Musculoskeletal Physiotherapy

MSc/PGDip/PGCert MSK physiotherapy: University of Brighton

What am I trying to say, or not say? Importance of appropriate language during consultations of persons with low back pain (LBP)

INTRODUCTION

Why do people with LBP seek physiotherapy?  They may attend because they would like to understand the whys, how, ifs, of their complaints and how to overcome them.  They would like answers, they need information and understanding (Stenner et al., 2018).  They may ask their friends, relatives and the internet for advice, but one study suggests that clinicians have a significant influence on their understanding (Darlow et al., 2013).  Therefore, the language we use during consultations of persons with LBP can have a huge impact on their prognosis.

 “Words have energy and power with the ability to help, to heal, to hinder, to hurt, to humiliate, and to humble” Yehuda Berg

The purpose of this blog is to explore the effect of the words and metaphors we use when discussing a diagnosis, investigation results and management strategies with LBP sufferers.  This will give clinicians more insight into their interactions within the clinical setting and how we can optimise the patient centred care.

DIAGNOSIS

When giving a diagnosis, the words we use will directly affect how our patients interpret their symptoms, how it impacts them personally, and how they will overcome their barriers.  For some, the labelling of their symptoms into medical terminology can be helpful as it validates their symptoms (Lim et al. 2019), and provides them with an avenue for exploring more information on the internet, in books, from friends etc.  Persons with LBP may also be able to relate to the diagnosis if someone else they know has the condition (Launer 2018).  However, in the context of LBP, various interchangeable diagnostic terms are used; ‘mechanical low back pain’, ‘muscle imbalance’, ‘muscle sprain’, ‘muscle strain’.  These terms are poorly understood by patients and can be misconstrued, being interpreted differently to the clinician’s intent (Barker et al., 2009).  In fact, 80-90% of LBP is diagnosed as “non-specific” (Vroman et al., 2009).  To the health care professional, this means LBP with no underlying pathology such as fracture, tumour, infection or structural fault (Stilwell et al., 2021).  However, to the patient the term ‘non-specific low back pain’ can imply that the clinician doesn’t understand the cause of the pain or how to treat it (Barker et al., 2009).  Therefore, ineffective use of medical terminologies may have a profound effect on the patient’s interpretation of their situation, potentially reducing their confidence in the clinician’s knowledge and ability to help them.  This could have a significantly negative affect on the therapeutic alliance.

Wording may also be very personal to the patient in front of you.  To some, a ‘lumbar sprain’ may not have any negative repercussions (Barker et al., 2009), but in one study the term caused a patient to interpret that she had badly damaged an area of muscle and needed to avoid moving to protect it (Darlow et al., 2013).  What we as health care professionals perceive as a reassuring diagnosis, could be a catalyst for unhelpful behaviours.  The diagnosis is integral and a necessary part of our management, however, the framing of the diagnosis should be carefully considered when verbalising it to the patient.  The differences between interpretations from the 2 studies above may be related to how they were conducted.  Barker et al. recruited 66 individuals from the West Midlands (UK) including professionals (Chiropractors, Osteopaths, Physiotherapists, GPs) and laypersons (grouped to gender, age and with or without LBP).  Each group (consisting of 7-8 individuals) was given a list of medical terms and asked to explain their interpretation within a 1- hour focus group.  Darlow et al conducted semi-structured interviews with 12 individuals with acute LBP and 11 with chronic LBP in New Zealand.  They were asked open ended questions, delving into more detail about their personal experiences of how their back pain came about, what it meant to them, and the impact of terms used to describe their low back pain.  The theoretical meaning of a list of words, as in Barker et al’s study, could give a more impartial perspective, whereas words and descriptions from Darlow et al’s study have been elicited from the individuals’ own personal experiences, carrying emotion and specific context.  Therefore, how patients interpret language in isolation has been shown to be very different to how it is interpreted during a clinical consultation.  Interestingly, in the study by Barker et al. clinicians reported that they would modify language depending on how the patient would subsequently gauge the severity of their symptoms, effectively manage it, and gain confidence in them.  However, there may be a difference between what is ideal in practice, and what actually happens in clinical conversation.

