Separating the specific treatment provided from the entire treatment encounter

Patients often seek specific treatments for chronic pain, and healthcare professionals hope to have patients adhere with the treatment and advice provided. However, for every type of treatment provided – be that medication, “hands-on” therapy, exercises or advice – the entire treatment encounter involves far more than the specific treatment provided. This includes the degree to which the person has been listened to, has been taken seriously, has perceived empathy on the part of the healthcare professional and has had their problem explained to them. These aspects of the treatment encounter are often considered by healthcare professionals as less relevant than decisions on which specific treatment to choose. This is reflected by people with chronic pain describing over and over again their struggle to be taken seriously, to be believed, and to be truly listened to by healthcare professionals. It is now clear that patient-therapist interaction is closely related to patient satisfaction and physical function in chronic pain, and adherence to treatment recommendations in a range of conditions. Consequently, there have been calls to pay greater attention to the patient-therapist interaction to help improve chronic pain outcomes, including this previous post.

This is not to suggest in any way that the choice of treatment provided is unimportant, as it should of course be based on the best available scientific evidence. Rather, our point is that consideration should be given to how the effectiveness of any treatment, and patient engagement with their management plan, could be maximised by enhancing the patient-therapist interaction. A key barrier to adopting such an approach is the tendency for healthcare professionals to be seen as technicians who administer a treatment, instead of being seen as facilitators of a management plan which will address the factors most relevant to each individual, and involve the patient in the process. Good communication is key to good patient-therapist interaction. There is evidence that healthcare professionals can be trained to become more empathetic. There are very few downsides to adopting such an approach, other than the need to develop enhanced communication skills, and possibly spending a little more time listening to the key concerns of patients. We owe our patients at least that much.

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