Intelligent, circumspect and considered
Anthony was a deeply contemplative man. The father of a dear friend, he was well known for driving his tractor right past the gate to his own farm, so deep in thought was he. Intelligent, circumspect and considered, he owned two chess sets – one for everyday games and one set up apparently mid game, as if the competitors had merely stepped out for a break.
The latter was in truth a game underway – an ongoing chess game being played between two friends across the oceans. Anthony’s childhood friend and he were bound in comradeship by a love of chess, and even when his friend left to become a priest they continued to play games when he returned on holidays. When Anthony’s friend eventually moved to California, as many did before him, they remained in constant communication by letter.
Bishop g2 to c6++
Every week a letter would arrive with the latest news and instructions about which move the Monsignor wanted Anthony to make on the chessboard. The Monsignor’s move was completed, tactics and strategy were contemplated and a reply written, complete with local news and instructions for the next move to be carried out in California. And so it went, back and forth. Weekly letters with news and unfolding chess moves. Over each year two full games of chess were played patiently, one letter at a time at other ends of the world.
During the annual visit home, the Monsignor and Anthony visited each other’s houses on alternate nights playing their game and catching up. When it was time to leave, the game was merely continued by correspondence. And so, once again, two chessboards an ocean apart. Such a lovely testament to friendship and of course… to patience.
Reflections on a virtue
Patience. Now there is something I have been reflecting on. Wishing to be bestowed with it in abundance, I have been wondering if you can in fact acquire more of it. How do those lucky people who have it naturally make being patient look so easy? It sometimes feels like a fatal flaw to be impatient. I like to think that some good things have been born out of it: perhaps an invention or two; a shortcut taken which led to the discovery of a new land; the curing of an illness or the creation of some extraordinary culinary delight when patience wore thin! Maybe this is the song of the deluded. For patience, we are told, is a virtue, which means that we all should want it, even if we don’t have it.
Treating patients with complex pain states can require even more patience than normal. A failure to explain pain in a way that makes sense to the patient can lead to frustration. Surely patience is one of the foremost components in a good relationship with our patients, allowing us to listen effectively, gain their trust and gradually challenge long held beliefs. Every aspect of the interaction from initial assessment, to building up a clinical picture and giving space for the patient to tell their story, all require it.
On that note, how many of us can say we are patient all the time? Have you ever considered the patients who left and did not return? The ones who slipped through the net when they did not improve in line with expectations? Did they sense your frustration and go elsewhere? If the clinician is impatient, how must that feel for the patient who is living with the pain? It certainly seems obvious that patience is fundamental to a good therapeutic alliance and so perhaps a short reflection on its merits for us all, may not be a bad thing.
-Blanaid Coveney
Blánaid is a practicing physiotherapist in Dublin, Ireland. Her professional interests include epidemiology, pain and all things brain related.
We’re hitting the road and taking our NOI courses right across this great southern land:
Townsville 29 April – 1 May Explain Pain and Graded Motor Imagery
Canberra 3 – 4 May Mobilisation of the Neuroimmune System (only Australian MONIS course for 2016)
Canberra 6 – 8 May Explain Pain and Graded Motor Imagery
Adelaide 14-15 May Pain, Plasticity and Rehabilitation (only Australian PPR course for 2016)
Noosa 17 – 19 June Explain Pain and Graded Motor Imagery
Perth 15 – 17 October Explain Pain and Graded Motor Imagery
EP3 events have sold out three years running in Australia, and we are super excited to be bringing this unique format to the United States in late 2016 with Lorimer Moseley, Mark Jensen, David Butler, and few NOI surprises.
EP3 EAST Philadelphia, December 2, 3, 4 2016
EP3 WEST Seattle, December 9, 10, 11 2016
To register your interest, contact NOI USA:
p (610) 664-4465
e noius@noigroup.com
You should write more , your imagery and descriptive prose is excellent. Patience. Its a work in progress.
Your description captured perfectly the ‘enforced patience’ through slow communication and reflection . Snail mail v’s email, planting deeper seeds other than soundbites on social media perhaps.
Yesterday, I forgot to take my newly acquired reading glasses to work and replied to one of the posts on here and discovered it was full of spelling mistakes as I couldn’t see the keyboard….a lesson in patience.
Modern health care is full of bullet points, the need for quick responses to slowly evolved healing responses. Without understanding and patience regarding the glacial nature of full recovery (particularly in tendons and spinal structures )in the middle aged body its easy to do the wrong thing.
