Back Doctor – Patient Expectations

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Welcome to the Back Pain Solutions Podcast – Back Doctor – Patient Expectations

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Introducing Back Doctor – Patient Expectations

When you consider treatment for your lower back pain what do you expect? Do you expect to leave the appointment with clear answers and a resolution after one treatment? How long do you expect it to take before you’re out of pain and do you expect that once you’re out of pain that it will never return? As a patient, experiencing back pain is a frightening experience and at the very least you should expect to be reassured by the clinician that you see. But what should your overall expectations be?

In this episode we discuss some of the things you should expect from the treatment you receive as well as outlining some things that you may want to consider before you seek professional help. Whatever back pain treatment options you consider there is no magic pill to solve the underlying issue and it is not only the responsibility of the practitioner alone to cure the problem.

Show Highlights Back Doctor – Patient Expectations

Back resolution requires a collaborative approach between the patient and the health professional. There needs to be motivation on both parts, and you shouldn’t expect to get a resolution quickly. Irrespective of the ‘back doctor’ you see you should always expect to receive a clear explanation of the problem, and reassurance that with the right treatment you can resolve the problem. But in order for you to do so you have to commit to following the advice you’re given and must take responsibility for your own health.

Interview Transcription for Back Doctor – Patient Expectations

Ben James 0:00

When we’re young, new freedom, confidence with a great resilience to injury. Somewhere along the line we’ve developed more and more smart strong features evidence base and practical advice to help you take back control of your health and get back to the activities you love. This is your guide to better health through movement so join us as we demystify some of the commonly held beliefs about back pain and build your confidence to a stronger back the smart way.

Good morning and welcome back to the back pain solutions podcast with me Ben James and my good friend and co host as always, Jacob stay morning, Jacob.

Jacob Steyn 0:37

Good morning.

Ben James 0:38

So today we thought we’d talk about patient expectations. We’ve alluded to this a few times, I guess throughout different podcasts to date, but today we thought we’d talk specifically about patient expectations and you know what we see when patients come into Sears in in the clinic setting and what should patients be really Thinking about when they turn up for treatment when they turn up for advice. So Jacob, I guess started off Have you got some good example maybe of where a patient expected to come in and just be treated and immediately better because I think we’ve all experienced those patients that come in. They’ve had back pain for a period of time and they kind of had this assumption that they’re going to see someone like a chiropractor, osteopath and crack, everything’s going to be okay.

Jacob Steyn 1:29

Yes, I’ve seen that many times. So, I think you’re referring to that patient who thinks that he’s gonna take one poll and it gets better. Turn chiropractic, osteopathy being the poll, the treatment may be the crack or the adjustment. And yeah, and I think we see that all the time. We see people who aren’t really in touch. I think it’s the patient is not really in touch with what’s going on not understanding what what’s nailing them. And so, you know, they come to you and they want you to quickly figure out what’s going on and just do whatever you can so they can get better. Sure. That’s a specific attitude, actually.

Do you find it that it’s a common theme? Or do you and how do you approach it personally? I’m interested to know, because obviously, we’ve always got to try and manage those expectations. We’ve got to educate those patients, but do you find that it’s it’s a common theme with the patients that you see?

It’s definitely common. And my practice varies. Maybe once a week, I’ll have accomplished a percentage on it, but I’ll have more people coming in. expecting that sort of treatment and some other weeks I’ll have less people coming in who, who has the sort of attitude, but I think it’s definitely like what you say it’s definitely something you have to manage and it’s sometimes you The biggest part of the actual the treatment plan is managing those expectations so that the patient understands how we’re going to go about this and how we’re going to get them to get better. And I think often if they have this sort of expectation that you’re going to just treat them once and get them better, and you know, it’s only it’s your responsibility to get them better.

Ben James 3:25

Yes.

Jacob Steyn 3:27

Then, then I think, you know, then you have a big task on your hands.

