Making Patients Cry
I have made more patients cry this year than in the previous 10. This wasn’t due to giving bad news or causing pain with an over enthusiastic elbow. Sadly, it hasn’t even been from my side-splitting anecdotes. Mostly, I’ve induced tears with simple questions and statements. 2021 has made asking the tried and tested opening line of ‘So, how have you been?’ a nerve inducing gamble. Lockdown fatigue has also amplified the power of the empathetic statement ‘Yeah, that must be tough’.
I like to laugh with my patients, be optimistic and reassure them within an atmosphere of positivity. I aim to comfort them yet also remind them that their recovery will involve patience, hard work and the occasion struggle. It’s my version of pseudo-psychology, grafted from the pages of various seminal self-help and non-fiction books, ‘trusted’ blogs, twitter handles and YouTube channels. In addition, I throw in a bit of the classic it works for me. This strategy for motivating and encouraging patients has stood the test of time. That was until 2021 and the second year of the pandemic came along.
Seeing a patient in Melbourne during the second half of 2021 during lockdown 6.0 is fraught with psychological landmines for both patient and clinician. Considering the patient’s presentation, I do as all clinicians are advised. Namely, I use the biopsychosocial (BSP) model to best consider the incalculable and complex variables that emerge as the patient’s painful lower back. Simple right?
Like a detective in a gripping crime show, I listen to my patient and hurriedly try to connect the dots. However, my attempts to Sherlock Holmes my way towards a flawless and concise diagnosis have been downgraded from competent at best, to mere novice during the pandemic. During those lovely pre-COVID times, I could have defined psychosocial factors as just that, felt professional in my ability to write a few down in my notes like poor sleep or feeling a bit stressed and proceed to focus on the more comfortable fields of biomechanics, training load and tissue state. Sure, psychosocial variables were important, but I was looking for the ‘big hitters’ like a lack of strength somewhere (Bias top tip: it’s always there if you look hard enough). I would usually ask about general health and medications that occasionally gave me insight into a patient’s mental health but for the most part it was safe to stick to the biological and we’d exercise our way to good health.
2021 has changed that. I’ve become acutely aware that psychosocial factors are easier to define and understand. I now find it easier for both myself and patients to appreciate how a combination of lockdown consequences such as home schooling, working from home, loss of income, insecure work, loss of leisure time and lack of social connection can affect their ability to follow an injury treatment plan. I can now better recognise that such psychosocial triggers can lead to patients becoming affected by levels of anxiety and depression. I better understand how some patients are only just coping. As a result, I confidently ask questions regarding their psychosocial environment that both better inform my treatment plan and also highlight to the patient the likely contributing role these psychosocial factors play.
This week I naively explored a patient’s back pain aggravating factors and asked if they thought juggling work commitments in the kitchen office on an Ikea Svenbertil dinning chair with subpar cushioning while simultaneously supervising Grade 2 maths and monitoring an unwell Labradoodle may have be contributing to their pain. Tears ensured, I reached for the box of tissues and offered a socially distanced reassuring hand on the shoulder.
A deeper understanding of what makes the psych in BPS helps me provide the optimistic and positive atmosphere I value. Conversely, a thin understanding of the BSP model is as useful as pointing out to a patient with knee pain that they have a stiff ankle but being unsure of its effect on their knee pain or what to do about it.
So, I have set myself the goal to better understand anxiety and depression and their effect on patients so that I can better guide them to help they need. I also aim to create a space whereby if a patient does become upset, I see it as an opportunity to talk about their challenges and we end up with an improved treatment plan. So the next time I make a patient cry, rather than feel awkward in the situation, I see it as a sign of a positive therapeutic alliance. Well, either something like that or it’s because I’ve just nailed the delivery on a hilarious tale.
There is a poignant quote, attributed to Socrates, ‘I know that I. know nothing’, and when it comes to the role of the psych in BPS – I have a lot to learn.
To explore this topic further join us at our Physio Social Club Tinto event - Exploring the Psych in BioPsychosocial
Online Event Wed 15th Sept at 8pm - click here for more info