INVESTIGATIONS

Investigations can include imaging such as x-rays and MRI’s.  Imaging is another important area that can lead to confused communication.  Imaging can provide great reassurance to a patient who is seeking a reason to their symptoms.  However, the language used when reporting findings can lead to anxiety.  Describing imaging reports of ‘degenerative changes’ and even to a lesser extent ‘wear and tear’ can have a negative impact on individuals (Johnston et al. 2018).   In a single case study by Stewart et al., (2018), Ben, a 15-year-old track athlete with LBP, was told that his MRI scan showed ‘degenerative discs” in his lumbar spine.  He was advised to read an online educational booklet designed for young athletes with LBP which talked about “disc herniation” and ‘risk for surgery”.  Stewart et al. hypothesised that these all contributed to heightening his angst, causing catastrophising of the situation.   As this was a single case study, we cannot infer how others would respond, however, Ben may have been influenced by prior beliefs, having a grandfather who had been diagnosed with ‘failed back surgery’.  Perhaps close attention to the persons history, may give more understanding of their pre-determined knowledge, to guide how we might articulate medical results.  Stewart et al. (2018) proposed an alternative term for ‘degenerative changes’ as ‘normal age changes’.  The word, ‘normal’ could change the whole context, giving the patient a more positive and reassuring interpretation.

As clinicians, it is our role to reframe the results of investigations into a more meaningful and helpful context.  This is reflected in a study by Karran et al., (2017) who found that for individuals referred for spinal imaging, altering terminology in the report and including epidemiological evidence improved perceptions.  For Ben, this could have been stating that 37% of 20-year olds without low back pain will have some ‘normal age related changes” in their MRI (Brinjikji, et al., 2015).  Karran et al (2017) used a simulated-patient, randomised, multi-arm experiment to investigate imaging reporting strategies including: i) scan with pre-information about normal findings, ii) scan with no pre-information and iii) no scan (‘best practice’ information given on why a scan was not indicated).  Those who received a scan were further subdivided into groups receiving a standard report, altered terminology or epidemiological information.  Of the 660 adults in the study, 94% had experienced some LBP in their lives, surmising that they could relate to the ‘patient experience’.  However, a further study with real-time patients could improve the validity of the findings, capturing the ‘raw’ perceptions.  This is pertinent because, in normalising the findings, we should also acknowledge, and not devalue the patients’ experience and suffering.  In the study by Barker (2009) one participant described the GP’s response of “Oh, it’s just wear and tear” as condescending, especially when she was suffering.  The words we use when describing investigations, and the manner in which we express them, can influence the patient’s beliefs, emotions and thoughts.  Interestingly, the best-practice approach yielded the most positive perceptions, suggesting that patients will gain more reassurance through a carefully considered explanation than through an actual scan.  This highlights the importance of language once again.  Are we using the right phrases to re-assure at the grass roots level before the patient goes on the journey of onward referral, investigations, and second opinions?

Terms used when describing investigations such as ‘degenerative’ or ‘degeneration’ could have negative repercussions to any individual, even to those who work in healthcare.  We may often use more technical terms when conveying information to patients with a medical background.  Perhaps we do this with good intentions, to not undermine the knowledge of our peers.  However, in a qualitative study by Thomson et al., (2017), a female 35-year old with chronic LBP, working in healthcare reported that she couldn’t remember the jargon used by the clinician, it being like a ‘different language’.  A 44-year old male with chronic LBP, also working in healthcare, said that he interpreted degeneration as a ‘fading away’, and thought his back was ‘buggered’ when the word degeneration was mentioned.  Interestingly, this suggests that despite prior exposure to some of the medical terms, words can still have an impact on ones’ feelings and sphere of control.  Thomson et al., (2017) interviewed 9 patients experiencing LBP who had received osteopathic treatment in the UK.  Semi-structured interviews explored how their LBP was explained to them by osteopathic clinicians, their feelings around the explanations, and anything that they didn’t understand.  Whilst I can relate to many comments, it may be pertinent to consider if the osteopaths in the study have a different language bias to physiotherapists.  As the 2 roles have a different educational curriculum and professional culture, they may use different language expressions with patients.  The different preconceptions of each role may also drive the explanations that are given by clinicians.

MANAGEMENT STRATEGIES

 

The language we use when discussing management strategies can be confusing and unhelpful if it does not give the patient clarity.  Last year a patient said to me “I’m sick of people telling me that I need to manage my LBP – what does that even mean?”.  I questioned if I knew what it meant!  Medical jargon was used to advise but with no context or personalised strategies that were meaningful to him.

