Latest / The STA Clinician Podcast / Ep.194: 'Communication Skills: When To Sit In The Mud' with special guest Ben Whybrow

Transcript

Ep.194: 'Communication Skills: When To Sit In The Mud' with special guest Ben Whybrow · The STA Clinician Podcast

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  You're listening to the Sports Therapy Association podcast, putting evidence
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  back into soft tissue therapy.
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  Music.
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  And we're live. Hey people, how are you doing? Welcome to the Sports Therapy Association podcast,
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  episode 194, 94, entitled Communication Skills,
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  When to Sit in the Mud, with my special guest, Ben Wybrow, a specialist physiotherapist
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  in an NHS pain clinic and clinical communication skills facilitator at Norwich Medical School.
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  My name is Matt Phillips. In case you don't recognise the voice,
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  I'm the creator of UncheckedLife.com.
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  And as always, this episode is being recorded live on a Tuesday at eight o'clock
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  on the STA YouTube channel and Facebook page.
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  So if you are listening to the podcast and you fancy joining us for one of the
• 0:55
  live recordings so you can ask questions directly to the guests or just hang
• 0:59
  out with like-minded soft tissue therapists, then all you have to do is join
• 1:02
  us on a Tuesday at eight o'clock on YouTube or Facebook.
• 1:07
  Before we start this week's episode, have you had a chance into last week's
• 1:11
  episode, episode 193, which was entitled Concussions, Causes,
• 1:16
  Risks and Treatment with special guest Nicola Hunt, Director of PhysioCare Rehab.
• 1:20
  In this episode, we unravel some huge misconceptions around concussion,
• 1:24
  and it contains key information about causes, dangers and treatment.
• 1:29
  It's a fantastic episode, I always say that, but I do encourage you to listen
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  to it, particularly, of course, if you do deal with people who could be suffering from concussion.
• 1:37
  And it's available, as always, on all popular podcast apps, as well as YouTube. to you.
• 1:42
  And if you listen to it, you will discover that there is an STA discount code
• 1:47
  available for Nicola Hunt's concussion courses, which are both online and face-to-face.
• 1:53
  For all details, you do need to be an STA member, but hey, that's another reason,
• 1:57
  reason 236B for becoming an STA member.
• 2:01
  If you check it out on the STA members page, then all details of that discount
• 2:04
  code will be found there.
• 2:07
  If you have joined us live, I'm just going to give a few little hellos to people who have joined us.
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  I can bring your question and name up onto the screen, which is one of the reasons for joining live.
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  For example, Amanda has walked to the door and Amanda says, hi,
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  everyone. Hi, Amanda. Thanks so much for joining us.
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  It's a good networking opportunity not to make it all sound too businesslike,
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  but it does mean you can bring up your company logo maybe and also meet other
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  people who might be in your area.
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  It's a great way of sharing education and maybe meeting up with people.
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  Cecily Hislop has just walked through the door. The sun is out,
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  so I'm just a tad too excited.
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  Cecily, it's 8.05 in the evening and the sun's still out. What part of the world are you in, Cecily?
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  Is this your mind? I need some of what you've been drinking in that case.
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  But thanks for joining us. Right, on with tonight's episode. So episode 195.
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  Like I say, my guest, Ben Wybrow, recently wrote a particularly well-received
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  article entitled, Sit in the Mud.
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  Listen acknowledge empathize which
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  appeared in February's edition of MSK Mag which is
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  an online and paper magazine produced by our friends at Physio Matters at the
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  end of this podcast we will be revealing a chance for one lucky listener to
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  win three months of free full subscription to MSK Mag so be sure to listen out
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  for that that will be open for anybody who listens to this podcast.