Ben James 3:31

Sure, because there’s that kind of, I guess, feeling that well, we’ll pay you to do the work. Get me better. But actually, it’s got to be a collaborative approach, isn’t it?

Jacob Steyn 3:45

Yeah, absolutely. Absolutely. I always tried to make that clear. straight off the start, especially if you start giving exercises you make them understand, look, this is your responsibility was your responsibility to start with and that’s probably where it went wrong.

Ben James 4:00

Exactly, yeah, and I think there’s, you know, from a, from a practitioner point of view, you’ve almost got a I read somewhere once called the Red Velvet policy, I think it was called where you where you pick your clients. So for example, those people that come and see you that are just not prepared to do the work, well, you know, you’re not going to get better, or you’re not going to get this the results that probably you want. And what, as a practitioner, you’ve we feel that they could achieve and therefore, they’re just not the right. Patients clients for us.

Jacob Steyn 4:38

Yeah, I think it’s also not very motivating for the, the practitioner, when you have someone with that sort of attitude, and it’s, you know, don’t get me wrong, I, I try my best to stay positive and to stay motivated with all my patients. That’s just, from my perspective, understanding their capacity And their ability or what they’re willing to do to get better. And that’s what you got to manage. And that’s different between each patient, of course, the ones willing to do more than the other one. Now, when you when you have somebody that’s willing to do what you tell them and they understand, okay, you know, I need to take responsibility, then it makes your job so much easier.

Ben James 5:24

Yeah, absolutely. Yeah, absolutely. Because you’re not having to, you’re not having to kind of try and motivate them, I guess, as well as support them and educate them in terms of their back health. Yeah. You’re kind of an in many ways, that is the role. You’ve been a coach, as much as you are. Anything else?

Jacob Steyn 5:44

Yeah. No, I think also quite a lot. Quite often, you’ll have people who, you know, it’s been too many other people to see if they can help them. And they’ve not been helped. And so they’re willing to do what they what they Do they just, you know, they’ve lost their motivation because nobody could help them so far. And they’re the motivational aspect is huge. And, you know, if you if you have a personal story to share with them or you can really talk to them about, you know, the, the ability to get better and and get them on board. I think that motivation plays a big role there. That’s, that’s a little bit different to to the patient, we’re talking about that that leaves you know that, you know, they’re looking at you with big eyes. Okay, what are you going to do to get the better?

Ben James 6:39

Yes. And so just to reiterate, you feel that the patients that have seen multiple practitioners and haven’t got better, they’re, they’re less motivated or they’re more motivated.

Jacob Steyn 6:51

Quite often, if they’ve seen quite a few therapists or practitioners already then and they’re not getting better they they lose motivation for

Ben James 7:01

Rather than being, I guess, more open and more prepared to put the effort in because what’s what they’ve tried before hasn’t worked?

Jacob Steyn 7:10

Yes, I mean, there’s two sides to it. Sometimes they, you know, they, they realize God, I need to do something about this, I didn’t get better. I’ve been to 30 other people. I’ve been to orthopedic specialists to a neurologist. And I’ve heard chiropractic could help me. And so they, they, they, they must be motivated to a certain point because they’ve actually stood up, you know, taking that step to to come and see another profession, or try another profession and see if they can help them. But it’s, you know, but saying that it’s different when somebody’s been 234 or five people. Then when they come to you first off, because when they come to you first off, they have they’re often my more open to what you’re going to tell them to do. And if they have a chronic problem you may need, you might need a few months to get them better. And so then it’s more difficult to get them on board for that time period, then it would be if they come to you straight off.

Ben James 8:20

Yeah, sure. And I guess a lot of it as well as is like with any kind of interaction is, is the questioning and the, I suppose, not challenging the patient, but you know, asking them out, right, you know, what are your expectations? How long do you feel that this will take to get better? Because I think there’s, it’s important, again, back to that collaboration that we’re on the same page as the patients with respect to their prognosis and their outcome. And, you know, if you know that from the offer, at least, you know, what you’re working with, I guess, and from a patient point of view, you know, it’s it’s thinking about how long you’ve had problem and, you know why it should get better so quickly or not?