Patients want tailored advice on how to take care of their back pain (Lim et al., 2019).  We need to ask questions to find out the real challenges for them personally.  How is their life being impacted?  If we are responsive to the patient’s beliefs, preferences and needs, building rapport and trust (Pluut 2016), we are better placed to find solutions.  The patient is also more likely to engage (Darlow et al., 2013).  Subsequent advice may be regular exercise if this is what helps their pain, or ‘making some adjustments [in their life]’ (Stewart et al.,  (2018), but by focusing on what they enjoy and what is meaningful to them, the pain won’t dominate their day and they can have a more fulfilling life.  This will then give them more positivity and direction.  The importance of empathy and putting ourselves in the patients’ shoes is highlighted by Vroman et al: “someone who has not experienced severe and long term back pain has no idea how bad it can be and often can give bad advice!!!!” (clbp) Vroman et al. 2008).  Perhaps poor choice of words and advice comes from clinicians who may not have experienced LBP themselves so find it difficult to consider fitting approaches, or from less experienced clinicians who feel ill-equipped to address the complexities of LBP.  Physiotherapists feel happy to manage LBP that is responsive to conventional treatments but feel unprepared when pain is ongoing (Slade et al., 2011).  Further training and support from expert practitioners may help clinicians to utilise better strategies.  It may also allow a more consistent approach so that patients are given the same advice from different clinicians.  This is particularly important as patients do not like conflicting advice (Lim et al., 2019).

Metaphors

In an attempt to reconceptualise information I often find myself using metaphors such as “faulty circuitry” to explain ongoing pain or the analogy; ”you need to move your joints to oil them” to support exercise.  This is my attempt to improve the patient’s understanding, justify the rationale, and give reassurance of why it is beneficial.  The presence of metaphors is so heavily embedded in language that we use 6 per minute (Stewart 2016).

For metaphors to be useful, we must be able to convey the meaning to the receiving person.  However, in clinical practice, clinicians and patients have been found to use metaphors in different ways.  A qualitative study by Skelton et al., (2002) looked at the use of metaphors between GP’s and patients within 373 consultations.  Doctors used metaphors to explain problems and solutions e.g. “it’s not a miracle cure”, whilst patients used metaphors to convey their sensations like “a Chinese burn getting tighter and tighter”.  This begs the question; can the patient and GP understand each other’s metaphors?

Metaphors used in clinical practice could be either problematic or helpfulStilwell et al., (2021) used an enactivist approach to look at the use of metaphors during consultations between 7 physiotherapists/chiropractors and patients with LBP in Canada, and during further clarification at subsequent semi-structured interviews.  Descriptors such as ‘knotted muscles, weak core and bones out of place’ were used by clinicians to explain causes of pain.  The clinicians, with best intentions, were using them to help the patient make sense of their pain.  However, the authors argue that the words could cause confusion if they are taken too literally; how can stretching a knotted muscle help? If I have no core stability, is my back fragile?  Do I need to be extra cautious?  Unfortunately, the author did not elaborate on the participants’ interpretations or demographics, so it is difficult to identity if, how and why the concepts were beneficial or detrimental to specific individuals.  What they did however highlight, is if the patient does not connect with the metaphor, further explanation is important to convey the message in a positive fashion: “why are my (knotted) muscles so tight?.. Because they should (be). You’re supposed to tense up.  This is normal” (Stilwell 2021).  Whilst this could allay any fears, is it factually, correct?  Are we manipulating the situation to over-reassure?  Are we going down a rabbit-hole of rationalisation?

