Hi Amanda! Please thank your mom for me. And thank you for the lovely note at the meeting, I am now using it as a bookmark! I spent a good deal of time sitting on the bench in the Cedar Grove and sent lots of pics to my dad and his sister and brother. They all loved the connection. Thanks again so much.
Whenever I (as a General Practitioner, Pain Doctor and researcher) am giving a teaching session about pain, I always begin by asking people to define "pain". After discussing a few approaches to such a definition, I then present two on a slide: (1) the IASP definition (which I think is good); and (2) "pain is what the person says it is." In fact, the latter is almost a cliché, in my experience, and has always been received positively. So that makes me wonder how we got from that understanding to the point that you're describing in your excellent article - a point which I fully recognise, and do my best to address in my own practice. Thank you.
Thanks so much for sharing this, Blair! And thanks for doing what you can to address validation (and invalidation) under all of the different hats you wear. I am also very interested in how we got here, and what we can do collectively to shift things toward belief, validation, and true person-centeredness in pain care, and really health care in general. I think a lot of systems change needs to take place to do so. So many of the wrong things are incentivized (Ian Harris's talks were eye opening to say the least...) and perpetuated. Another speaker, Chris Kenedi, said that what people need is what systems won't give them - time and understanding. Systems are made up of people, though, including us and folks like us, so there is hope that we can change them!
Thanks always for your kind words, encouragement, and support, Blair. It is so appreciated.
You've given me the topic for our weekly team CPD with all those validating and invalidating statements. The invalidating ones are so useful as I can see ones that I know I'm guilty of despite my best efforts to centre everything around the person in pain.
Replacing the persons story with a clinical narrative is one that I constantly have to be careful about. My intention is to help them make sense of their story and be able to engage with it in a more objective way but I'm going to redouble my efforts to listen better so I'm expanding their story to include a clinical narrative rather than replacing.
Starting with believing the person in pain to me feels like a no brainer as they are the expert on them. How am I supposed to help them in a person centred way if I can't get an understanding of what being them is like and what is meaningful to them.
Your last months writing gave me so much to think about that I never managed to put it succinctly into a 'comment'.
This is the nearest I've got... reflecting on you talking about everything sitting together at a level table and discussing essentially why they are here as equals.
This made me think that for the majority of healthcare I don't see people getting into it in the first place for the right reasons which can only ever be to help people surely!!! Medicine and healthcare in general comes with status, power and control as practices in the mainstream and this starts with putting people in their place by calling them patients. Generally then people (patients) respect, listen to and consider the healthcare provider to be the most important person in the room all whilst the healthcare profession is increasingly saying they follow a patient centred approach, which is bollocks if they are not starting with listening and wanting, no needing to know the person's story if they are to truly help.
So you keep standing on the platform you've earnt and be you at conferences and point out that the system for ongoing pain isn't as a whole winning. Last time I checked low back pain was still the leading cause of disability globally.
In the business world the companies that obsess about their customers are the best ones so why should healthcare be any different and why is it only a recent thing that the 'customers' of healthcare are being involved in research and asked to present at conferences.
Keep going and pushback even if polite shows you're going in the right direction ♥️
Another dynamite comment! Thanks so much for sharing your reflections here. And I'm so stoked to hear about validation being the weekly CPD meeting topic! I'd love to hear how it goes :)
I really appreciated when you said 'I'm going to redouble my efforts to listen better so I'm expanding their story to include a clinical narrative rather than replacing.' I love the phrasing of expanding their story to include what they can learn from you, as well as you redoubling your efforts to listen better so that you are also learning from them. I think that co-learning and co-creation of a new narrative is an important bit that is often rushed or skipped altogether.
And ooof...you've given me a lot to think about with your reflections on the last post. You've put to words something I've found difficult to articulate myself and have really hit upon something. 'Medicine and healthcare in general comes with status, power and control...' it really does matter why someone got into the profession, eh? And if that status and power are wielded for personal benefit - which can then never truly be person-centered - or wielded in ways that share power and center the persons in their care (or on their research team or in their health system or co-workers or students, etc).
So often I am preaching to the choir - people who DID get into healthcare for the right reasons. That becomes the anchor or lens (can't find the right word here...) of their worldview, which makes it all the more baffling for them when they hear how shitty so many people are treated within health systems. But they do see it. They see that invalidation is happening. They may have even experienced it themselves as a patient at some point, or when a loved one was a patient. They see the objectification and dehumanization. They may even feel invalidated and dehumanized in their role as clinicians or academics or researchers.