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  And basically a winner will be picked out by
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  my guest next week which is going to be the
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  23rd of april according to my maths hopefully i'm
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  right so if you listen to the podcast and it's before the 23rd of april
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  you can still do what i say at the end of this podcast right
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  people coming through the door just a few highs as well to
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  gary benson founder of the sds in the room today hey
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  gary how you doing nicola davis says good evening
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  from sunny cardiff why does it seem to be it's a
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  time warp going i'm looking out my window and it's like dark and
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  i've got owls out there so i'm not quite sure what's
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  happening in the south coast here but it's dark here um cecily
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  says she's in cornwall okay maybe it's i don't know i'm not sure what's happening
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  on now but i'm going to move on if you are some in the world where it's sunny
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  then good on you i'm happy for you he said right without further ado let's bring
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  up my guest for episode 194 for communication skills when to sit in the mud
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  with my special guest ben.
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  Music.
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  You're listening to the sports therapy association podcast evidence back soft tissue therapy,
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  hey hello how are you i'm fabulous how are you it's not it's not sunny where
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  i am i know i'm not sure i'm not sure what's going on here let me let me ask
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  somebody who's reliable and a good source of information. Sarah Clackworthy, fantastic.
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  Sarah, could you explain what it looks like outside your window?
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  Because I think there's a bit of a conspiracy thing going on here.
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  You feel like everywhere is beautiful and there's just Independence Day is happening here in.
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  Not so sunny lansing sarah what's it like where you are anyway ben
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  thanks so much for joining us really appreciate it well thank you matt maybe something
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  about southwest england and wales that they've got better sun than
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  we do no idea well wales deserves some way
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  of being better than us anyway where are
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  you in cambridge are you cambridge that's right yeah so a bit southish
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  not as south as you are but we uh
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  certainly we've had a great weekend of weather
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  and then past two days have been a bit more variable in
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  the weather's emotions this is so English isn't it for international
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  listeners it's true it's not a myth we do spend a lot of time just chatting
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  about the weather that's what we do it's very exciting right so Ben I'm really
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  excited to have you along thank you so much like I said we'll talk about that
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  article shortly but I introduced you as somebody who's a specialist in pain
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  and you work in a NHS pain clinic and a clinic and communication skills,
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  facilitator at Norwich Medical School could you tell us a little bit about how you got there your
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  history and how you arrived to where you are today sure thank you
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  so I graduated almost 10 years ago now
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  in a few months and as a physio from
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  heart university of Hertfordshire went classic band five rotations and I'll
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  be honest with you Matt if you had told me as a student that I would be working
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  MSK or especially in pain I would have told you where to go with your opinion
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  because I could have pictured my career in an ICU somewhere putting tubes down
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  people and all the fun things So.
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  But by fate or the universe, whatever it is, I got put on a musculoskeletal
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  rotation first and loved it.
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  It was so nice to be in control.
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  And just when you start out in physio career.
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  You have something i call band five life where the case is pretty much half.
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  Post fractures or post surgery something and these
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  patients are you realize later on they're going to get better just
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  job is to make sure they get better and then you have the other simple things
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  like a knee away and a back pain and stuff like that very simple things that
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  again should get better but i thought you know this is nice but i would go back
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  into my go back to the wards where i had my visions as a student didn't like
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  it i actually realized msk was for me and i spent
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  pretty much all my time in msk since i've five years almost now in a pain clinic i just.
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  Found that the people and as we might come on to people in a pain clinic,
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  have a lot more as i say biopsychosocial needs it's a big word to use on tuesday
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  evening but there's a lot more variables up in the air with their life i just
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  found it a bit more exciting.
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  And then i realized as i was going through that obviously the communication skills are very
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  important in a pain world and where
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  i work in cambridge i have the university
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  attached to it and i had
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  no idea this thing existed when i was training or quite
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  working up to this point there are things called communication skills
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  facilitators which it turns out has been
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  a thing for over 20 years where basically mostly dot
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  x or doctors or okay a few nurses physios
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  dietitians etc will go into medical school
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  and they facilitate those medical students learning
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  about communication skills i know that
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  a medical student will get at least at
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  uea something like 60 hours of communication
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  skills teaching across those years which
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  is well i'll be honest with you i got none in
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  my physio degree because they realize it's
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  so important and i just really fell
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  in love with it and I realised this is great for the students but
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  where's this for those that are sort of qualified and
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  hence why I've then started putting things that
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  we do in the teachings at universities but now available to everyone because
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  I think they know it's important as a student but from my experience and I think
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  the experience of many other people is when you graduate and you've been working
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  for those three four five plus years that you truly realise how important it is because.
