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The One Thing Our Patients Need To Succeed
There is a question that burns within all of us at one time or another: What do our patients need to succeed? What are the requirements?
In this article, I want to talk about something that I believe to be a key requirement for our patients to succeed, and for us to have a successful working relationship with them.
Let me start by setting the stage.
Much of what we’re dealing with when working with people is subjective in nature.
The experience of pain is a subjective experience. There are biological correlates that can be observed and measured, but it is well understood that these are merely parts and are not representative of the whole. And the effects on patients' quality of life from pain or functional loss are also subjective.
Yes, we deal with things that are objective and measurable, but these things mostly exist in relation to the person’s goals and their definition of success, which again is subjective.
Dealing with subjective things requires us to rely heavily on the individual to give us information about their experience so that we can work with them. But in order for them to give us information, they first need to know the information for themselves.
This requires awareness. Without awareness on the part of the patient, there is little we can do to help them.
This is where we begin.
In this article, we’ll discuss:
Why awareness is critical to the success of our patients
What kind of awareness is important
How we can help our patients build awareness so that they can succeed
I also created a printable tool that you can use to help your patients in the awareness-building process.
Why Is Awareness Important?
Let’s first talk about the importance of awareness.
Aside from the crucial role that awareness plays in our ability to work with people on subjective aspects of their lives, there are two other important aspects of awareness:
1. Awareness Leads to Influence
Think about anything that you want to change in your life. It could be a habit, a problem, a circumstance, a lightbulb.
Changing something requires intentional action. Action that is aimed at something specific.
In order to take intentional action, we need to know what we’re aiming at. We need awareness of what is, and what needs to change.
The more aware we become, the more potential we have to influence something.
Let’s say I want to exercise more. Well, I can leave it at that and hope that it happens. But if I become aware of what kind of exercise I want to do, why I want to exercise more, what I mean by more, what would help me to exercise more, and what could get in the way of me exercising more, it’s much more likely to happen.
This is due, in part, to the next aspect of awareness.
2. Awareness Leads to Care
It’s human nature for us to take care of ourselves and take care of others. This is wired into our DNA. It’s part of how we’ve survived as a species— by taking care of ourselves and by living in groups (which requires prosocial behavior).
But we can’t take care of that which we’re oblivious to.
The more awareness we build around something, the more likely we are to take care of it— naturally.
When we become aware of ways in which we’re sabotaging ourselves, ways in which our behaviors are discordant with our values, or ways in which our actions are contributing to our pain or suffering, we naturally course-correct. Perhaps not immediately, as it’s not always easy, but we have the drive to do so nonetheless. It’s in our nature.
These two aspects of awareness, combined with the role of awareness in forming a working relationship between us and our patients, make it a critical piece of our patients’ paths to success.
What Kind of Awareness is Important?
Now let’s talk about what—specifically—is important for our patients to be aware of.
There are 3 main foci for our patients’ awareness that I call The Big 3.
The Big 3
1. Awareness of the body
This has to do with what we’re feeling in our bodies and how we’re using our bodies (how we’re moving, positioning, holding our bodies)
2. Awareness of the mind
This has to do with what we’re experiencing in our minds (thoughts, emotions) and includes our beliefs.
3. Awareness of cause & effect
This includes :
The related factors (how certain factors cause/contribute to the problem)
Aggravating factors
Easing factors
Other contextual factors
Thoughts
Emotions
Behaviors
Circumstances
How we respond to the problem (the effects of the problem)
Thoughts
Emotions
Behaviors
Avoidance
Persistence
Persistence-Avoidance
Getting More Specific
Let’s walk through an episode of care and see where these 3 show up.
