Communication is not just about the words we use but also the way in which we deliver those words. In order to provide helpful words to patients, you need to understand what their beliefs and understanding of their condition is. What are they avoiding? What do they think the long-term effects of their condition will be?
Placebo/nocebo response to sham intereventions is a very interesting phenomena. Why do people have responses to sham treatments and some very dramatic responses at that? There are many extreme examples that could be cited. Researchers claim there must be something else that influences the patients response to the placebo. Communication is thought to be the key to this effect.
There are lots of positive messages that can be given to patients that will empower them to take control of their health. Using back pain as an example see the list below of good methods of communication:
One of the key messages is to avoid inducing fear. Help patients to understand their condition with positive messages and to be equipped with strategies for working towards their goals.
Patient’s will have heard many of the myths that there are about their condition from the media, friends and family. Everyone becomes an expert giving their advice when someone is struggling – all well-meaning but it can leave patients very confused about what they should or shouldn’t be doing. Practitioners have a very important role as educators and spreading positive, empowering messages to help patients. This is something we will refer to in a lot more detail in future blogs.
The chartered society of Physiotherapy has produced some excellent resources – back pain myth busters and 10 things you need to know about your back.
Their poster of myths and facts and is free to download and use:
Myth 1: Moving will make my back pain worse
Myth 2:I should avoid exercise, especially weight training
Myth 3: A scan will show me exactly what is wrong
Myth 4: Pain equals damage
Or a more positive message, 10 things you need to know about your back:
1 Your back is stronger than you may think
2 You rarely need a scan and it can do more harm than good
3 Avoid bedrest, stay in work and gradually resume normal activities
4 You should not fear bending or lifting
5 Exercise and activity reduce and prevent back pain
6 Painkillers will not speed up your recovery
7 Surgery is rarely needed
8 Get good quality sleep
9 You can have back pain without any damage or injury
10 If it doesn’t clear up, seek help but don’t worry.
These are available as a poster and a video, free to use from the CSP.
Giving consideration to your patient’s personality traits is important too. Optimists have been shown to experience less stressors and evaluate them differently and cope with them differently to pessimists. Being aware of your patient’s tendency can help you to tailor your educational advice and interventions. This kind of research is in it’s early days but is showing some promising results.
Certain styles of consultation can lead to patients becoming dependent on practitioners particularly if you induce a negative self-perception in your patients. Heavily biomechanical education is now considered irrelevant:
- Resting posture does not correlate well to pain or injury
- Foot pronation during gait does not correlate to increased rate of running related injuries
- Core stability and core strengthening are no better than any other exercise for low back pain
- It is unlikely any manual technique can impact the length or structure of the IT band
- Manipulation doesn’t change joint position
And so on and so on….
Empowering messages that can be used in clinic include:
- Telling the patient the positive things about what works well in their body
- Assurance that they will get better
- Personal motivators
- Young patients will experience faster healing rates
- Benefits of a good family support system
- Encourage cardio work and how much that can help pain and health
- Highlight good ROM and that you’re impressed with how well they move
- Explain about normal findings – e.g. disc degeneration – normal aging
- Explain that pain is normal and good for many situations
- Inform that inflammation is an indicator of a healthy immune system at work
Put health in your patient’s hands. Think carefully about how you use your words, how well your patients understand the messages you convey. Reflecting is a good technique to use in clinic to repeat back what has been heard. It tests the understanding of the practitioner of the patient and how well the patient has understood your message.
This is a large topic but hopefully this article has stimulated some ideas for you. Ask any questions or share any good communication ideas and tips that you have, we’d love to hear from you.