, perhaps its best to re-visit our article from two years ago looking at the psychology of pain: https://footnotesblogging.com/2015/06/22/the-pain-game-pain-perception/

“The brain is our interpreter of all messages; it is the deciding factor if we as individuals feel pain. Age and gender have shown to not influence how we feel pain, however; life experiences and cultural identity have an influence on how we express pain.”

When treating a patient, usually in the first consult it is important find out what brought the patient to see you. Many times the answer is “pain” but then you find out that the patient has had this pain for 2, 6 or more than 12 months. So if the pain has been present for so long, then why is now the time they have chosen to see you? What is their goal?
And it’s usually at this time you find out said patient with forefoot pain has a wedding in three weeks and has a very specific pair of heels they wish to wear…
Nonetheless if that goal means something to them and you can tailor your consults to achieve both your physical and psycho social goals as a practitioner a patient is more likely to adhere to management strategies you put in place.

Additionally, a systematic review by Kamper, et al, found that the use of a multidisciplinary rehabilitation program was more effective than “usual care” or physical therapy alone in the decreasing of both pain and disability of people with lower back pain. This is primarily attributed to the relaying of similar messages through different practitioners and channels, an increase in compliance due to regular rehabilitation appointments and the increased mobility associated with rehabilitative programs. However, it has been noted that with the implementation of a multidisciplinary program also comes cost, resource demands and time consumption.
This again why it is important to develop an understanding about what the patient’s goals are and what your goals are a practitioner. If the treatment of a condition can be brought back to the benefits associated with the patient’s goal, they are more likely to agree to treatment that they may otherwise perceive as a burden.

In many cases trust of a practitioner is a virtue that may be taken for granted, especially when a patient has had poor experiences with practitioners previously or are of the belief that nothing can fix their present issue. In general, we are not trained to deal with attitudes towards ailments, management strategies or doubt placed upon themselves but, when we come up against a road block such as this it is important that we show empathy to a person’s situation not sympathy.
Introducing the patient to another patient who has had a similar condition and been rehabilitated with an improve quality of life or even a practitioner who has seen the benefits of the management plan you wish to pursue can have a fantastic effect on the patient’s confidence.
Similarly, sitting with a patient and having a discussion about how the complaint has impacted them and their lifestyle as opposed to clinically relevant questions can also help humanize the presentation.

I studied podiatry at university not psychology. But it has quickly become apparent over the last three years of treating people how important the wording and delivery of messages can be when discussing issues associated with pain with someone. The old adage “never assume someone knows what you mean by the words you speak”, is just as true in any situation. When conversing with a patient I will generally give them a summary of their diagnosed condition, what we plan to do in the coming appointments, a visual example of what we have discussed or what they should be doing in the coming days (video or demonstration) and a contact number/email if they have any questions. If a patient on remembers approximately 7% of that discussed in an appointment, then it is best to supply them with that stated information in written form.
Until Next Time,

Jackson McCosker
Director/ Chief Editor

References

Bhatti, A. (2015). Treating The Patient – Not The Disease. Arizona.

Boonstra, A., Reneman, M., Preuper, H., Waaksma, B., & Stewart, R. (2014). Difference Between Patients With Chronic Musculoskeletal Pain Treated In An Inpatient Or An Outpatient Multidisciplinary Rehabilitation Program. Groningen: International Journal Of Rehabilitation Research.

Hoogeboom, T., Stukstette, M., De Bie, R., Cornelissen, J., Den Broeder, A., & Van Den Ende, C. (N.D.). Non-Pharmacological Care For Patients With Generalized Osteoarthritis: Design Of A Randomized Clinical Trial. 1 – 36.

Kamper, S., Apeldoorn, A., Chiarotto, A., Smeets, R., Ostelo, R., Guzman, J., & Van Tulder, M. (2015). Multidisciplinary Biopsychosocial Rehabilitation For Chronic Low Back Pain: Cochrane Systematic Review And Meta-Analysis. Bmj, 1 – 11.

Koenders, N. H. (2015, June 30). Stepped Care Strategy For Patients With Hip And/Or Knee Osteoarthritis In Primary Care: A Retrospective Analysis Of Medical Record Data. Utrecht: Physiotherapy Science Urtecht University.

Lewis, J. (2015). Treating Patients As A Whole And Not As A Disease. 1-4.

Parikh, R. J. (2016). Treating The Patient, Not Just The Disease. Comprehensive Cancer Centers Of Nevada.

Rittig-Rasmussen, B. (2014, November). Physiotherapy For Patients With Pain. Physiotherapy Works. The Association Of Danish Physiotherapists.

Spaeth, G. L. (2015). Treat The Patient – Not Just The Disease. Review Of Opthamology, 1 – 23.

Tavafian, S., Jamshidi, A., & Mohammad, K. (2011). Treatment Of Chronic Low Back Pain A Randomized Clinical Trial Comparing Multidisciplinary Group-Based Rehabilitation Program And Oral Drug Treatment With Oral Drug Treatment Alone. The Clinical Journal Of Pain, 811 – 818.

Whyte, G., Senior, R., Shave, R., & Sharma, S. (2007). Treat The Patient Not The Blood Test: The Implications Of An Increase In Cardiac Troponin After Prolonged Endurance Exercise. British Journal Of Sports Medicine, 613 – 615.