Auntie Version - MSKMag's Agony Aunt -May 2024
Hello! I’m Auntie Version and I am unbe
lievably excited to be MSKMag’s very own agony aunt.
Oh the arrogance in my assumption that I have any wisdom to impart about your life, and the irony that much of my advice will implore you to resist that clinician’s urge to fix and advise! Nevertheless, I do hope you’ll find this column informative, thought-provoking, occasionally amusing and that you’ll find some helpful tips amongst my best guesses and opinions.
Q: My friends and family always want free treatment, it is 1. Exhausting and 2. My income stream. Should I charge them, say no or suck it up?
A: I’m sure everyone reading recognises this challenge. I certainly do and over the years my responses to such enquiries have varied from,
“Yes, of course, pop round and I’ll take a look.”
To,
“Sure, could you take a look at my car whilst you’re round, it’s making a terrible noise.”
I’d like to say that what comes out of my mouth is based on some complex internal algorithm. Honestly, it probably depends how much energy I’ve got. And I don’t mean energy to provide the treatment, I mean energy to set the appropriate boundary. Of course we shouldn’t be expected to hand out free treatment in our homes and in our spare time, but we all know how awkward it is to explain why we’re not prepared to do that.
I bang on all the time about self-care but this is exactly why it’s important. When you are well-fed, rested and resourced, you’re much more likely to find the right words. What you say is up to you. I often use something along the lines of,
“I could see you at home but actually I’ll be able to help you much better at work where we’re in the right environment and my head is in physio mode. Would you make an appointment to see me next week?”
Or, as a clinic owner, I have the luxury of saying,
“Do you know, we have an amazing physio at the clinic, Clare is brilliant with hips!”
Q: I don't know if we are allowed to ask trans people questions of any kind now. Are we allowed to ask if they are trans or is it transphobic to assume they are but also to ask if they are?
I think it’s important to consider why you are asking the question and how the answer will change your management. If someone’s had top surgery for example and you are treating the shoulder then it might be a consideration. The relevant details would ideally come out in your subjective assessment, but as with any patient they may not share that information, comfort levels vary hugely as we know when people are talking about their own body.
If you decide you need to ask more direct questions it’s probably helpful to explain why you need the information and to be specific rather than just “Are you trans?” which likely wouldn’t give you any helpful clinical information anyway. If you’re keen simply to avoid awkwardness in conversation then asking about preferred pronouns in your pre-questionnaire is a good idea.
Apparently about 20% of transgender people surveyed in the 2011 National Transgender Discrimination Survey report that most people never realise they are transgender. And of course many non-transgender people have appearances that don’t conform to gender stereotypes. So we need to be mindful of our assumptions.
I think most of these suggestions apply to any patients. See the human and be a human, drawing on all your skills of empathy, sensitivity, compassion and humour when appropriate.
Q: I disagree with my colleagues outdated and non-evidence based treatment techniques. What should I do? Confront them? Tell my manager? Tell the HCPC?
A: Are these your only options? It might be helpful to put yourself in the shoes of your colleagues and seek to understand the reasons for them continuing to apply what you consider outdated treatments.
Many believe for example that the patient experience is an important factor left out of many research trials. Your colleagues may feel the positive feedback they get from patients is justification for their treatments.
They may know they are working in a non-evidence based way but feel nervous about opening that ‘can of worms.’
They may be interpreting the evidence differently to you.
I’m not saying any of these justify ineffective treatment but perhaps a reframe of ‘confronting them’ to simply ‘opening a conversation’ might be helpful.
Perhaps there is an opportunity to co-create some cpd for the whole team in a way that respects current skills and experience but also offers a chance to challenge each other’s thinking. Could you introduce data collection and benchmarking methods so that effectiveness can be measured more objectively than just opinion?
You may get responses which lead you to conclude there isn’t a future for you and this team, in which case you might choose one of the other options you suggest. But at least you will know you tried to find a way that moves everyone forward respectfully.
Q: I find one of my patients very attractive and we get on really well. When is it acceptable to ask them to go on a date??
A: We’ve actually had a couple of questions along a similar theme. I guess the question is whether it’s acceptable to date a patient whilst they are still under your care.
Obviously, clinicians do treat people they are dating but often this will be someone who was your boyfriend or girlfriend before they became a patient. If someone has entered into a therapeutic relationship with us, is it fair for us to effectively change the goalposts of that arrangement, even if they are as keen as we are for it to progress to something romantic?
Say this person feels the same way but isn’t comfortable continuing to see you as a patient? That’s fine as long as they are equally happy seeing a different therapist but what if they now have to choose to see someone they trust less to help them?
I don’t think it’s inherently wrong to date a patient but I guess you’ve got to be really honest with yourself about whether you’ll be able to deliver the same quality of care. Only you know the answer to that question.
The obvious and simplest answer is to wait until treatment has come to its natural end and then move things on if the other person wants it. If it’s meant to be it’ll wait. But I appreciate affairs of the heart aren’t simple and tidy, I wish you all the best.
If you’d like Auntie Version to address something that’s on your mind in next bi-monthly column, drop her an email at jo@mehab.co.uk. We can’t promise that every question will be featured or responded to directly but we’ll do our best to address common themes.
If there is something you’d like to explore more deeply through 1:1 coaching with (Jo) please go to www.mehab.co.uk and book a free call.