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The part of the conference that was most practicing evolving for me was the idea of the pain-buffer. As a new graduate, I still feel uncomfortable when a patient tells me they are experiencing high levels of pain. My mind does a great job of running wild with catastrophic and sinister thoughts. It is reassuring to understand that even while in the presence of high pain, the patient is still a great distance away from the ledge of tissue threat.
I believe Moseley made this argument for the chronic pain individual. What does everyone think about a patient who is experiencing acute pain? What about a patient who is post-op?
Helen, I think considering the patient’s irritability is a good idea. Asking a patient to perform an exercise they find painful (i.e. an isotonic squat) may bring on fear, and perpetuate the problem. Modest interventions such as isometrics may be the better approach. Perhaps once their irritability has decrease we can then begin loading in a more functional way?
There were two quotes from the article that I enjoyed. The first, “Our profession is committed to the principles of evidence-based practice”. The second, “We should strive to discover the patient’s expectations and then deliver and exceed it.”
After reading this article I was left reflecting on a question asked by my CI, “How are you going to shape the patient’s experience?” At the time, I did not have a good answer to his question. However, the answer he was likely looking for stems from this paper. Treat the patient in a way that is consistent with their beliefs, while also focused on best practice.
Shaping the patient experience may not only regard coming down to the level of the patient. Sometimes we have to rise to the level of the patient. Taylor and I recently discussed a time where the patient was highly educated. This individual required a more robust explanation of what our hypothesis was regarding his signs and symptoms. If this patient was told, “You have some normal wear and tear” they may have left the clinic feeling dissatisfied and/or invalidated.
As clinicians, it is our responsibility to read our patients effectively and provide a sweet spot that includes evidence-based practice, and patient expectations. In doing this, hopefully, we can inherently minimize nocebo while maximizing placebo.
Helen:
“I often think I need to assess everything fully, but, as the article discussed, if the symptoms are highly irritable, we may need to back off on our exam. ”
This quote resonated with me. I feel DPT school does a great job of teaching us how to collect all pertinent information, reproduce symptoms, and come to a diagnosis. However, depending on the irritability of the patient, we may have to focus the examination on alleviating the patient’s symptoms instead of provoking them. Very glad you captured this idea.
I feel utilizing the SCRIPT tool or VOMPTI clinical reasoning form to be incredibly useful. As a new graduate and novice clinician, I have found myself relying entirely on Systems 2 (analytic) thinking. This has also led me to perform very drawn out initial evaluations in fear of missing relevant information. This abundance of information has, at times, made it hard to achieve a clear diagnosis.
After my examinations, I have found it difficult to know what I should reflect on first. Instead, I have found myself going down unproductive rabbit holes, knowing I could have done better but unsure where to start. I believe the clinical reasoning form will be beneficial as it provides a structured reflection. I feel us novice clinicians will benefit greatly by being guided to reflect on areas that we may neglect, be ignorant toward, or uncomfortable confronting.