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  And I just fell in love with it. And here we are 10 years later.
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  I don't think I could go back to MSK or a different part of physio now.
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  Fantastic. It's interesting. I'm sitting here and I'm hearing you create quite
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  a wide wall, the separation between MSK and pain clinic.
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  And I'm wondering whether that is, should it be such a big wall?
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  Isn't part of the problems in msk is that they're not doing
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  some of the stuff that they do in pain clinic or i think
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  that i may have may have said it
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  i haven't said it very well but certainly
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  yes there is a better bridge between the two there
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  is a lot more for therapists to
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  learn about and know about persistent pain
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  management than they used to be it was always a case of the pain
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  clinic is this mystical place that exists somewhere patients
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  go to and you never see them again but now we
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  the physios myself my colleagues in the pain clinic work in
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  the same department as the msk physio and i
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  think there should be a lot of interlinking and therapists i think it is
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  becoming much more well talked about and
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  known over the past five years ten years something
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  like that where this idea of pain management
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  is becoming much more integrated and i
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  say that that because the classic back
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  pain patient you know the one who's got fearful of movement they've had the
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  scan and they've got the degenerative findings right and they're worried about
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  that you know looking for the trying to get into the drugs and all the passive
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  treatment and not trying to be at we don't see many of those these days in our
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  pain clinic because i think they're,
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  therapists be it msk physios sports therapists whoever are managing a lot better on the hole.
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  These people don't come, we don't see much of that anymore.
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  What we get a lot of these days is widespread pain, inflammatory conditions or fibromyalgia.
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  And there's more psychological distress, not just related to the pain,
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  but maybe related to other things as well in life.
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  And we have a lot more of that and just trying to juggle more pieces in the air.
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  But I certainly feel that it's the management of pain and the skills that come
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  with it has been certainly better integrated among the MSK therapies,
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  because those types of patients that used to come through aren't coming through as much anymore.
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  Interesting. OK, that's good. Right. OK, so for people who aren't familiar with
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  your article, they'll still be looking at this advert for this episode and thinking,
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  sit in the mud, what the hell is he talking about?
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  So we should really explain.
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  Let's do a little bit of context for people who didn't see the article,
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  because I think it is still behind a paywall for MSK Mag. I don't know. I mean.
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  I get MSK Mag, but let's give people a little bit of context.
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  So I'll bring this up on the screen basically what we're talking about people is MSK
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  Mag and this isn't a an advert for it you can get it you don't
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  have to get it it's totally up to you but it's brought to you by the
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  Physiomatters team which you might be familiar with the Physiomatters podcast
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  which was started by Jack Chu and Jack March is involved with Jim March depending
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  on what day you talk to him on and there's a lovely picture here on the screen
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  of the team together and they've now moved interestingly back to the magazine
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  format which is available online
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  and as a paper version as well
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  it's a real throwback to magazines i used to write in
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  about 10 years ago this looks like the old running magazines you used
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  to read on wh smith i quite like it i got one of
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  the magazine copies through and you know what maybe just
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  i'm getting older but i love just flicking through the magazines and folding
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  pages down and kind of it's lovely maybe it's just a throwback but they've decided
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  that that's the format they want to do but it's available still online and this
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  is where one of the articles which this particular one i read online i think
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  it was February wasn't it in the edition by Ben appeared sit in the mud.
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  Like I say, I saw it straight away and just fell in love with it because it
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  just summed up something we've talked about a lot on this show about not rushing in to fix people.
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  And we'll talk about this in a second. It's very much.
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  It used a lovely analogy where sometimes the person who comes to visit you and
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  they will put as much better than me. I'm just summing it up because we have
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  talked about it on the show.
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  Sometimes the person who comes to see you doesn't want you to fix them.
