Your patient will come to your clinic with many preconceived preferences, attitudes and values. As your consultation proceeds and there is a discussion of their condition and treatment options many of these preferences, attitudes and values should come to light. Pain science has an increasing focus on how patient’s underlying thought processes affects persistent pain.
Your patient will probably have discussed their condition with several people, read articles in newspapers and magazines and are highly likely to have referred to google too. They will therefore have ideas about what is wrong with them, what treatment will benefit them and how quickly they will get better. We have all had patients visit clinic with the ‘My friend…..’ stories.
Patients also come with values regarding the importance of healthy lifestyles, the need to preserve or restore their self-image, the importance of work, family, the ability to take an active role in life, and the importance and usefulness of research in health-care decision making. If you listen carefully many patients will subconsciously be telling you their values. Maybe the condition gives them an excuse not to do something, maybe they feel a sense of inadequacy because they have been unable to do something. For some persistent pain sufferers having pain has become part of who they are. Whenever they meet people one of the first questions is ‘how is your pain?’, the reason they don’t work is their pain – so the thought of being without the pain may be a great threat – what would my identity be? -they are often known as – “Mary – she’s got terrible back pain.” These are all issues that can be helpfully explored in the clinic room as you come to a shared decision on the proposed treatment plan, and realistic goals and expectations.
For some patients discussion and education will significantly change their preferences, attitudes and values but there will always remain those patients for whom their convictions prevail. It is not the right time for change for them, but it could be on a future visit.