Jacob Steyn 9:06

Yeah, I think that’s, and that’s what I tried to do as well, with my, with my, in my practice, I tried to be very open and very clear about what at what time, the time the prognosis the time period that’s going to take the you know that what we’re going to have to do to get you better. And I’ve had not many I’ve had a couple of times where people said, you know, sorry, I’m not willing to do this. But But I feel good about that. Because they they know what my plan is. They know what my what I anticipate in terms of the time period it will take to get better.

Ben James 9:47

And at least they’ve been honest.

Jacob Steyn 9:50

Exactly, exactly. And you know, I wish them the best. Maybe somebody else could do something differently. There are more than one road to Rome. That will get them better. You know, in a different way in life, I’ve seen that so, you know, but that, you know, I’m honest about the way I work and the way I attempted and it’s then their their choice.

Ben James 10:10

Have you seen many patients that have said they won’t do the work, and they’re not prepared to do the work and then further down the line, they’ve come back and said, Yeah, I’ve not got better elsewhere and therefore, you know, I’ve reflected on what you’ve said, and it kind of makes sense. So now I’m open toto listening.

Jacob Steyn 10:28

Yes, I’ve got I’ve definitely had a couple. And, you know, and or, yeah, they haven’t necessarily been somewhere else. They’ve just not done what I said and came back and said, Look, I wanna I want to take this serious because I’m not getting better. So can you show me again, what we need to do?

Ben James 10:45

Sure. And do you find Do you find when the patients because a lot of times, you know, I find that some of the people that are involved in in sport and go to the gym regularly, they’re the guys that are quite happy to do the exercise. But sometimes they’re not the best patients because they’ll try and do too much, or they, you know, they’ll try and do it too regularly. Whereas those patients that maybe haven’t done the exercise or been involved in sports are motivated to do it. They kind of stay to that strict plan that you’ve provided.

Jacob Steyn 11:22

Yeah, yeah, totally. I think what I’ve noticed is, it’s more, it’s more about the discipline. So if they, they don’t necessarily have to be doing sport, they just have to have the discipline. Those who have more discipline, will do their home exercises 567 times a week, and maybe not even go to the gym with because they haven’t been going to the gym. And so it will be a very focused approach, what I suggest because, as you know, when some problems, you know, people think the more I move, the more I do, I do need to do, I’ll do Jacobs exercises, and I’ll do some stretching because I am Remember that these stretching exercises from the physio will do them as well. And I’ll, I’ll go cycling on my race bike three times a week, I won’t do too much of it. Because I know if I do an hour and a half, it’s gonna get my back. And so yeah, those, you know, you sometimes you need to dial it down, sometimes you need to dial it up.

Ben James 12:21

Yeah, sure. And I think that’s a good message for people listening is with respect to the varying activities you’re doing throughout the day, certainly in the initial phases of recovery. If it’s an acute problem, or you know, even a chronic problem right here. You’re seeking advice, the more activities and things you’re trying to do throughout the day, the less likely it is you’re able to establish exactly, you know, what those causative factors movements triggers are, and therefore, you know, you’ve got to, you’ve got to take some consideration for that, because you really need to be, again, back to the collaboration you really need to be trying to identify throughout the day. What those things are causing you pain discomfort with respect to your back backhaul. So, try and I suppose rein it in and just be more conscious of those things that you do. And we’ve said that before, but like you say, focus on a few core exercises that you’ve been advised to do. do them well, and then see what the reaction is. After that, rather than trying to say, Okay, now I’m, I’m given the green light as it were to do some exercise. So therefore, I can do any exercise, which is clearly not true, as we’ve discussed before.

Jacob Steyn 13:41

Yeah, that’s it that that focus approach makes a huge difference, because then you can also use your work with isolation. When you look at these exercises, and then you can really tell Okay, what is it doing?

