I started to write a piece about Bayesian inference, predictive processing and how various models of probability can give us insights into how we might better manage the expectations of others. But then I realised I’m not bright enough to do so and thought I’d instead write this admission so as to better manage your expectations.
I increasingly believe that expectation management is the crucial element of success and failure across various areas; especially those which I care most about in my role as
MSK-Ponderer-in-chief:
Clinical Practice
Education
Service Delivery
Health Policy
For once in my waffly career I’ll jump to the punchline. I think it’s uncertainty that often breaks the human spirit and that anything that can clarify, elucidate or tidy up our predictions of the future is therapeutic. For example, behavioural scientists have long known that we can tolerate longer waiting times for trains, taxis and food deliveries if we are given a sense of how long they’ll be and ideally, where they are on a map. [1] [2]. There are all sorts of reasons for this but let’s keep it as simple as me and indulge the basic premise that by knowing where our lifts and food are with more accuracy, we can update our expectations, plan our consequential actions and mitigate any risks that would come from delays.
As is standard in healthcare, it will be several decades before these basic lessons are translated into our sector but let’s pretend for a second that we were quick on the uptake and wanted to give better predictions across my aforementioned fave categories.
That would result in:
Detailed prognoses
Accurate timeframes for knowledge translation
Evidence based operational reforms
Policies which track population demographics
But you, dear MSKMag readers, don’t drink unicorn piss on the lash with the fairies so you know that we in healthcare must keep an air of mystery about us because our sense of expertise is tightly wound up in the hidden truths of our intricate assessments and special ’bio-hack’ solutions… probably a bit harsh, but only a bit…
The fairer reason for us struggling to optimally manage expectations is because we’re uncomfortable with how genuinely uncertain we would have to be in order to be honest. Well meaning and thoughtful clinicians often manage expectations poorly because they think that to discuss the nuances and trade offs would be too awkward and that to be definitive would be dishonest. The latter is true but the former is essential. It’s my strong opinion that we MUST get stuck into the very messy but very human chats about everyone’s expectations. What do patients expect, what do you expect, what does your boss expect, what does your regulator expect, what does your patient’s spouse expect, what does their boss expect… etc etc. Know what you’re dealing with by first finding out.
Hopefully I’ve been consistent enough in these pages for you to realise that I don’t apply such lessons only to clinical practice, so I extend this to inter-professional discussions, trade disputes, contract negotiations and first dates! Put your cards on the table more overtly. Ask more direct questions. Leave space for insightful answers. Understand expectations better. Manage expectations better.
Speaking of which… subscribers to a magazine might expect a magazine to be delivered to their door which they can enjoy over a brew at home with the dog or in the staff room debating who Glen O’Humeral is. Well as of next month you can!
If you’d like a paper copy of MSKMag delivered to your door at no further cost to you then click here! (ensuring you’re a premium Physio Matters member or an annual MSKMag subscriber… because I’m not made of stamps).
In this month’s issue, Steph Wynne leaves you aghast with some facts and figures about lung cancer in never-smokers that we need to improve. Andrew Walton gives his ‘View From The Top’ informed by a fascinating career building the largest MSK provider in the country; Connect Health. Jack March challenges you to be less complacent about diagnosing OA. Auntie Version is back with another excellent round of public counselling. Michael O’Reilly is likely to make you sit up straighter as he makes the case for postural correction and Michael Schumacher reflects on his own recent experience as an MSK patient and suggests that we have a lot of work to do!
So to manage your expectations on this issue, it’s absolutely class, as per usual.
Jack Chew
Editor In Chief
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