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  Them okay that's really and if they don't want you to
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  fix them then you know what you're probably not going to be able to despite
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  how amazing you think your manipulations or whatever you're doing is they just
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  want they need somebody to talk to and that's what the analogy of to sit in
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  the mud with them is and that might sound easier said than done and this article
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  kind of talks about that so,
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  that's probably a terrible description of what this article set out to do but
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  ben was that kind the idea behind it and that gives you a chance yeah there
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  will be situations in your clinic where,
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  patients you're they're coming to see you for a problem i'll tell you a story
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  at some some disability a lady i've been seeing for her widespread pain she
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  has a plan in place i'm seeing her for her third follow-up or something like
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  that comes in through the doors sits down,
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  already kind of doing that you know when people are starting to cry with these
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  the lips kind of starting to quiver and she says i'm sorry my past two weeks
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  have been terrible my husband's had an affair.
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  Now, in that situation, she's not expecting me to go around,
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  turn up and go, well, let me make that better for you.
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  OK, because know what? I'm going to make an assumption here.
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  OK, if someone's come in, they've disclosed that to their musculoskeletal therapist,
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  they're probably not expecting you to sit there and solve that problem because
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  that's a problem that's done. You can't solve that.
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  OK, but you can listen, sympathize and empathize.
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  As you've got on your screen there and they that you know you can't fix that but you can,
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  be that person that they as you just said there matt can talk
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  to you and that's what we did she came in she said that to me starts to
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  cry and gave her space a simple question
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  is what happened what's this you know you don't need to ask how do you feel
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  because you can see it in them right tears coming down someone's face they're
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  looking at the floor they're hunched over you don't need that question you can
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  see it in them and what happened and then.
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  They'll divulge more information how can i help because this has taken over their life,
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  right now that she said it herself right this is
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  just i can't we had plans in place she
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  has a little routine how can i do it that's gone
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  out the window right because her life's
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  just being flipped upside down like the story in the articles about
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  i think i called it it's a real life story i changed the
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  details for some confidentiality but
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  the story is true you know someone's partner passed away suddenly again they
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  know that you can't fix or reverse what's happened right they're there for a
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  separate reason and they know that this has taken over their life and again
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  Again, you can't can't fix,
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  but you can be the person they can talk to because they may not have had that chance by this lady.
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  Both situations actually they hasn't really
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  had anyone to properly open up to they had
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  family but they were having to be the carers for
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  the family members if that makes sense so they
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  in this case with children having to look after the
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  children while these situations were going on so they
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  then couldn't have the time to grieve or you
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  know go through that process like you would but simply
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  letting them do that and feeling
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  that they have support even knowing that you can't change
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  the situation they're in necessarily just having
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  someone they can talk to they get just get things out can
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  help someone move forwards and obviously there are places you can direct them
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  to help if needed various types of
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  psychological support if you feel it's if you and they feel it's
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  appropriate but sometimes just
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  being there when you can't fix is enough
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  and more probably sometimes more
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  than they expect in in these case in either these cases was there a another
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  underlying condition or suspected injury or something that was being kind of
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  associated with the pain they were feeling and this was amplifying it or why
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  did they originally come I mean, what were they trying to have fixed?
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  The one had inflammatory arthritis of some type. I can't remember exactly what type.
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  And the lady in the article, I think it's neck and arm pain.
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  Nothing particularly worrying on any scans, the kind of classic onset of pain.
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  There were other stresses in life and other issues with work and things that
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  have come on quite both quite.
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  Things you would see as a musculoskeletal therapist that may come through your
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  door with additional factors but then these things had just taken over and then
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  yes you say amplified the situation and made it harder to manage than already
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  difficult to manage situation,
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  people who come to see you have normally
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  been directed or referred to the pain clinic
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  because there's it's not working through kind
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  of like other conservative methods and stuff so maybe
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  they are already thinking you know there's
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  something going on here i need to see this kind of works
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  but professional advice so but i'm i'm presuming
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  that this could well happen if somebody with this same
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  situation goes on decides to go for a massage because their
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  lower back is hurting they might not even realize that that
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  pain could be being amplified by the divorce
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  they're going through all the issues they're having with their teenage daughters so
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  i guess this is where you you mentioned biopsychosocial in
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  the beginning and a lot of our listeners are familiar with that so is
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  what you're kind of saying you know although it's
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  one system living in you know different ecosystems this is where the psychosocial
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  factors could be playing a big part in their pain experience that's right spot
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  on it's never as many people have said it's never just bio it's It's never just
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  psycho. It's never just socialist.
