Get a few pain people together to talk about how we can change the face of healthcare to embrace a more current understanding of pain and reliably the conversation will head towards a consistent answer: students.
Reaching out to existing clinicians to get them on board with a more modern view of pain is tricky for a few reasons:
- Some of them don’t go along to appropriate professional development courses, choosing to fill their CPD quota with business marketing courses and therapeutic courses that fall well short of what I believe the public expect of government registered practitioners to fulfill every year.
- Some of them have ventured into learning about pain science and find it too much of a paradigm shift because:
- It invalidates their way of practice (it doesn’t necessarily)
- It devalues their contribution to previous therapeutic successes (it doesn’t – it just my change their understanding of why such success was obtained)
- It is a threat to business (it doesn’t have to be – we all need to move with the times. Be thankful you are not a taxi driver in a city with Uber!)
- It can feel to them like they are learning that the earth is flat. The cognitive dissonance kicks in and they turn their back on it.
- Having said that, not everyone is getting left behind. Clinicians are paying attention and pain science is is becoming more and more present in the mainstream.
But students and new graduates are the obvious way forward to create a generational change and shift in the way we deliver healthcare – one that fits a little more closely with our current scientific understanding.
Having been in contact with both students and new grads from universities in Australia and the USA in both osteopathy and physical therapy professions, I am confident that the wheels are in motion. Students are embracing a biopsychosocial model in their early years and are clever enough to navigate a system where they are learning about social and psychological factors that influence pain in one class and biomechanics based treatment approaches in the next class. They are the first generation to be integrating this understanding from the get-go – and I envy them!
New graduates are equally important for us to be focusing our attention and mentoring skills towards. No clinician can forget those early days going home after a crappy day thinking: “ I am just not doing it right – my patients are not getting better”. That crushing feeling that your manual skills are just not up to scratch because you had this idea that you should be able to fix everything with your hands! Despite having a better understanding of this as the “bio” bits of a biopsychosocial approach, it can still be difficult and in the event that they seek counsel from a clinician with a very “bio” understanding of pain, they can end up seriously disillusioned. The weight of words from experienced and well respected clinicians can be enormous – especially, for example, when they are telling people that X-rays for an asymptomatic patient with a common spinal anomaly are needed. Or perhaps even running courses that advocate such understandings. How do we help a new grad navigate this? Some suggestions:
- Mentor them – if you employ a new graduate in your clinic it is your responsibility to help shape their understanding, handle the tricky cases and integrate their knowledge with clinical pearls of wisdom.
- Help them set out their professional education calendar for the first few, very influential years
- Run a journal club with your own clinic or other local practitioners
- Make observation of other practitioners a regular part of your clinic – we can all learn from each other and the feedback and scrutiny for the treating practitioner can be fantastic.
- Sponsor or mentor a student – have them in regularly for a chat and some observation. Pay for them to go along to courses that you think will benefit them.