As some of you may already know, my wife and I run a Kumon Centre which is a program for maths and English and aims to have students studying above their grade level. Now just last week I over heard a young boy saying quietly to himself, “ I’m dumb”, and “I can’t do this”. Of course I intervened gently and asked what the problem was and with very little guidance he was able to self correct his mistake and go on to finish the workbook quite well. I imagine with a little more practice he will be saying this is too easy and will move onto something more challenging in no time.
Why am I telling you this?
Well, I see something so similar and just as harmful as these negative beliefs in many of my patients every day.
“That’s my bad leg”
“It’s bone on bone”.
“I can’t …
So while I think we all acknowledge that negative self efficacy and self talk are no good, and there is plenty of behaviour change programs and approaches aimed at changing the "I can’t" to "I am not there yet", it’s probably not as well identified at a public level in a health context, particularly musculoskeletal health.
Within our professional literature there is emerging evidence of the harm these negative beliefs (often referred to as Nocebo language- the opposite to placebo) can cause. I think many people have unwittingly been told harmful information from a family friend, and worse still a health care worker.
Think of this, “ Your uncle Barry had that and had to have surgery, he never got back to his golf though”. My personal bug bear from health professionals ( and I am not taking a swipe at surgeons or GP’s, many of my health practitioner colleagues still make this mistake) is “ It’s the worst I’ve seen”, or “You have the back of an 80 year old”. These words to a worried patient can be so detrimental, often resulting in withdrawal from activity they can still safely do for fear of making things worse. Ultimately, there is a decent into chronicity and reduced function.
As is the case with many challenges in life, whether it be a new concept in mathematics or recovering after a knee injury, change can be slow and is usually the result of a conscientious and consistent effort over time. It’s often said nothing worth having comes easy, I think this can be the case in a person’s rehab journey.
So what is my approach?
There is a very solid body of evidence showing that education and reassurance can have wonderful benefits in patient care. Following a thorough assessment, letting someone know their prognosis is not all doom and gloom, and although there are some changes on your X-Ray we should be able to get back to what it is they love with a few simple interventions is a profoundly empowering thing. It is something I place a huge emphasis on. My job is to build self efficacy, not make the patient reliant on ME to FIX them. By shifting the locust of control back to the individual and letting them take ownership of their rehab I see people walk out of my rooms a little taller and hopeful. It’s an absolute highlight of my day to be able to reassure a patient that they are not ’stuffed’, and there is absolutely something they can do to improve their quality of life.