I have recently been treating a lovely patient who has had a long list of surgeries for a dodgy knee, scraping, cleaning, trimming, washing, a veritable shopping list of orthopaedic procedures. None of this has helped his ongoing knee problem and in fact has worsened his pain due a knee infection undiagnosed for months. As this infection abates I have been trying to encourage him to mobilise doing some new exercise. Normally I am careful how I speak with my patients. To my shame on this occasion I asked him to move his sore leg (or did I say his injured leg ?)….. I blush when I think of it. He looked me in the eye and said, I prefer to call it my “recovering leg”. Beautiful. Talk about something simple making you change your practice! I vow to be more careful in the words I use from here on.
Speaking of which, I found a lovely analogy for a patient who is ignoring his affected limb. Somewhere I read that we need to facilitate the patient to re embrace his recovering limb (you see I am learning !). As an aside the word for embrace in Italian is ” abbraccio ” which literally means to put your arms around…. Isn’t that lovely? (forte abbraccio is a bear hug !!). So now we are trying to find ways of him embracing in or welcoming his recovering arm back into the fold so to speak. It re – emphasises the power of the words we use and their ability to foster healing.
– Blanaid Coveney
What a wonderful story and a beautiful metaphor. Reading your story about being corrected by your patient I was reminded of a powerful learning experience I had in a clinic quite a few years ago.
It was a Friday afternoon, cold (or at least an Adelaide version of cold) and wet and nearly time to finish. A client who I had seen on a number of occasions came in to see me and I set about the consultation in a usual, but perhaps bustling, kind of way (it was Friday, cold, wet and nearly time to go home…). After a quick hi and a perfunctory subjective I asked her to lay down on the treatment couch so that I could get to treatment.
She got angry at me and then burst into tears. I stopped. It felt a bit like a slap in the face.
Out tumbled her story in between sobs; a horrible week at work on the background of problems at home. Here was a woman who felt like she had “the weight of the world on her shoulders”, trying desperately to “hold on to her marriage and her family” and was “sick of hitting her head against a brick wall at work” with a boss that was rude and wouldn’t listen to her (she had come in for neck, shoulder and arm pain and headaches; could there be anything in that??).
I felt shamed, embarrassed, more than a bit upset too, and at the same time humbled that another human being was sharing such raw emotion with me, just a physiotherapist.
As a clinician it was a powerful (and a bit painful) reminder to honour the human in front of me and their story. I think some of the lessons that our patients teach us are surely the most powerful and memorable of all.
On a final note, as she left she gave me a forte abbraccio. At the time I was bewildered – I hadn’t even done any treatment; just listened to her for the entire length of the consult and then a bit more, and was to overcome to say anything much at all. Looking back, I don’t think that she was hugging *me* at all.
Thanks again for sharing Blanaid
Many thanks for that link. It is so interesting to see the power of the placebo over and over again. It is a really well-constructed trial building on an earlier lovely study on a population of US Veterans (one of my favourites!!). That randomized, placebo-controlled trial assessed the efficacy of arthroscopic surgery of the knee in relieving pain and improving function in patients with osteoarthritis.
There was strong evidence that arthroscopic lavage with or without débridement was no better than a placebo procedure in improving knee pain and self-reported function. Indeed, during follow-up, objective function was at times significantly worse in the débridement group than in the placebo group.
Considering that the procedure is done over 700,000 times a year (in the US) at a cost of approximately $4 billion it should give pause for thought if not a radical overhaul of the system where the billions of dollars spent might be put to better use.
Moseley,JB et al. A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee. N Engl J Med 2002; 347:81-88 July 11, 2002
http://www.nejm.org/doi/full/10.1056/NEJMoa013259 – t=articleDiscussion
Thanks for your reply. I am glad that I am now in a confederacy of 2 at least ! Its extraordinary how lessons hard learned are often those we remember most vividly. I am sure we are not alone in being humbled by a patient and their story.
Perhaps as you say remembering to honour the human and their story is the key to it all.
I have just finished an Explain Pain class with a lovely group of Bostonians. In the session on language, the issue of “the bad leg” emerged. “Involved leg” was suggested but I think “recovering leg” is a wonderful alternative. However one bright soul up the back of the class said “if it’s a left leg, what is wrong with calling it the left leg?” Probably helps with left/right discrimination too!
Might your left leg be even better?
Definitely Tim! Any chance for integration should be taken up. That is me lapsing into old habits.
Brilliant David. Jokes aside, I have a small problem discerning right from left when the patient turns over.!!!. I think I had better get cracking at Recognise myself. Blanaid
Aha – I was reminded at a course last weekend in Atlanta that even the use of “We” may be disemboding.”We will get you going etc.”