I’m a PA student, about to start my clinical year. I want to thank you for your discussions of clinical practice issues as well as training. I really appreciate your discussions on approaches to obesity, TRT, current models of pain generation, and all sorts of other problems that come up constantly in primary care. Following BBM has been extremely influential in helping me think about the kind of care I want to provide.
I have a more general question about your approach to patient education. I’m constantly thinking about patient education, and how we have so little time to shape the patient’s understanding of their condition, how it’s going to affect their life, changes they may or may not be motivated to make, etc. I expect many patients will be relieved to hear that their pain is not a harbinger of disabling injury, and are excited to be given permission to return to their previous level of activity. I can attest to this personally: by educating myself on current pain models, I’ve overcome a lot of fear and anxiety stemming from old injuries. On the other hand, I imagine it’s a challenge to provide education to patients that may have low medical literacy, or just lots of competing narratives about pain and disability. I can see those patients possibly misunderstanding, and hearing instead that their pain is “all in their head,” or not real. Have you noticed any specific language that you like to use or avoid when educating your patients on pain generation?
I started thinking about this question after seeing Dr. Baraki share an excerpt from an article on MSK injury. The article featured a table offering alternate phrasing to commonly used language that may have the potential to nocebo the patient. My understanding is that it’s far easier to intervene early, at the time of the injury, and set appropriate expectations about the course of an injury, return to activity. I imagine altering thought and behavior patterns is much harder down the road, when the patient may have a history of useless or even harmful interventions (narcotics, activity avoidance, etc). I know it’s a broad question, but I was just wondering if you had advice about breaking through the noise on some of these topics where people are inundated with bad information from seemingly authoritative sources. (One of my strategies, and motivations to train, is to look the part, like someone the patient can trust about physical fitness and general health!)
