Wearing Our Learning Lightly

How Much Do Patients Need to Know?

James looked at me in a way that conveyed “That thing that you’re thinking, it’s just not right” and I knew a teaching point was coming.

James Lavers is a great teacher of video techniques for personal or brand marketing, and his courses are worth attending for the action they will inspire in you.

I was in London, on the south bank of the Thames close to Tower Bridge, a postcard backdrop to the course during our coffee breaks.

He had asked me something like “What do you want your viewers to do?” and I had answered with “I want them to understand….”

That’s where he stopped me. Then he said something that has always remained with me and informed my physiotherapy practice as well as other parts of my life.

He said “Your patients don’t need to know your expert shit.”

I don’t think I understood the implication of that at the time. I took it as something I should not do, that is to explain things I didn’t need to explain. And that this would make my videos or video courses better.

I’ve been reflecting on that sentence ever since. And repeated it to many people, with proper attribution to James, who most of them do not know.

The real relevance has slowly struck me ever since, and was strongly reinforced when I next visited London.

CFT at the Royal Free

Along with my colleague Neil Davey, I attended Professor Peter O’Sullivan’s last course on Cognitive Functional Therapy at the Royal Free Hospital. The course is always inspiring for the clarity of thought and the practical demonstrations.

The practical demonstrations are amazing! Peter interviews a patient he has never seen before, in front of 300 physios and other health professionals, and shows us how we can help a person change. And they change right in front of us. And the change persists.

Now Peter is a person who has always worn his learning lightly, you never feel any superiority from him although he is clearly more able than pretty much all of us.

This time, however, a new thought struck me as I was walking back to Crouch End with Neil. Peter had seen four patients over a day and at no time had he done any “physio explaining” about pain neuroscience or disc structures or cognitive influences on pain. That seemed new.

He never showed his expertise openly to the patient but guided them towards finding their own ways to change. By showing them that their feared movements or postures did not result in a catastrophic outcome, he made them rethink their views of their body and how it could be safely used.

Do Patients NEED To Understand Anything? Or Do We Need Them To?

Now Neil and I have somewhat different views on this. I’m more of the view that a patient never needs to understand anything about their back or other pains, although I take that position more to limit over-delivery of our technical knowledge than I mean it literally. I think – just show them that the movement or activity is safe and that’ll do it.

Neil is not so sure. He probably has a point.

I’m starting to read the literature around pain education and reassurance, both of which I’m very sceptical about at this moment. But that might change….

Wearing our learning lightly means we don’t let our egos get in the way in showing the patient how knowledgeable we are about this or that subject. It’s just not needed.