Regular readers of my blog will know that one of my pet topics is how do you know which Health Care Professional (HCP) to go to? How do you work with them for a good outcome? And how do you know when to run out of the appointment and never return to that person again?
My lumpy rehabilitation journey has allowed me to build up a larger-than-average sample of interactions, create a picture of myself as a ‘failed patient’ after two years of never managing to succeed on two successive weeks of physio exercises, and now I am delighted to say that my quest has led me to meet a rock star physio (and actually succeed!) So I wanted to tell you all about it…
How did I find him?
Part of spending months and years incapacitated has led me to want to really understand what is going on for me physically. So I have attended every single free seminar/webinar/TED talk etc online that I can find related to recovery. It has been fascinating and illuminating.
Paul Hobrough has written two books (‘Running Free of Injuries’ and ‘The Runner’s Expert Guide to Stretching’) and is so famous that even my Mum has heard of him. Initially I thought this is because he is based in Northumberland (where my parents live), but actually it is because he has a great common-sense column in one of the national newspapers! I heard him speak on an England Athletics webinar and when I heard that he was doing tele-medicine appointments, I had to give it a go….
Sharing the history
After years of being in and out of treatment rooms, I think that I have my history giving down to a pretty good delivery. It is definitely a learned skill that requires years of practice and improvement before graduating to professional patient level, but I hate the oral tradition of history taking. Here’s why:
- All HCPs are pressed for time, so when you have a complex history (as I have) I have seen the panic start to rise in their eyes and them start to look for straws to grasp at – which means that landing the holistic overview of the situation is hard. And any glancing contact with something that they have been taught is a red or amber flag leads to them jumping in with an early diagnosis and potentially the whole appointment and interaction is derailed as you either succumb to a snap-judgement that you think has already been investigated, or you try to have a respectful debate with someone who is (and wants you to know that they are) so much more of an expert than you are.
- In my experience the majority of HCPs are very bright, studious people with a strongly introverted approach to life. This means that they are brilliant at really thinking deeply about issues and working out great solutions – but only if they are given the time to do this. Hence the extrovert’s style of iterating through oral history-giving has to be bad for them. Additionally, they need time to consider how they are going to share their views back with you (the patient), so that you can understand them.
- From a patient point of view, there are times when I am in such a mess that I can barely string a sentence together let alone a complex history under time pressure. Because pain makes you live in the moment, it can be hard to step out of the moment and give a balanced overview at that point of time.
This is why I always email my history over before an appointment. Almost every time I have done this the HCP has pre-read it and come in with questions (only one did not – they proceeded to read it aloud in the appointment and then lecture me on what a pathetic specimen of a human being I was for not understanding what was needed – for a whole hour without me getting a word in edgeways – that was an appointment where I should have stood up, paid and left).
What was the difference that a rock star physio made?
Here’s the parts that blew me away:
- EMPATHY: Paul created instant connection between us by making a very humble joke about his presentation at the seminar that I had attended. I went from being very nervous to laughing in seconds, and I also understood that the ground rules were that it was OK for me to ask anything – which completely changed the power dynamic in the appointment.
- DIAGNOSIS: In the first 5 minutes he not only summarised his diagnosis of what the issues were, but also how he thought I understood them – he repeated back to me the language and things that I had said in my email.
- UNDERSTANDING: We then spent another 5 minutes where I was able to question him about this more – and I felt like I was having a personal medical masterclass, where he simply and clearly laid out medical theory, practice and levels of certainty in lay language that genuinely made sense to me and where it was also OK for me to say where I did not fully understand it.
- REFRAMING: Within this he completely reframed my expectations. I saw the medical process as me vs pain – with success as elimination of pain. He got me to talk about triathlon racing and the normal types and levels of discomfort in training and racing. From there we agreed that it was about control, pacing and self-management of pain – which seemed so obvious (but was a new insight for me).
- GOAL-SETTING & OWNERSHIP: As we got to the midway point, he moved me into goal-setting. At the time I was in the split mentality of “I want to return to Ironman Triathlons but think that will be impossible – and my day-to-day is governed by so much pain that I often cannot walk to the corner shop”. He gently nudged me to explore a goal that I thought was an impossible ask, and he saw as a very viable 3-month goal. It was so exciting!
- DETAILED PLANNING OVER 3 MONTHS: Then he moved into explaining to me the specific movements that were going to be challenging, how to dose them in, what signs would show that it was working and what would show that I needed to regress the progress. He was completely unapologetic that it was a lot of work – that even writing the excel sheet with the programme on was a lot of work – but even that was exciting to me. I wanted to be a part of this and I was completely signed up to whatever work it took.
- SETTING UP SELF-MANAGEMENT: So having specified the programme in detail, he delegated me to write it and email it to him for review and any feedback/changes within the next 3 days. I did, but he had explained it so clearly within the appointment that no changes were needed.
- TRANSMITTING CONFIDENCE, BELIEF & HOPE: Then he wrapped up with the ‘piece de resistance’. He said “I back my opinion and experience and I really think that with this plan, you can make this goal in 12 weeks. But it won’t be easy – I think that you will have a number of setbacks – and we’ve talked about what it looks like when you need to regress, how to monitor symptoms, how long to rest it and how to move forward again each time. I also accept that no-one can truly know what is going to happen and in the event that in 12 weeks this really hasn’t worked then there is another more interventionist path that we can take, that has good scientific evidence behind it and has worked for a lot of people.” In that closing minute he had imbued me with his sense of confidence, belief in the plan, readiness for setbacks and knowledge that even this plan was not the end of the road – so there was always hope. If I was summarizing it as a mantra it would be ‘you’ve got this!’
What happened next?
I followed the plan – it happened 100% as Paul said. It was hard work, it took patience and tracking. I had set-backs and had to follow the approach that we had talked about. I doubted at times, but always thought back to his confidence to reassure myself and follow the exact detail that we had agreed. In 12 weeks I hit the goal that I had only dared to dream could be possible.
All from one 30-minute appointment – where an incredibly intelligent and kind man with a wealth of knowledge gave me the keys to the castle, to unlock so much of my misery.
I haven’t seen Paul since – and I feel bad that I only paid him for that one appointment. I can only reassure myself that by not clogging up his agenda with more he has been able to change so many more lives for the better.
Thank you Paul.