Over at our friends at BIM, Laura Rathbone asks the most common Explain Pain question of all. Basically it is “I have been through all the Explain Pain stuff with my patients but some of them still don’t get it”. By the way Laura, if it’s only the odd patient who isn’t helped, you are doing very well. Your curriculum content sounds good.
I don’t have a specific answer, but I am driven by the notion that education should be for all. I have a few broad suggestions to start with.
1. Remember that obstacles to conceptual change may reside in the domains of the patient (eg commitment to existing beliefs) , the education deliverer (eg knowledge), the message (eg media) and the societal context (eg who is paying).
2. Things may be different on the next visit as Laura notes so hang in. “Anchors” for your educational material may have been found.
3. Education is two way. A common error is that clinicians give knowledge displays without attention to the level of misconception that a patient may have. This is a complex issue, now only just being discussed and researched in education science. We have started discussion here but it appears a reasonable assertion that some people with chronic pain who have only linear neurosignatures (eg A must happen before B rather than together, singular blame sources etc) will have difficulty taking on the notion of chronic pain which is an emergent phenomena.
4. Time and repetition and information in different contexts may be needed.
5. Any other support out there? Or perhaps the patient is returning to the community with your message which is a delicate and easily knocked off schema only to quickly return to the usual existing societal mental framework – that of linear biomedicalism.
6. How is your story store? Do you have enough adaptable metaphor and story?
7. Maybe in some there is nothing too wrong with an educational joint wriggle, muscle stretch or massage. Maybe we can get a bit precious sometimes.
Perhaps let’s not forget that while knowledge enrichment is easy and suitable for many patients, conceptual change requires conflict. There is quite a skill in conflict resolution.
– David Butler