But what do they/we do in the face of colleagues or bosses or administrators or students who got into healthcare for the wrong reasons? For the status and power and control (and in some professions, the money). Who may actually outnumber us! Bucking the status quo is hard, and it puts individuals at risk. That's why we need to come together somehow. We have more power and sway when we are a collective rather a bunch of individuals in our individual silos trying to fight the good fight and do right by people when faced with so many barriers to change.
Lots to think about here. And might not have articulated that well, but thank you for the thought-provoking reflections, which I will continue to reflect upon! And I will continue to stand on my platform, too. As small as it may be, it is something. And it has led me to meet so many wonderful people who want to see change. It's about harnessing that that we need to figure out. Renegades, unite!!
And thanks for the reminder that pushback means I'm going in the right direction. It is well timed and well received!
Thanks so much, Steven. So so glad you are here. And would love to hear how the weekly team CPD goes!
I've been meaning to let you know how our validation CPD chat went and as my pot of tea brews seems like a perfect opportunity. Being in mind that our core values as a clinic are person centred care, searching for the root causes and evidence informed care it's not the first time we have talked around such matters.
Something that came up was someone talking about the tricky balance between wanting to show the person you are helping that you know what you are talking about so they can trust you and being practitioner centred rather than patient centred. I suppose being a guide of sorts and helping lead them to a better place without being dictatorial. Watching Pete O'Sullivan with patients, he listens, listens, validates, questions (non judgementally), offers alternatives and empowers people to try but by the end of the session he is quite bossy with them, often throwing a bottle of water on the floor for them to pick up and telling them off when they revert to old guarded ways of moving. So we were debating this balance quite a lot.
A question we had for you was around your comment and I paraphrase on healthcare providers suggesting some variation of it's in your head. Would trying to explain predictive processing or sensitisation come under that from your perspective and it's defo your opinion we're after so no sugar coating please 😃
We're all going to the London workshop of Pete O'Sullivan. Would be awesome if there was a little bit of you there. I don't know how tight timings are but would you consider a little video or something? I'll perhaps email you and James Davis who coordinates and see if feasible.
Thanks so much for letting me know, Steven! It sounds like a great chat, with lots of good questions that came up!
I would be happy to do a video or something ahead of the London workshop - when is it? Send me an email (joletta.belton@gmail.com) if you think it'll be possible to set something up.
When it comes to Pete, I think part of the bossy bit comes from getting to know the people who are the demos he works with. There's a whole lot of selection bias there, in terms of the people willing to become a patient demo. And I know quite a few of his demos have similar backgrounds, for that reason. Like Joe, the other firefighter that has been in a few of his videos (two Jo/Joe firefighters is something else!). There is a lot of former athletes as well. People who were really active at one point, then back pain upended their ability to do those things they identified by (a job, like firefighting, law enforcement, military; or an athlete, either competitive or recreational - a runner, a lifter, a cross-fitter, etc). All of those people have something in common in that at one time they were really good at following direction, and thrived in competitive environments, so his approach at the end is sort of like an academy instructor or coach or captain. It was perfect for me.
When I was the patient demo, there was a second demo who was an older man. He did not have that same sort of background and Pete's approach was a bit different with him, more gentle, where with me he hammered me with exercises! And I loved that, it made me feel like my old self.
I think that the framing is important to the encounter. I don't know if Pete would say he was trying to help me, he was trying to understand me and work with me to get back to being me. It was a co-learning opportunity, where I felt intensely and intently listened to and respected, and I trusted him completely by the time we got to the exercises. That trust and respect was crucial. When he was so confident that I could do something, it made it that much easier to be confident in myself.
As for predictive processing and sensitization, I'd lean much more closely to the former than the latter. I think people get that we keep doing things in a 'usual' way. That usual way was disrupted by pain and be began to do things differently, then that became 'usual'. Now we're trying to disrupt that 'usual' in a positive way. We're trying to change our expectations, our predictions of what will happen, and what we're capable of. I think there are ways of talking about it using examples from the person with pain's life rather than getting to sciency about it.
I hope that helps! Happy to discuss further, as always, too. And to do a video if that works out!
I love your simple predictive processing description and have been using it with better buy in than my previous analogy so thanks 🙏
The Pete O'Sullivan workshop is the last weekend of June. I spoke to James and he thanks for the offer and said he would contact if needed but he thought they were full for content already.
Really appreciate your take on being sat across from Pete and the not trying to help but to understand comment has really given me something to think about in regards to making sure I understand before I suggest I can help.
You made it to our Cedar Grove! My Mum will be thrilled. Thanks for making the trip all the way down South.
