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Observation as one key to success

Very early in my career, I realized I needed to develop my ability to relate to patients. Specifically, I needed to learn much more about how individual patients value care. For example, pain reduction isn’t the only, or even the main, factor in how some patients measure success. But discovering how each patient measures success when without specifically verbalizing these goals is sometimes quite challenging.

During the past decade, several areas of research have illuminated our understanding of the importance of affective (building rapport, demonstrating empathy) and cognitive reassurance (explaining a condition in understandable terms) in the doctor-patient interaction.(1) Research has also shown that assuming the role of coach rather than primarily as provider can sometimes be a useful therapeutic strategy by helping patients be more active and effective in their rehabilitation.(2) Skilled providers know (among other things) how to efficiently communicate rapport and empathy, and incorporate useful education in a wide variety of ways.

One way to better understand how to communicate effectively with patients is to refresh our understanding of a fundamental clinical process, observation. By observing patients and ourselves through a biopsychosocial lens we can potentially become more effective communicators, which can translate to enhanced clinical success. To this point, I include a quote from a recently published article entitled Theoretical Considerations for Chronic Pain Rehabilitation, by Martin Lotze and G. Lorimer Moseley.(2) The quote artfully describes the key principles of observation, listening, and discovering what patients are communicating both on and below the surface.

“To really listen is to conjure your attention on the patient, on what they say (and indeed on what they do not) and how they say it – not just the words they use, but the entire behavioural package; their manner, their posture, their ease of articulation, their expression and the attributions they provide for their pain. Recognition that every aspect of this behavioural package reflects activation of neural representations and compels us to integrate those things into our clinical reasoning. A truly biopsychosocial framework of pain accepts that the things we say, do, think and hear, are all potential modulators of pain itself and may all be suitable targets for rehabilitation…”(2)

Reference List
(1) Pincus T, Holt N, Vogel S, Underwood M, Savage R, Walsh DA, et al. Cognitive and affective reassurance and patient outcomes in primary care: a systematic review. Pain 2013 Nov;154(11):2407-16.
(2) Lotze M, Moseley GL. Theoretical Considerations for Chronic Pain Rehabilitation. Phys Ther 2015 Apr 16.

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