-by Audrey Kitching
This fascinating piece of art illustrates someone holding the most important part of a human – which is life – in his/her hands. Our hands, the most valuable tool we utilize in our profession, is what we use to change lives – we touch, we treat and do everything with our hands. We have a great deal of responsibilities towards our patients and we make life-threatening decisions on a day to day basis.
A deeper concept meets the eye: the helping hands of a physiotherapist uplifting the spirit of a patient. This concept came to my mind when reflecting on a recent clinical experience. In clinical practice health professionals experience countless difficulties and the most common one I came across during my clinical block was: ineffective treatment despite having an appropriate treatment plan. There are numerous factors that can hamper the efficacy of treatment and most commonly those factors are portrayed by the patient but we tend to sympathize with the patient and continue with our mission. We need to become active listeners, who digs deeper, deeper into the patient, their story in order to empathize with our patients.
Reflection
” Another patient with chronic low back pain”. “She is so demotivated”. “It has been two weeks, why isn’t she getting better?” “Surely not doing her exercises at home”. “She does not want to help herself”. These statements crossed my mind almost every day I saw her. Rushing through the assessment, “I know what is wrong with her”. I was too busy focusing on finishing the assessment, so I can start treating her and move on to my 5th -and hopefully- last patient for the day. I used every single technique for this specific condition and still I was being ineffective. By the 3rd week I lost all hope and consulted my clinician, who advised me to read up on chronic pain and yellow flags.
“I had to quit my studies because of the pain”, “I am unable to work”, “this pain limits me from doing things I used to do”, “it is causing me to lose my faith”, “I am too scared to move – it will cause more pain”. For the first two weeks my patient mentioned these statements at least 3 times during the 4 sessions we had. “I’m so irritated by her.” “I don’t have any sympathy left for her.” It’s 1 o’clock, treatment session done, I will see her next week. I prayed for the first few minutes for time to pass.
During the 3rd week I sat down with my patient and had a normal conversation with her and as she spoke about her life as it is now and how it was before I realized that I’ve missed out on a lot that could have helped me to be more effective within the first 2 weeks. I had to put myself in her shoes to try and see things from her perspective to try and empathize with her. I was able to sympathize with her at first but because I turned a blind side to her, I struggled to show empathy.
According to research, psycho-social risk factors – better known as ‘yellow’ flags – have been found to increase the risk of the development of chronic low back pain and disability (Parker, 2007). While I was doing my research, I reflected back on the first encounter with the patient and I realized all the above-mentioned statements were the actual signs of psycho-social risk factors.
We as students are apt to do everything by the book, which is correct, but not always enough. I was rushing through my assessment, because I knew what was wrong with the patient, I had a full treatment plan set out for her I just had to implement it. Without noticing it, I was putting up a barrier between my patient and I and that is why I missed all these risk factors. I was listening to her complaints but did not show any empathy. According to Dzaher (2016) empathy is the ability to understand and accept another person’s reality, to accurately perceive feelings, and to communicate your understanding with the other party involved.
Literature suggests that psycho-social factors increase the risk of the development of chronic Low back pain (Parker, 2007). These risk factors include specific behaviour, beliefs and moods. Studies have shown that there is a consistent relationship between these risk factors and the transition from acute to chronic pain. These psycho-social variables have been characterized as important determinants for future pain and disability (Nicholas, Linton, Watson, & Main, 2011). Thus, identifying and addressing yellow flags is of utmost importance for us as physiotherapist.
We try our best to treat the patient holistically but sometimes it means treating the symptoms to produce the desired placebo effect. Sometimes we rush our assessments to get the treatment started and prepare for the next patient which make us blind to these risk factors that can hamper our treatment. Physiotherapy play an enormous role in the management of patients with CLBP. The interventions include mainly manual therapy (manipulation and mobilization), exercise, advice as well as education. However, recent interventions were shifted to a multidisciplinary approach where the main focus was group rehabilitation which included multidisciplinary treatment, behavioural treatment combined with exercise therapy (Naidoo, Mudzi, Ntsiea, & Becker, 2012).