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  And what influences at what times is variable, right?
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  And we were talking about this actually before we started that,
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  you know, that if you're going to see someone, you're going to give them a massage, they're lying down.
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  Someone can really just that relaxing they're going through can really actually help them calm.
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  And sometimes the emotions I've had people say to me, they've been for a massage
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  or something in the past, and then their emotions just come out. Right.
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  I'm not saying that's going to happen every time. I'm not saying it needs to,
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  but you know, that can happen.
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  And actually the easiest way, if you want
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  to kind of get to know those intricacies
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  just ask questions while the you
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  know it could be doesn't have to be a massage of course you could
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  be going for exercises with them you could be doing something
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  else with them but just open
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  questions of that start with what or how you know
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  how have you been coping with this what's this
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  effect happening in your life you know how how
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  how can we support you better and those
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  kind of things just open someone up they can't just answer
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  yes or no and you can roll with the answers can
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  really you know you've got you talk about this as well time with
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  them can really get to know someone and they may themselves think as they say
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  it oh i hadn't thought of that how actually what i'm going through at work Like
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  it isn't helping with my pain or that stress I'm getting with, I don't know.
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  Neighbor across the street or I'm not getting enough sleep.
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  People will pick up on it. You know, people, as they say it.
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  Because they say it they're more likely to then think oh you know what that maybe
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  that is applicable to me because they've come up with
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  it right we buy into ideas that we
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  come up with ourselves so if they hear
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  it and then you may have ideas
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  yourself so if they talk about sleep you may have advice on sleep or
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  you maybe you could direct them to someone for the psychological support you
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  have probably have contacts i'm sure we in
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  our clinic have an mdt so of you know
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  physio psychology ot and others we can
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  refer to so certainly you know being
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  in that where you are as a massage therapist for example you've got a right
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  opportunity there for someone really to relax and get out things they may not
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  have told anyone else before that's great that's really nice to hear coming
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  from you from a kind of pain specialist and also from a physio because you know massage.
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  Therapists do traditionally and we say this a lot but they do have a lot of
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  imposter syndrome where where they feel that, yeah, they can make someone feel good,
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  but they feel that all other, especially allied health professionals,
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  are kind of looking down going, oh, you're just giving them a rub and you're
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  not really that involved in proper serious kind of solving kind of pain experiences.
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  But based on what we're saying, when we consider the psychosocial effects on pain,
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  that time they're spending with you could play
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  a huge part in multidisciplinary care in relaxing
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  down the nervous system especially when we talk about behavior change that
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  person is not going to consider the sleep the lack
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  of sleep hygiene or the nutrition or the argument they're having
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  with their daughter or the divorce they're going through they're not going to solve those
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  they can't change their behavior those things until they relax a little bit
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  down so we're always kind of saying it's just nice coming from a specialist
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  mouth that massage can play because we all need confirmation of that is is tricky
• 23:04
  for massage therapists well i'll say this this Matt if patients come in and.
• 23:09
  Whether that's massage, whether it's manipulation or something else,
• 23:14
  you know, we have, if they want to spend their money and go and do that once
• 23:18
  a week, every other week on full knowledge that it's giving them short-term benefit,
• 23:23
  that's allowing them to keep going with their life,
• 23:27
  and they're happy and they're fine.
• 23:29
  No problem. And you know what, actually, if that keeps their pain under control
• 23:32
  and they don't need stronger pain relief,
• 23:36
  opioids or strong anti-inflammatory actually stuff like that that can have significant
• 23:40
  side effects or actually be detrimental long term you know what great yes there's
• 23:46
  obviously a question about management with long-term pain but if someone wants
• 23:50
  to spend their money and do that for we have no problem with it at all.