Clinicians’ models of explanation for diagnosis, cause of symptoms, and management are heavily embedded in a biomedical model (Thomson et al., 2017, Darlow et al., 2013, and Josephson et al., 2015).  Practitioners describe the body as a system (Skelton et al. 2002), and a mechanical device (core, alignment) (Stilwell et al., 2021), using analogies such as “rusty doors that need movement to loosen” (Thomson et al., 2017).  Interestingly, I believe this is my bias of explanation; it is how I make sense of their symptoms with my anatomical knowledge.  However, what happens when the patient doesn’t get better?  How do we then explain the cause of their pain?  The field of pain science acknowledges the need to move away from the biomedical model to contextualise the complexity of casual factors for LBP (Moseley & Butler, 2015), especially if the biomedical model promotes the fearful beliefs that something needs to be ‘fixed’ or something is permanently damaged (such as slipped discs) (Coulehan (2003).  The use of figurative metaphors can help patients with ongoing pain to understand their symptoms.  Louw et al. (2019) evaluated the use of such metaphors within a pain neuroscience education programme.  The education involved a 30 minute one-one conversational session with pictures, books, and metaphors to explain their pain prior to surgery for lumbar radiculopathy.  Participants were sent a survey (expert reviewed) one year later with a 70.3% response rate.  One of the most useful metaphors was that the body had an ‘extra-sensitive alarm system’.  The metaphors helped to rationalise and reassure the patients of their experience, something that is commonly sought (Lim et al., 2019).  The authors concluded that on average, no one metaphor was more helpful than another, implying that they all had their place.  However, one participant found the metaphor ‘hurt does not equal harm’ very unhelpful.  This illustrates how data collection which looks at the mean, cannot allow for individual interpretations of language, something that is highly important when considering patient-centred care.  Therefore, with a pool of possible metaphors, we must carefully consider their effects on each individual.  Additionally, there was a time delay of 1 year between participants receiving the education programme, and being asked about the usefulness of the words and metaphors.  What life experiences have they had within this time-period to affect their understanding and attitudes to the questions, how has their subsequent spinal surgery impacted their beliefs and attitudes, and thus has their understanding of the metaphor changed?  A final point is that the education programme explained pain using multiple metaphors in various mediums (words, diagrams, graphics).  By presenting information in various ways, it may change the interpretation, allowing greater comparison of thoughts.  A picture can paint a thousand words!  Stewart (2016) proposes that ‘in our desperate attempt to both understand and be understood, art provides a means of expression that words alone cannot accomplish”.  Therefore, as clinicians should we be reflecting on whether we are using the best methods of communication to enhance understanding of the person in front of us?

CONCLUSION

This blog has demonstrated that the most important aspect of language is the meaning within the words and metaphors we use in the consultation.  As physiotherapists, we should use the ‘therapy’ part of our role to encapsulate useful ‘meaning’ for the patient to give them a sense of purpose and direction.  In being vigilant with our language, attentive to the person in front of us, and allowing time for clarification, we can ensure our influence is to heal rather than to harm!

Quote:  “The words become your world” Nadeem Kazi

REFERENCES

Barker, K.L., Reid, M., Lowe, C.J.M., (2009) Divided by a common language? – a qualitative study exploring the use of l anguage by health professionals treating back pain, BMC Musculoskeletal Disorders, 10:123

Brinjikji, W., Luetmer, P.H., Comstock, B., Bresnahan, B.W., Chen, L.E., Deyo, R.A., Halabi, S., Turner, J.A., Avins, A.L., James, K., Wald, J.T., Kallmes, D.F., and Jarvik, J.G. (2015) Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations, Am J Neuroradiol, 36, pp. 811–16

Coulehan, J. (2003) Metaphor and Medicine: Narrative in Clinical Practice, Yale Journal of Biology and Medicine, 76, pp. 87-95.

Darlow, B., Dowell, A., Baxter, G.D., Mathieson, F., Perry, M., Dean, S. (2013) The Enduring Impact of What Clinicians Say to People With Low Back Pain, Annals of Family Medicine, 11(6) pp. 527-534

Josephson, I., Woodward-Kron, R., Delany, C. and Hiller, A. (2015) Evaluative language in physiotherapy practice: How does it contribute to the therapeutic relationship? Social Science & Medicine, 143, pp. 128-136

Johnston, K.N and Williams, M.T (2018) Words and perceptions: therapy or threat? Journal of Physiotherapy, 64, pp. 137-139

Karran, E.L., Medalian, Y, Hillier, S.L. and Moseley, G.L (2017) The impact of choosing words carefully: an online investigation into imaging reporting strategies and best practice care for low back pain, PeerJ 5:e4151 https://doi.org/10.7717/peerj.4151

Louw, A., Puentedura, E.J., Diener, I., Zimney, K.J. and Cox, T. (2019) Pain neuroscience education: Which pain neuroscience education metaphor worked best?, South African Journal of Physiotherapy, 75 (1), a1329

Lim, Y.Z., Chou, L., Au, R.TM., Seneviwickrama, K.L.M.D, Cicuttini, F.M., Briggs, A.M., Sullivan, K., Urquhart, D.M. and Wluka, A.E. (2019) People with low back pain want clear, consistent and personalised information on prognosis, treatment options and self-management strategies: a systematic review, Journal of Physiotherapy, 65 pp. 124-135

Moseley, G.L. & Butler, D.S., (2015) ‘Fifteen years of explaining pain: The past, present, and future’, The Journal of Pain 16(9), pp. 807–813.