Patience is what I tried to convey to the lady following a shoulder replacement, who bereaved and with years of pre op pain and coexisting anxiety, expected much more from her surgery. The surgeon saw a snapshot -a lack of progress and unwittingly gave the impression it was due to ineffective rehabilitation. Perhaps it was.
Practically , I have more patience and have more to give , more flexibility of the chess piece moves perhaps when we (patient and therapist) are sitting at the same table, engaged in the same game. Often its not easy as the person simply is sitting at the wrong table with the wrong person , they are ‘sent’ rather than choosing consciously to address their difficulties .
It requires patience to see the person rather than the limb or the protocol stapled to the form and it requires patience and reflection to look at literature that may help keep the enthusiasm for health care interactive communication alive.
Positively , I am enthused that articles like this are being written and other bloggers such as Neil Maltby and Dave Nichols are exploring the role of Physiotherapy much more widely with historical and philosophical awareness. This reflective and humanistic approach – a move away from the purely ‘physical/mechanistic’ is optimistic and relevant . Perhaps my own patience is paying off in a way since I have never believed that ‘science’ provides all the answers to the daily clinical conundrums or life in general for that matter. Other approaches such as reflecting on life between two distant chess players in rural Ireland and America and the motivation for doing this are sometimes more relevant and interesting too.
Thanks Ian,
Such nice reflections on patience! You bring up an interesting point relating to expectations; not just the patient’s or the clinician’s but potentially dealing with others, such as the surgeon’s (“you are not doing as well as I expected ”) or even family and friends’ (“surely the pain has gone by now!”). Surely the management of expectations is a key part of the therapy, which may receive less attention than it deserves but may be an influencing factor on treatment adherence and outcomes.
I had not considered the notion of being “sent” to a particular clinician but of course you are right. The concept of “sitting at the wrong table with the wrong person” is well put. How many arrive having been sent by someone else and have had little choice or involvement in the matter? Choosing the therapist rather than being “sent” may be a reflection of many things: how informed the patient is; or their assertiveness, or may even be a reflection of their coping strategies. But I wonder if it has an effect on treatment outcomes? Are you more likely to comply with a self-management programme for pain or have a better outcome if you choose the therapist rather than being sent? I don’t know the answer to this but would like to. In a nice review by Dorflinger et al (2013) on the role of providers in improving patients’ adherence to self-management pain programmes, there seems to be agreement that a collaborative or working alliance between the patient and clinician is the best approach, or as they put it:
“In keeping with the spirit of shared decision-making, the discussion of a possible referral can be conducted over a series of meetings to provide patients with the opportunity to consider the referral, ask questions, and discuss their preferences”.
It’s a far cry from “being sent” isn’t it!
Regards Blanaid
Dorflinger, L., Kerns, R. D., & Auerbach, S. M. (2013). Providers’ roles in enhancing patients’ adherence to pain self management. Translational Behavioral Medicine, 3(1), 39–46. http://doi.org/10.1007/s13142-012-0158-z
You might be interested in this article in todays Guardian …http://www.theguardian.com/books/2016/apr/22/literature-about-medicine-may-be-all-that-can-save-us
Great article Ian, Highly recommend it, Thanks . Blánaid
Yet again a beautiful piece Blanaid. Patience is indeed a must in any interaction with those that seek to trust us. Without it we will never creat the necessary environment for the brains of the sufferer and the clinician to do their stuff in harmony……..
Picking up on a couple of points made in your article:-
Only patience will lead the way to finding those harmonies of understanding to explain pain to the sufferer in a rhythm that THEY feel and can dance to. Again quoting my old friend Geoff ” I know you thought you heard what you think I said but did you actually understand what I meant.”
Equally only patience will create the space within which the sufferer can fully tell their unique story and “Feel” heard. ………..
Patience is a virtue to aspire to and only gifted to a rare few……
DB London
😘
You should all write more!
Many of us are quick to become impatient with a person with chronic pain. Linked perturbed cognitions such as mental inflexibility and vagueness and perturbed emotions such as anxiety, all a part of the person’s pain construction, often push us to impatience.
The issue which most forget is that in many cases, the perturbed emotions and cognitions were created by health professionals in the first place and thus we may be impatient due to something which we created. Seems a bit unfair on the sufferer.
David