I’m back. Things I’ve learned during my absence

Maintaining a blog is much harder than I thought. Major kudos to everyone who keeps up with regular blog posts!

It’s been more than a year since my last post and I am coming to the end of my Physiotherapy program. I still want to finish off the ankle sprain “series” that I started but I just wanted to reflect on some lessons that I have learned over the past two years:

1) Watch your language.
1a) “People First Language”

Language is powerful (It might even affect how much money you save). We learned about “People First Language” last year. The idea behind this language is that we should refer to the person first rather than the condition when we talk about patients. For example, instead of saying a “stroke patient”, I would say “a patient who has had a stroke”. Or instead of saying a “chronic pain patient”, I would say “a patient with chronic pain”. Why the change in language? Especially if it is much more cumbersome to say? By referring to the person first, this acknowledges that I am treating a person, not a disease or condition. In the end, we treat people…people who are all unique and have different things they want to do in life. I think that using “People First Language” can be a good reminder for ourselves to work with patients to make goals that are meaningful for them. A post-TKA patient may need more knee flexion but a patient post-TKA may want to be able to get back to gardening. I don’t think you need to use People First Language in order to be patient-oriented but I think that language has powerful subconscious influences on the way we think.

On a somewhat related note, I remember reading this blog post about how pain science is science. Do you think there would as much of a pain science “camp” if we called “pain science” “science of pain” instead?

1b) Let’s not tell people they are broken and need us to fix them.

If pain is an output of our brains intended to protect us (Read Explain Pain by Moseley and Butler if you have not already), will someone experience more pain if they think that their bodies are broken and therefore require protection? More importantly, will someone experience more disability if they think that their bodies are broken and they need to be very careful with it? And yes, some people do end up feeling like their backs are vulnerable and need protection, according to a recent qualitative study by Darlow et al. I haven’t even graduated yet but I’ve already heard stories from patients about how other HCP have told them they can’t golf/dance/other things they love because they will wear out their backs/knees/hips. I know these HCP mean well and are just trying to be helpful…but these ideas are rather outdated. Of course, I am just hearing what the patient thinks the HCP told them, which could be different than what the HCP actually told them. It would be interesting to do qualitative study comparing what HCPs tell their patients and what their patients understand from it. What if we think we’re being careful with what we’re saying but our patients interpret it differently?

2) People are not lazy, they have different values.
One of my pet peeves is the assumption that if patients are not doing their exercises or are leading unhealthy lifestyles, it is because they are lazy. As health care professionals (HCP), I think we take for granted that many of us value good health and therefore will be more motivated to take care of our health without the need for external support. I don’t think that people don’t exercise because they are lazy. I think that they simply have other priorities based on what they value. I think that a major role we can play as HCPs is to:
a) listen to patients to learn what they care about
b) guide patients to see how their health can affect what they value (*ahem* Motivational Interviewing *ahem*)
c) help them problem-solve how they can make sustainable lifestyle changes, including the incorporation of exercise into their lives (*ahem* provide self-management support *ahem*).

I think this is what it means to truly empower patients to take better care of their health.

3) Research is easy to critique but much harder to do.

During PBT, it is expected that we bring in primary literature and incorporate it into our discussions with a critical eye. It has become easier to find limitations in each study. The tables were turned on us though when we had to do a research project in the last unit of our program. It was no walk in the park! We only worked on it for ~4 months but I already have a much greater appreciation of what it is that researchers have to do. Thank you to all the researchers out there who help to answer the questions we have.

There you have it. A glimpse into what I’ve learned from my past two years at PT school. There is more but I think it would take me a while to write it down concisely and I don’t want to procrastinate on blogging anymore :). What major lessons have you learned in the past year?

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3 comments to this article

  1. Alex

    on August 6, 2015 at 3:54 pm - Reply

    Hello,

    I stumbled upon this post and have found it an interesting and reflective read.

    It is concerning if patients hear something different than what the HCP is trying to tell them. Perhaps just asking the patient to repeat what was said or what was understood could help eliminate any miscommunication. Or, encouraging patients to ask questions for clarification!

    • VeeWong

      on August 6, 2015 at 4:32 pm - Reply

      Thanks for your comments Alex!

      We actually had a couple of classes on health literacy where we learned about ways we can facilitate communication (e.g. teach-back as you suggested!). I think the perceived barrier is that this takes more time. That extra time is probably worth it if it means patients are more engaged and understand what is going on so that they can make appropriate decisions. In class, they gave an example of how a woman had a hysterectomy without understanding what it actually was. As you can imagine, she was devastated when she found out what she lost in the surgery.

      • Alex

        on August 13, 2015 at 1:47 am - Reply

        I understand and agree that it does take more time, but like you, I think it is worth it, as demonstrated in the example you have given. Poor woman!

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