Someone who is under the care of a local NHS pain clinic called up today and wanted help. During the conversation, she said “I had an accident 9 months ago. I was referred to the NHS Physio service but when I went, they wouldn’t even touch me. I was in so much pain they were scared to damage me. I went 12 times but all they did was talk to me…. I went to the pain clinic and they told me my pain is in my mind, but they haven’t done anything to help.”
When I asked: “What would it be like to have some help?” she said it would be “great”. Then she went on, “a really good rub down might help”.
Very recently I’ve watched a ‘launch’ video on YouTube for a NHS pain clinic. It’s in my location, based on an existing model at the clinic the person called went to. The Youtube was clear, the staff, healthcare professionals are trained in a science based approach to pain care. I’m sure if I chatted to the clinicians they could rattle off the neuro-matrix framework in medico-science speak.
However, the words, explanation, the person who phoned, gave me, implies that a core part of the patient/clinician interaction is being missed. How can this intelligent person have had 12 sessions with a Physiotherapist and retain a belief that they didn’t touch her, because they were scared to damage her?
If I am understanding things correctly she believes they said that touching her in those early stages would have made her worse. At the conclusion when I asked her ‘what would it be like to have help?’ she responded “great, I’d like a good rub down”, she wanted ‘hands on’, ‘touch’.
Listening to the explanations that people use in clinic. Making note of the words and going deeper to have a better understanding of their lived experience is an intrinsic part of good clear clinic communication.
Last week, someone came along to clinic, I used the card that I have above to check out what he interprets as the meaning for common words he hears in clinic. I’ve designed the card as a bit of a crib sheet. The often used clinic word on the front and common language on the reverse. This gives me a hint on what someone might interpret it to mean. I chose the words because they were part of some research I’m doing based on a publication.
I didn’t show him the card initially, but started out by asking him to tell me what he remembered people telling him. What could he remember people called the problem, what words they used and how were things described. During the chat, I made notes. Then I asked him what he interpreted the words to mean.
He started off by explaining he has been told his problem is ‘chronic’ and that this means he has ‘really strong pain’
I explained that this might lead to a confusion due to meaning disparity. When I use the word chronic I’m meaning ‘pain that’s been around for over 3 or 4 months/ a long time’.
So, he was understanding the word chronic as a measure of degree and severity of pain. I use the word in relation to time. That’s quite a big mismatch which needed clarification.
This kind of miss-communication, is also happening when he goes to clinic.
As we began to explore what treatment he was receiving he explained that he has some electrical stimulation of the nerve, under scan imaging. He couldn’t remember what it was called, so I asked what he had been told it did. He said “The doctor has told me he is sending electrical impulses through the nerves to shock them into waking up”.
Here, the well-meaning medical professional is attempting to give a simple explanation. However instead of providing a simple science explanation, the person remembers a fairy story. Nerves are not Sleeping Beauty to be awoken by a shock. It reminded me of my cousin. He was told he would ‘grow out’ of eczema by age 7. He was devastated to wake on his 7th birthday and find it still there.
Talking & explaining is a two way process. Clinicians need to listen to the person in front of them and understand how meaning can lead to confusion. But also people in clinic need to have the confidence to query what the health care professional means.
Ultimately the goal is to help people to understand, manage and live a great life with reduced nasty pain. But that goal is completely lost if the patient gains a very strong belief that they were not listened too, or that their health care professional said that their pain is in their mind.
Neither can these reports be lightly dismissed, they must be accepted as the lived reality of the individual. Alongside, we mustn’t judge clinic room interactions based on solely onesided patient or healthcare report. We did not sit and record their interaction. We only know what each person tells us and usually, thats based on their memory. Miss-communication needs to be accepted as a risk in every patient/healthcare professional interaction. This needs to be addressed in clinic because misunderstood word meaning can be a foundation for unhelpful beliefs.
Coming back to my phone call client, I’m looking forward to meeting her and I will be ‘hanging on her every word’.
Divided by a lack of common language? – a qualitative study exploring the use of language by health professionals treating back pain Karen L Barker, Margaret Reid and Catherine J Minns Lowe BMC Musculoskelet Disord. 2009; 10: 123