Seven things that made me go ‘gggrrrrrrrr!’ in 2008

It’s the time of year to reflect and review, so today I’m going to look at some of the stand-out events and issues that got me riled.  You might, after reading these, think that a kind of theme fits these things but as I write them I promise I’m not choosing them to fit any preconceived ideas!  They appear in no particular order, either…

1. Health professionals ‘turf protecting’ - it could be occupational therapists holding out to be ‘the only ones who do goal-setting’; clinical psychologists saying ‘but we’re the only ones who can really do CBT’; physiotherapists proclaiming ‘but only we can do talk about posture’; anyone who says ‘but I don’t want to do generic case work because I’m special’ - well you know what I mean!  Enough already, there are a bunch of generic skills out there that anyone who has health professional training can and should be able to do.  Let’s get over ourselves and just do it, OK?
2. System that focus on seeing lots of patients and generating lots of income without ensuring teams are able to provide quality treatments. In health care, it really does make a difference to the patient if the focus is on quantity rather than quality.  If we don’t spend time reviewing our practice, integrating research, developing strong teams and caring about what we do and how we do it, our patients don’t benefit.  It’s not simply about efficiency, it’s about effectiveness.
3. Medics who can’t resist the ‘just one more’ approach. People living with chronic pain are so often on a roller-coaster of ‘it might help’ then ‘but it didn’t’ that someone at some point needs to say that it’s time to get on and live.  It is actually possible to live a full, rich, rewarding and enriching life despite experiencing chronic pain.  Reducing pain doesn’t improve the unhappy relationship, stop the job from being a dead-end one, or connect a sad person with new contacts.
4. Quality systems that consist of ticking boxes about furniture and standardising handouts and reacting to complaints from one or two people - but don’t measure whether the patients and staff care, or whether what they do makes a difference in people’s lives. (See number 2)
5. Any therapist or provider who jumps on a new bandwagon without checking out long-term outcomes and whether it really applies to this patient at this time.  Perhaps I’m getting long in the tooth, but over the years I’ve seen various fads come and go in pain management - it’s been ‘muscle imbalance’, and ‘leg length discrepancy’, and ‘dry needling’, and laterality training and - the list goes on and on and on.   Until I can see a good couple studies in patients that look like the people I see (not carefully selected ‘research’ patients), I think I’ll wait before revolutionising my practice.
6. Really bad, or nonexistant, clinical reasoning. ‘Nuff said?  No?  What I mean is, we don’t work with patients who fit any boxes - they’re complex individuals with a load of different factors all influencing why this person is presenting in this way in this place.  So you cannot work from a recipe.  It might be great for a research project, it might mean every patient can be sure of getting the same thing, and it might mean ‘trained monkeys’ can deliver the material - but people are people, not cookies.  We don’t look the same, we don’t respond the same, and as clinicians we surely need to be responsible enough to know why we want to use a specific approach with a patient.
7. Administrators, whether they be buying a service, or simply working with clinicians, defining what should be included in clinical management. As one person, who should probably remain nameless, when a patient is sent to an orthopaedic surgeon, the type of surgery carried out by the surgeon is not decided by the funder.  And if a patient is assessed by one surgeon as needing a specific procedure, the patient isn’t then sent to another surgeon to have that procedure carried out (at least not without the second surgeon carrying out his or her own assessment!).  So why, oh why, would the situation be any different in pain management?  Is it really OK for a funder to decide what does and doesn’t go inside a pain management programme?

OK, I’ll stop now, I feel — somewhat lighter…