To manage a patient holistically and to ensure better therapeutic outcomes we need to remove potential barriers that might prevent us from digging deeper. We need to be approachable, open and able to listen to our patients. We are likely to sympathize but not many of us are able to empathize with our patients. Having conversations where you can empathize with a patient can convey messages that you understand what they are saying, and you come across as non-judgmental (Azzida Dzaher, 2016).
Empathy allows us to use our imagination attentively in order to understand, respect and appreciate the patient’s feelings, especially when you haven’t had similar experiences. Therefore, we need to dig a little deeper than the physical condition in order to become more empathetic than sympathetic.
References
Azzida Dzaher. (2016, July 23). Healthcare Professionals: Empathy vs. Sympathy. Retrieved from MIMS Today : https://today.mims.com/healthcare-professionals–empathy-vs–sympathy
Naidoo, V., Mudzi, W., Ntsiea, V., & Becker, P. (2012). Physiotherapy Modalities used in the management of Chronic Low Back Pain. SA Journal of Physiotherapy, 42-46.
Nicholas, M. K., Linton, S. J., Watson, P. J., & Main, C. J. (2011). Early Identification and Management of Psychological Risk Factors (“Yellow Flags”) in Patients With Low Back Pain: A Reappraisal. Physical Therapy, 737-753.
Parker, R. (2007). Physiotherapy Students’ Assessment of Psychosocial Yellow Flags in Low Back Pain. SA Journal of Physiotherapy, 3-8.
3 thoughts on “Dig a little deeper…”
you wrote a very good review. i enjoyed reading it, i mean even if someone from outside our field is to read this they wouldn’t struggle because you made your message clear. i loved how support your piece of writing with evidence, well done with that
in paragraph 2 you mentioned that we need to dig deeper to identify the risk factors that negatively affects our treatment, with that i agree but i think it is important that you explain how to dig deeper because other patients are very sensitive, how do we handle such patients?? is there a specify way to dig deeper so we can get those risk factors??
general your work is very good easy to read and to follow but it looks more like a research report than a reflection. don’t forget to add the reference list at the end .
thanks for sharing
Your work is very precise and clear, i get the message you are pointing across and understand it quiet well, it is sometimes hard for students to dig deep because we think we should not cross certain boundaries.
As Masindi said above, people who would read your work would want to know according to you, what is it that you think we should dig up more during clinical practice.
You do have good references and seems that you researched more about your topic, but the reflection does not show how you handled the situation once you saw the “yellow flags” as much as we have to reference, do not forget to mention your feelings and how you handled the situation
Overall great read and your work makes one think more holistically about patients, thank you.
Vuyolwethu Ndlabulala
Hi Tameroon-Lee
Wow! Great piece of work, I truly enjoyed reading your thoughts, and I am very much impressed with how you conveyed your views across, bringing your very own personal experience in Clinical practise, well done with that!
Content: Satisafoctory. As I have afore mentioned, the piece shows that you have utilized your knowledge of Clinical Practise in this Ethics module and have also used your Ethics guidelines in the management of your patient. Also, the piece conveys that for you initially, all you wanted to adress was the patient’s physical condition forgetting some other factors that come to hand.. however, you went back and reflected, asked your clicinan and did your own research of how yo manage better the patient looking at other factors as well, I love that! Keep it up!
The link between your art and reflection is also on point, I’m impressed! However, like Vuyo and Masindi jave mentioned? How do you reckoned we should go deeper in digging with patients who are very sensitive and sometimes not even willing to open up? What is your utmost advise to get through such patients?
Argument: Satisfoctory. You argued really well. I love the link between your art and reflection, your references in support for your views was also a job well done!
References: Excellent. In text referencing very well done. Just try to reference the art as well, not sure if you did?
Writing: Your choice of words, gramma, punctiatuin etc was up to stretch!
Thank you for such a pronounced writing, THIS IS A MASTERPIECE. I wish you all the best with your final submission.