• 23:54
  And you know what they may go through the
• 23:57
  process of a pain clinic or physio or gp or
• 24:00
  whoever and as we said earlier they may
• 24:04
  go through that and if you're chatting to them in your residence it's massage manipulation
• 24:07
  something else they may just if you
• 24:10
  asked enough right questions come out with things that they
• 24:13
  may not have told anyone else so far that
• 24:16
  could be the key to then then managing that
• 24:19
  situation a lot better so this
• 24:22
  is where this is the kind of interesting caveat and the
• 24:24
  important thing comes yes massage therapists can be really useful
• 24:28
  as part of a recovery strategy
• 24:30
  or part of multidisciplinary healthcare but old school
• 24:34
  massage therapists and and by that i just mean
• 24:37
  anyone who learned massage kind of like more than
• 24:40
  eight years ago or is continuing to have
• 24:43
  massage taught by an outdated kind of syllabus they
• 24:46
  were told some they've seen as fit they still see themselves
• 24:49
  as fixers so if they are telling their clients you know what i'm
• 24:52
  going to massage this and put this in here i'm going to undo this scar tissue
• 24:55
  which is causing your sensations i'm going to massage early upstairs because
• 24:58
  that's causing the trauma tip that sort of thing if they're telling the patient
• 25:02
  i'm going to fix you then we get into dangerous water don't we but if the massage
• 25:06
  therapist is using this as an opportunity to give that patient some good.
• 25:12
  Listening time active listening and then potentially a
• 25:15
  little bit of support and maybe even education then
• 25:18
  that could be really powerful which brings us on to listening skills
• 25:21
  because there's a nice comment here which i think will be
• 25:24
  a good caveat well first of all becky's has said something wonderful here
• 25:27
  how privileged we are to be that person that our clients
• 25:30
  can share these sensitive details with it is isn't it it kind
• 25:33
  of sends shivers down your spine you must see it all the time when people open
• 25:36
  up to you it is a privilege you know they're not
• 25:38
  told anyone else and it's responsibility which
• 25:41
  means how you apply to that person or when or if is
• 25:45
  is serious you need to have training in it my wife goes why were they telling
• 25:50
  you that what's that got to do with it and i think but you're becky is spot
• 25:54
  on it is a pivot and actually okay people especially in persistent pain may
• 25:58
  say things that make you go oh god what do i do with that,
• 26:03
  But just, again, we said, just be in there. And if you know where to direct
• 26:07
  them to for further help, great.
• 26:09
  But if you don't, then a bunch of people you could ask or services you could
• 26:14
  ask, I'd say, I've got this patient who said this with X need.
• 26:18
  Who or where can they get help with this?
• 26:21
  And the fact they're telling you, okay, they may, minority cases,
• 26:27
  tell you something quite potentially quite dark or scary.
• 26:30
  The fact they're telling you is a generally a
• 26:34
  good thing because as you said there
• 26:36
  matt they may not have told anyone before and it's
• 26:40
  their way of saying they're not saying it with their words
• 26:42
  but their action is saying maybe i'm willing to consider this this thing i've
• 26:48
  hidden for the past 20 or however many years maybe i'm now willing to and i'll
• 26:55
  talk to someone about this and they almost it was kind of testing you a little
• 27:00
  bit we call it picking up on cues,
• 27:02
  so giving another example recently a chap long-term back pain very i'm going
• 27:08
  to be a bit stereotypical very masculine likes to get physically fit push through
• 27:11
  it tons of passive and also really
• 27:15
  high exercise right trying basically trying to out exercise his pain,
• 27:19
  if i exercise enough i'll get there and we were just chatting yesterday or whenever
• 27:25
  it was and And he says, you know, we'd be talking for at least 50 minutes.
• 27:28
  He goes, occasionally I'm getting these feelings of anxiety where I'm sweating and shaking a bit.
• 27:35
  And, you know, I don't know.
• 27:37
  And I said, you know, talk to him about this. He goes, no.
• 27:41
  And it was this little kind of, I could, at that point, I could have just gone,
• 27:45
  right, well, anyway, let's go on to these exercises for this.