Pluut, B. (2016) Differences that matter: developing critical insights into discourses of patient-centeredness, Med Health Care and Philos, 19, pp. 501-515

Skelton, J.R., Wearn, A.M. and Hobbs, F.D.R (2002) A concordance-based study of metaphoric expressions used by general practitioners and patients in consultation, British Journal of General Practice, 52(475), pp. 114-118

Stewart, M. (2016) The hidden influence of metaphor within rehabilitation: A Clinical Perspective, Journal of the Physiotherapy Pain Association, 40, pp. 28-35

Stewart, M. and Loftus, S. (2018) Sticks and Stones: The Impact of Language in Musculoskeletal Rehabilitation, Journal of Orthopaedic & Sports Physical Therapy, 48 (7) pp. 519-522

Stilwell, P., Stilwell, C., Sabo, B. and Harman, K. (2021) Painful metaphors: enactivism and art in qualitative research, Med Humanities, 47, pp. 235-247

Stenner, R., Palmer, S. and Hammond, R (2018) What matters most to people in musculoskeletal physiotherapy consultations? A qualitative study. Musculoskeletal Science and Practice, 35 pp. 84-89

Slade, S. C., Molley, E. and Keating, J.L. (2011) The dilemma of diagnostic uncertainty when treating people with chronic low back pain: a qualitative study. Clinical Rehabilitation, 26 (6) pp. 558-569

Thomson, O.P, Collyer, K. (2017) ‘Talking a different language’: a qualitative study of chronic low back pain patients’ interpretation of the language used by student osteopaths, International Journal of Osteopathic Medicine, 24, pp. 3-11.

Vroman, K., Warner, R. and Chamberlain, K. (2009) Now let me tell you in my own words: narratives of acute and chronic low back pain, Disability and Rehabilitation, 31(12), pp 976–987

 

PART 2 – QUESTIONS

Q1: How do you think the construct of the narrative can influence the choice of words that we use?

Thank-you Tom.  This is an interesting concept.

Who constructs the narrative?

To explore this concept, I would first ask myself who constructs the narrative?  The narrative is the person’s story (Launer 2018).  Narratives can come in various forms; patients often use illness narratives to describe their experience, and chaos narratives to impart their sense of disruption and vulnerability, whereas health professionals use restitution narratives, to depict the recovery process (i.e., diagnosis, treatment and resolution (Vroman et al., 2009)).  During a consultation, it is the exchange of stories between the patient and practitioner that shape the dialogue.  This then provides the framework for the combined choice of words (Johnston 2018).

How can we influence it?

Secondly, I would consider how as practitioners can we influence it?  Roberts et al., (2013) looked at the structure of the consultation and found that when physiotherapists asked more questions on the patient’s history and background, less advice was required.  Rodriguez et al., (2008) also found that the timing of questions could improve communication; the physician’s ability to “explain things in a way that was easy [for the patient] to understand” was attributed to “keeping quiet after asking a question”, and ‘trying to talk less at the beginning”.  Therefore, the choice of words, and thus impart of opinion, could be influenced by when and how the clinician interacts with the patient.  Interestingly, in the study by Roberts et al (2013) the greatest proportion of advice (15.4% of consultation time) was given in female clinician – female patient scenarios, whereas the least amount (5.3% of consultation time) was male clinician to female patient.  This suggests that the gender dynamics in the therapeutic relationship may influence the conversation; for the same patient, a male physiotherapist may have a very different conversation to a female colleague.  The degree of training and clinical experience may also influence the way that the clinician interacts; physicians in the study by Rodriguez (2008) had training in agenda setting prior to the study.

As clinicians, we feel that we have a lot to say and offer.  However, we may fall into the trap of the righting reflex (Miller and Rollnick, 2013); automatically giving our opinion on what we think the problem is, and what the patient should do about it in our quest to help, thus providing unfiltered and excessive information.  This has also been termed ‘compulsive explaining’ (Launer 2018, p. 60).  What might be more useful is to hear what the patient has to say first.  In doing so we can work with their story to evolve a new one (Launer 2018).  This type of approach is also advocated by Stanier (2020).  He advises us to stay curious for a little longer, thus allowing patients to voice all concerns (Stenner et al., 2018), The narrative that ensues allows us to understand how the story-teller (patient) makes sense of their reality, with the words that they use (Charon 2006) and the metaphors that they construct (Haigh et al., 2011).  We can then echo the same words and language in our expressions to them.