Ben James 13:55

Yeah, what’s the reaction to it?

Jacob Steyn 13:57

Exactly. And that’s how you can dial it in more and fine tune it and work out exactly what’s needed. And I’ll use an example I have this, this personal training client at the moment. And I really respect him for what he’s doing. Because he came to me with his shoulder and his low back, and we got better and he said, Jacob, I want to do CrossFit. I said, Okay, good. I’d like to do this thing that you do, you know, preparing somebody for CrossFit with a few personal training sessions. And so I see him now once in four weeks and I you know, as I’m guiding him with the exercises, he’s doing much better as no more pain, shoulders doing well. And he’s really, he’s really eager to do all the CrossFit moves and you know, get out there and smash the place. But he, he knows that he’s very is over enthusiasm. Stick. And so I’ll give him his exercises for the next four weeks. And he’ll do those. And those are specifically to work on his weaknesses. And he’s like, but can I do this? Or can I do that? I’m like, you know what, no, let’s stick with these exercises. Prepare your body for the next step. And we’re going to get there, you know, and he understands very well that that over enthusiasm has gotten him into trouble in the past. So

Ben James 15:31

Yeah, so again, it’s those past experiences clearly have have an influence. But I think the important important message is to, I guess, take the advice from the clinician because people it’s a simple message, but it’s not always adhered to. And the reality is, you know, if you’re paying for for treatment, I always say if you’re paying for treatment, then take the advice that you’ve been given, and let’s see if you know this This plan works for you because otherwise, you know, I saw a patient once with a shoulder issue, advised him in, he enjoyed the JMP enjoyed going to the gym and exercise he was in pretty good shape. But he had this shoulder issue. And we discussed what activities he should avoid, and what activities exercises he should be considering to try and manage the problem. And then a day or so later, just so happened. I was in the same gym as him. And he was doing all the exercises I said he shouldn’t do. So I kind of looked at him. And I said, you know, watching you. And he kind of sheepishly acknowledged that he was he was doing exercises, we don’t advise that he shouldn’t. Then when he came back to see me, I said, Look, you know, you’re paying me for this treatment. I’m advising you not to do those exercises. And these are the reasons why again, so it’s up to you. You know, but don’t, don’t kind of kid yourself, you know that you’re that you’re paying for treatment. And this is the other thing you pay in for treatment and you feel psychologically, like you’re taking action and you’re trying to manage the problem, then you’re not taking the advice, it’s not getting better. And then you’re frustrated, and it’s not getting better. But the reality is, you know, deep down, that you’re contributing to the problem. And this is what we say in the past in terms of those pain triggers in terms of those things that have caused the problem in the first place. The likelihood is, for most people, it’s not a traumatic event. It’s the activities and the habits and the daily lives we lead that cause the problem. Exactly. So you are a cause of your own problem in many cases.

Jacob Steyn 17:45

Yeah, I think in most executives, you’re saying in most cases, the biggest part of the responsibility is up by yourself, in terms of being aware of what you do, when you should Do and, you know, and that’s even before you see the clinician.

Ben James 18:06

Sure. And I think that, you know, this isn’t to kind of put it back on the patient and not and not to say, you know, it’s all your fault. But it’s, again, it’s back to that collaboration. It’s understanding that the things that you do every day as a patient will absolutely influence your risk in the first place, but also your reaction and your prognosis, moving forward, moving out of pain. And so it’s working together to identify what those triggers are so that we can help modify that treatment plan and, and continually evolve that treatment plan and that rehabilitation plan. But absolutely be aware of those things that you’re doing every day. Because when it comes to expectations, again, if you’re, if you’re going in and want to get better, but then you’re going back and doing things the following day. That are going to aggravate the problem, and then it’s just going to be a vicious cycle and you’re going to get frustrated and think that there’s no way out. But there is always a way out, as we’ve said before.