Hi Amanda! Please thank your mom for me. And thank you for the lovely note at the meeting, I am now using it as a bookmark! I spent a good deal of time sitting on the bench in the Cedar Grove and sent lots of pics to my dad and his sister and brother. They all loved the connection. Thanks again so much.
Whenever I (as a General Practitioner, Pain Doctor and researcher) am giving a teaching session about pain, I always begin by asking people to define "pain". After discussing a few approaches to such a definition, I then present two on a slide: (1) the IASP definition (which I think is good); and (2) "pain is what the person says it is." In fact, the latter is almost a cliché, in my experience, and has always been received positively. So that makes me wonder how we got from that understanding to the point that you're describing in your excellent article - a point which I fully recognise, and do my best to address in my own practice. Thank you.
Thanks so much for sharing this, Blair! And thanks for doing what you can to address validation (and invalidation) under all of the different hats you wear. I am also very interested in how we got here, and what we can do collectively to shift things toward belief, validation, and true person-centeredness in pain care, and really health care in general. I think a lot of systems change needs to take place to do so. So many of the wrong things are incentivized (Ian Harris's talks were eye opening to say the least...) and perpetuated. Another speaker, Chris Kenedi, said that what people need is what systems won't give them - time and understanding. Systems are made up of people, though, including us and folks like us, so there is hope that we can change them!
Thanks always for your kind words, encouragement, and support, Blair. It is so appreciated.
Again dynamite writing!
You've given me the topic for our weekly team CPD with all those validating and invalidating statements. The invalidating ones are so useful as I can see ones that I know I'm guilty of despite my best efforts to centre everything around the person in pain.
Replacing the persons story with a clinical narrative is one that I constantly have to be careful about. My intention is to help them make sense of their story and be able to engage with it in a more objective way but I'm going to redouble my efforts to listen better so I'm expanding their story to include a clinical narrative rather than replacing.
Starting with believing the person in pain to me feels like a no brainer as they are the expert on them. How am I supposed to help them in a person centred way if I can't get an understanding of what being them is like and what is meaningful to them.
Your last months writing gave me so much to think about that I never managed to put it succinctly into a 'comment'.
This is the nearest I've got... reflecting on you talking about everything sitting together at a level table and discussing essentially why they are here as equals.
This made me think that for the majority of healthcare I don't see people getting into it in the first place for the right reasons which can only ever be to help people surely!!! Medicine and healthcare in general comes with status, power and control as practices in the mainstream and this starts with putting people in their place by calling them patients. Generally then people (patients) respect, listen to and consider the healthcare provider to be the most important person in the room all whilst the healthcare profession is increasingly saying they follow a patient centred approach, which is bollocks if they are not starting with listening and wanting, no needing to know the person's story if they are to truly help.
So you keep standing on the platform you've earnt and be you at conferences and point out that the system for ongoing pain isn't as a whole winning. Last time I checked low back pain was still the leading cause of disability globally.
In the business world the companies that obsess about their customers are the best ones so why should healthcare be any different and why is it only a recent thing that the 'customers' of healthcare are being involved in research and asked to present at conferences.
Keep going and pushback even if polite shows you're going in the right direction ♥️
Another dynamite comment! Thanks so much for sharing your reflections here. And I'm so stoked to hear about validation being the weekly CPD meeting topic! I'd love to hear how it goes :)
I really appreciated when you said 'I'm going to redouble my efforts to listen better so I'm expanding their story to include a clinical narrative rather than replacing.' I love the phrasing of expanding their story to include what they can learn from you, as well as you redoubling your efforts to listen better so that you are also learning from them. I think that co-learning and co-creation of a new narrative is an important bit that is often rushed or skipped altogether.
And ooof...you've given me a lot to think about with your reflections on the last post. You've put to words something I've found difficult to articulate myself and have really hit upon something. 'Medicine and healthcare in general comes with status, power and control...' it really does matter why someone got into the profession, eh? And if that status and power are wielded for personal benefit - which can then never truly be person-centered - or wielded in ways that share power and center the persons in their care (or on their research team or in their health system or co-workers or students, etc).
So often I am preaching to the choir - people who DID get into healthcare for the right reasons. That becomes the anchor or lens (can't find the right word here...) of their worldview, which makes it all the more baffling for them when they hear how shitty so many people are treated within health systems. But they do see it. They see that invalidation is happening. They may have even experienced it themselves as a patient at some point, or when a loved one was a patient. They see the objectification and dehumanization. They may even feel invalidated and dehumanized in their role as clinicians or academics or researchers.