ADDITIONAL REFERENCES

Charon, R. (2006) The self-telling body, Narrative Inquiry 16(1), pp. 191–200.

Haigh, C. and Hardy, P (2011) Tell me a story – a conceptual exploration of storytelling in healthcare education, Nurse Education Today, 31, pp. 408-411

Launer, J. (2018) Narrative-Based Practice in Health and Social Care: Conversations Inviting Change 2nd Ed.  Oxen: Routledge.

Miller, W. and Rollnick, S. (2013) Motivational Interviewing: Helping People Change. 3rd Ed. London: The Guilford Press.

Roberts, L.C., Whittle, C.T., Cleland, J. and Wald, M. (2013)  Measuring Verbal Communication in Initial Physical Therapy Encounters, Physical Therapy, 93(4), pp. 479-491

Rodriguez, H.P., Anastario, M.P., Frankel, R.M., Odigie, E.G., Rogers, W.H., Glahn, T. von., Safran, D.G (2008) Can teaching agenda-setting skills to physicians improve clinical interaction quality? A controlled intervention, BMC Medical Education, 8(3)

Stanier, M. B. (2020) The Advice Trap: Be Humble, Stay Curious & Change the Way You Lead Forever. Toronto: Box of Crayons Press

 

Q2: How is the current information on patient experience collected?  Is there anything wrong with this and is there a better way to understand patient experience?

Thank you for your question, Fi!  Patient experience is highly valued, and guidance has been provided by NICE (Patient experience in adult NHS service; updated 17th June 2021).

What is the patient experience?

Interestingly, there is no universal understanding or standardised definition for ‘patient experience’! (Oben 2020).  This is probably because it is an umbrella term, uniquely formed by each person’s own fusion of multiple factors, including interactions between the health-care provider and themselves, the organisation’s culture, and their own life experiences.

How are we gathering evidence?

As patient experience is so diverse, we may need to rely on various methods of research to acquire evidence, and thus guide practice.  This is because each method of research will provide different genres of information, thus putting together the ‘ingredients’ of patient care.

The study by Darlow et al. used a qualitative approach of interpretive description, to explore the impact of what clinicians say to people with LBP.  The benefit of this methodology is that you use the findings to create new themes and phenomena, rather than setting out to prove or disprove something.  Clinically, this is important as it allows us to think ‘outside the box’, and to look at new ways to practice, working for the benefit of the patient, rather than to a set script.  However, the process is the investigators interpretation, thus we do not actually know the patients’ own reflections on the words and language used in consultations.  Interpretation is a dynamic and fluid process, always changing as more information emerges, therefore, should further research look at repeated interviews over time, to evaluate how and why those beliefs have changed?

Louw et al. used a quantitative method; a non-experimental cross-sectional descriptive survey to evaluate the helpfulness of metaphors in PNE.  Whilst this method is effective to evaluate service delivery, the grading system does not allow for individual perspectives, something that is more evident in qualitative design.  Also, I would question the sensitivity of the Likert scale, with most scores ranging between 2-4, of a 0-4 scale.  Does this accurately represent the patient’s thoughts on the metaphors?  Whilst I can criticise a lack of individualisation, perhaps we do still need data that looks at the generalisability, as it gives us guidance on strategies that work for the majority!  Many of the studies referenced in this blog had small sample sizes (<30) and excluded non-English speaking participants.  Therefore, we cannot infer that the same conclusions could be drawn in different clinical contexts.   How patients make sense of information will depend on various factors including their beliefs, values, attitudes, experience and knowledge, social roles and cultural background (Figure 1).  Therefore, the influence of these variables within a study will affect the outcome, and the combination of these factors in a clinical setting, will influence the patient.

(Figure 1, Adapted from Qiong 2017)

Is there a better way to understand patient experience?

Oben (2020) states “understanding the humanity of patients is the critical foundation upon …any successful patient-centred experience”.  This highlights how humility is integral to a service that relies on one human-being helping another human-being.  The experience is subjective, emotive and unique.  Therefore, whilst research around the clinical setting is important, perhaps we could enrichen the ‘patient experience’ by incorporating skills from our wider world of experience?

ADDITIONAL REFERENCES

Oben, P. (2020) Understanding the Patient Experience: A Conceptual Framework.  Journal of Patient Experience, 7 (6) pp. 906-910

Qiong, OU (2017) A brief introduction to perception. Studies in Literature and Language. 15 (4) pp. 18-28

Emma Willcox • October 10, 2022


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