History
For us to understand the problem on the symptom level, the person must have some awareness of cause & effect to relay information such as:
Onset
Aggravating factors
Easing factors
Daily symptom pattern
Their behavioral response to the symptoms
For us to understand the problem on the quality of life level, the person must have some awareness of the mind to relay information such as:
Their concerns
Their beliefs
Their expectations
Questions/confustions
How they hope we can help
Physical Exam
In order for us to test appropriately, the person must have some awareness of the body & mind to relay information about:
What they’re experiencing (in their body, in their mind)
How things are changing during the testing process
The relative familiarity of sensations (so we know if we’re reproducing their familiar symptoms or not)
Treatment
In order for us to navigate the person’s symptoms with them, the person must again have some awareness of the body & mind to relay information about:
What they’re experiencing (in their body, in their mind)
How things are changing before/during/after interventions
Conclusion of Care
If our goal is to help our patients get to a place where they don’t need us, they must have a certain level of awareness for this to happen.
And because nobody lives their life pain-free (unless they have a genetic abnormality) they must be able to problem-solve when things arise in the future. This requires awareness of body, mind, and cause & effect so that they can take themselves through a similar process that we’ve taken them through when future problems arise.
How Can We Help Our Patients Build Awareness?
So now let’s get into the ‘how.’
How can we help our patients build awareness so that they can succeed?
Much of what we do throughout the process of care, I believe, is teaching our patients to become more aware. Through our questions, our conversations, and our process, we’re constantly cueing our patients to pay attention whether we know it or not.
But the more intentional we can be about this, the more impact we can have and the more likely it is to stick.
Again, we’ll break this down by phase of the episode of care, and by the kind of awareness we’re targeting.
Through The History
Awareness of Cause & Effect
If someone doesn’t know the related factors (aggravating factors/easing factors, etc.), we can’t just gloss over this. It’s really important that we discover these factors.
We can hope to find some of the answers during the physical exam, but if they are to succeed we need them to put in some effort to discover this in the context of their own life.
Two options for helping people explore the related factors are:
Simply asking them to pay attention and let you know at the next visit
I often strongly encourage them to look broadly and to write things down as they discover them.
Fill out a symptom journal
This is the process of examining the entire context during episodes of pain or other symptoms. The person can be guided to look broadly through the use of a template that prompts them to reflect on:
Symptom location
Symptom intensity
What they’re doing
What they’re thinking about
How they’re feeling
Who they’re with
How much sleep they got last night
What their diet/fluid intake has been lately
How they’re responding to the symptom
The effect of their response
Other discoveries/realizations
Click here to scroll down to a free printable symptom tracker you can use with your patients.
It’s very important to let the patient know why this information is important. If we’re asking someone to put forth some effort, they must feel that it’s important, or else they probably won’t do it.
I often say something simple like, “The more we understand how the pain behaves, the more potential we have to influence it. Without this awareness, we’re shooting in the dark when it comes to treatment.”
Awareness of Mind
The second kind of awareness we can target in the history is awareness of mind.
Simply asking questions that speak to this type of awareness can be an insightful process, not to mention rapport-building. This can include such questions as:
At this point, what’s your main concern?
How do you hope that I can help you?
What are you hoping to get out of today’s session?
What doesn’t make sense to you about all of this?
What questions do you have?
Asking open-ended questions such as this leads the person to reflect. And reflection leads to awareness.
When asking open questions, it’s very important to keep them open. “What’s your primary concern?” is a very different question from, “What’s your primary concern— is it more this, or that?” Adding that little closed-ended tail shuts down the range of possible answers to two unless the person is willing to speak up and say neither of those options.
It’s also important to allow for silence. Open questions call people to think, which can mean a pause. Pauses are OK. Embrace the awkward pause.
Through The Physical Exam
We’ve talked about cultivating awareness of cause & effect and awareness of the mind through the history-taking process, now let’s talk about how the physical exam can be used to build awareness.
Awareness of the Body
The physical exam is a huge opportunity for building awareness of the body. Much of this involves simply cueing the person to pay attention and keeping them engaged throughout the examination process.
Let’s follow the exam process and see where our opportunities lie:
1. Explaining what’s about to happen & the purpose
This can lo