Jacob Steyn 19:10

Exactly. And there’s always a way out and you know, just sometimes you have to take extreme measures. Yeah, you know, and that’s, that’s difficult for certain patients. Maybe they have, you know, serious commitments. They have a family and they have to take care of them, they can’t stop work or they self employed. So there’s, you know, there’s no pay if they don’t work. And then the extreme measure of Okay, you have, you know, you have to, you have to do less, or you have to, you have to do certain things during the day to to allow your healing to take place, but it’s just not possible where they’re working if they you know, there are many examples. Yeah. And I wanted to say sometimes it’s a matter of Removing certain things certain, like you said certain triggers, becoming aware of them and then removing them. And other times it’s a matter of building up the resilience building up the tolerance. So you can actually cope with those triggers. Yes, yes. And that’s where the commission comes in and makes a huge difference if they are equipped, if they have the ability to help you with that. And to fine tune that. Okay, where do we dial it down? In terms of pain triggers, and where do we prepare you to cope better with with certain things you have to do?

Ben James 20:44

Yeah, absolutely. I think that you make a great point there in terms of just kind of, I don’t want to I don’t want to use the term working into the pain but it’s, it’s getting that fine balance in terms of movements and activities that may cause some slight discomfort, but actually the the, the outcome is going to be beneficial. But it’s again getting that balance in terms of the frequency and intensity duration of that exercise that is right for you as a patient. And that’s where, again, the collaboration and the feedback is is so, so important. But I think the take home message really, is that it is a collaboration, you shouldn’t be going in to see a practitioner and expecting to walk out without any discomfort and not have to do anything yourself. And again, if you’re not getting that interaction with your clinician, then you should really question the plan for your problem for your back pain because ultimately, those things that you’re doing are going to going to have a huge, huge impact every single day.

Jacob Steyn 22:00

Yeah, no, I totally agree there. Yeah, I just wanted to add to that patient patient client expectations. I think that quite often, and maybe you’ll agree with me, Ben, I think patients want to be understood. Yes, that’s where I’ve had the experience some people coming to me, you know, and I can see that, either they, they will say that they haven’t been taken seriously. You know, by by, you know, by having a poor investigation of their problem over and so they don’t feel understood. And clearly not having the feeling that they clearly haven’t investigated properly and so their pain or their problem hasn’t been shown to them.

Ben James 22:52

Yeah, there’s a lack of empathy there. A lot of times, you know, there’s a, there’s a, you know, and again, depending on who you see that And there’s there’s often negative thoughts around or you know, in the media about back pain and people trying to get off work and these kind of things and I think empathy is a big thing. You know, you’ve you’ve got to be you want to be believed you want to be understood, and and you want someone to be able to relate to that discomfort because, obviously before it for many people, you know, this is a big, big fear, it’s, it’s a fear that they can’t get better. It’s a fear that impacts their lives and their work and their ability to earn money and support their family and all these different emotional factors that that come with, you know, experiencing significant pain. And again, that’s back to you know, the expectations that you should definitely have from your clinician is you get that empathy and you get an understanding of the the impact that this has on your on your life so that you can work together to come up with with the plan that It’s gonna get you get you to where you want to be.

Jacob Steyn 24:02

And I think for a lot of guys, it’s also sometimes a matter of pride. And I think that’s why I see more women. Generally, I think a lot of people will agree with me, then then guys. And so you know, a lady, a woman’s more likely to come and see you for a minor problem, which they want to get fixed then then then a guy would come for a minor problem. men would usually, well, more often come for a more serious problem, you know, like, kind of a debilitating problem.

Ben James 24:40

Yeah, okay. So yeah, they’ve, they’ve left it a lot longer. before they’ve admitted. I need some help.

So there you have it, guys. Swallow the pride, get help early, take action. And as always get over to the smart, strong website, www.smart.strong co.uk. There’s a lot of advice here. There’s a free book for you to download with a lot of advice and links to videos. And as always, help support us get over to iTunes and give us a rating it all helps to spread the word. Thanks very much.

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