But what do they/we do in the face of colleagues or bosses or administrators or students who got into healthcare for the wrong reasons? For the status and power and control (and in some professions, the money). Who may actually outnumber us! Bucking the status quo is hard, and it puts individuals at risk. That's why we need to come together somehow. We have more power and sway when we are a collective rather a bunch of individuals in our individual silos trying to fight the good fight and do right by people when faced with so many barriers to change.
Lots to think about here. And might not have articulated that well, but thank you for the thought-provoking reflections, which I will continue to reflect upon! And I will continue to stand on my platform, too. As small as it may be, it is something. And it has led me to meet so many wonderful people who want to see change. It's about harnessing that that we need to figure out. Renegades, unite!!
And thanks for the reminder that pushback means I'm going in the right direction. It is well timed and well received!
Thanks so much, Steven. So so glad you are here. And would love to hear how the weekly team CPD goes!
I've been meaning to let you know how our validation CPD chat went and as my pot of tea brews seems like a perfect opportunity. Being in mind that our core values as a clinic are person centred care, searching for the root causes and evidence informed care it's not the first time we have talked around such matters.
Something that came up was someone talking about the tricky balance between wanting to show the person you are helping that you know what you are talking about so they can trust you and being practitioner centred rather than patient centred. I suppose being a guide of sorts and helping lead them to a better place without being dictatorial. Watching Pete O'Sullivan with patients, he listens, listens, validates, questions (non judgementally), offers alternatives and empowers people to try but by the end of the session he is quite bossy with them, often throwing a bottle of water on the floor for them to pick up and telling them off when they revert to old guarded ways of moving. So we were debating this balance quite a lot.
A question we had for you was around your comment and I paraphrase on healthcare providers suggesting some variation of it's in your head. Would trying to explain predictive processing or sensitisation come under that from your perspective and it's defo your opinion we're after so no sugar coating please 😃
We're all going to the London workshop of Pete O'Sullivan. Would be awesome if there was a little bit of you there. I don't know how tight timings are but would you consider a little video or something? I'll perhaps email you and James Davis who coordinates and see if feasible.
Better go teas brewed, keep being you xx
Thanks so much for letting me know, Steven! It sounds like a great chat, with lots of good questions that came up!
I would be happy to do a video or something ahead of the London workshop - when is it? Send me an email (joletta.belton@gmail.com) if you think it'll be possible to set something up.
When it comes to Pete, I think part of the bossy bit comes from getting to know the people who are the demos he works with. There's a whole lot of selection bias there, in terms of the people willing to become a patient demo. And I know quite a few of his demos have similar backgrounds, for that reason. Like Joe, the other firefighter that has been in a few of his videos (two Jo/Joe firefighters is something else!). There is a lot of former athletes as well. People who were really active at one point, then back pain upended their ability to do those things they identified by (a job, like firefighting, law enforcement, military; or an athlete, either competitive or recreational - a runner, a lifter, a cross-fitter, etc). All of those people have something in common in that at one time they were really good at following direction, and thrived in competitive environments, so his approach at the end is sort of like an academy instructor or coach or captain. It was perfect for me.
When I was the patient demo, there was a second demo who was an older man. He did not have that same sort of background and Pete's approach was a bit different with him, more gentle, where with me he hammered me with exercises! And I loved that, it made me feel like my old self.
I think that the framing is important to the encounter. I don't know if Pete would say he was trying to help me, he was trying to understand me and work with me to get back to being me. It was a co-learning opportunity, where I felt intensely and intently listened to and respected, and I trusted him completely by the time we got to the exercises. That trust and respect was crucial. When he was so confident that I could do something, it made it that much easier to be confident in myself.
As for predictive processing and sensitization, I'd lean much more closely to the former than the latter. I think people get that we keep doing things in a 'usual' way. That usual way was disrupted by pain and be began to do things differently, then that became 'usual'. Now we're trying to disrupt that 'usual' in a positive way. We're trying to change our expectations, our predictions of what will happen, and what we're capable of. I think there are ways of talking about it using examples from the person with pain's life rather than getting to sciency about it.
I hope that helps! Happy to discuss further, as always, too. And to do a video if that works out!
I love your simple predictive processing description and have been using it with better buy in than my previous analogy so thanks 🙏
The Pete O'Sullivan workshop is the last weekend of June. I spoke to James and he thanks for the offer and said he would contact if needed but he thought they were full for content already.
Really appreciate your take on being sat across from Pete and the not trying to help but to understand comment has really given me something to think about in regards to making sure I understand before I suggest I can help.