• 27:48
  But we stayed on it. and it was the
• 27:51
  first time he really told anyone or
• 27:55
  if he had said it people were talking it in and it's
• 27:57
  the first time you may get help
• 28:00
  on something where really he needs the help and it
• 28:03
  doesn't need me he actually needs someone else and it's almost like a little
• 28:06
  they're giving you this little easter egg and they all call it cue and if you
• 28:11
  can pick up on it and then act on it now in your case it may be this massage
• 28:16
  let's say or doing exercise with them they may just come out with something
• 28:19
  and if you can click it and go oh they've said this,
• 28:23
  man and ask more questions about it again that could be the thing that really
• 28:26
  opens the door to where really they that need that they've either not considered
• 28:32
  or not wanted to consider,
• 28:35
  and if you can help them open the door with them guide them through the door
• 28:39
  to that it might talk about it could be talking therapy it could be something
• 28:43
  it might be a change of work it may be moving house it may be something that
• 28:49
  could be the thing again just keep an eye out for these
• 28:51
  little cues and they will maybe really change someone's trajectory as where they're going.
• 28:57
  Hey there matt phillips here sorry to interrupt the
• 29:00
  podcast just 60 seconds to remind you that
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  if you're looking for beard grooming products there is
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• 30:03
  I'm just going to scroll down to just reassure Cecily that wasn't only a go-to.
• 30:09
  Cecily Hissoff says, please let me assure you that some of us old school
• 30:12
  mts are up to date with our knowledge and guess what's played a
• 30:15
  big part in that now indeed cecily believe me i first started
• 30:18
  doing massage 21 years ago now but what
• 30:21
  i mean is if you were taught that long ago that
• 30:24
  you would definitely no one would buy no one
• 30:27
  was taught apart from you know a couple of people who
• 30:30
  we never knew about no one was talking about bicycle social or kind of
• 30:33
  you know the research just wasn't hadn't reached the shop floor so we were all
• 30:37
  learning that we are breaking down knots and adhesions and that we are help
• 30:42
  flush out toxins and there's still people today who will say make sure you have
• 30:46
  a glass of water because you're going to have lots of toxins i've just pushed
• 30:48
  out your body it's a standard thing and unfortunately.
• 30:53
  It is physiologically wrong. And whilst you're saying that, you're not saying
• 30:55
  more important stuff, which is better placed.
• 30:58
  And you're making that patient think that you've done stuff to them that you haven't.
• 31:01
  And obviously, Cecily, I follow your intense living.
• 31:04
  You've expressed some wonderful information out there. But that's the important
• 31:07
  thing about staying up to date, isn't it?
• 31:08
  You have to stay up to date. You can't rely on what you learned about eight
• 31:12
  to 10 years ago, which is why just saying you've been in this game for ages
• 31:14
  doesn't mean you're great.
• 31:16
  It's a fallacy of antiquity or something.
• 31:19
  Or it's just because you're old, you've done it a long time,
• 31:21
  doesn't mean you're good at what you do.
• 31:22
  If anything it opens the door to potentially that you
• 31:25
  might be doing things which which need changing and
• 31:28
  updating so yeah cecily obviously i i know
• 31:31
  that there's plenty of old people including myself who have who have
• 31:34
  updated what they originally learned i wanted
• 31:37
  to bring up steve here because this is steve kirby
• 31:40
  hasty how you doing says i really feel in fitness and well-being there are three p's
• 31:43
  physical physiological and most important psychological fully agree
• 31:46
  with ben we have two ears and listening is an important part of being
• 31:49
  a therapist which is great but i'm going to use this as a
• 31:52
  segue because there's listening and then
• 31:55
  there's listening isn't there and sometimes the interpretation can
• 31:58
  be if you just shut up and don't say anything give them that time wash
• 32:02
  your massage and then you've done a good job of listening and that might be
• 32:04
  what they need at that time but i want you to ben with with with the knowledge
• 32:09
  you've got to explain the different types of listening what we need to be conscious
• 32:13
  of and skills we need to pick up when it comes to listening i mean i will be
• 32:17
  start this by saying yes listening is the most important
• 32:20
  thing you can do right but there is a a little caveat with this and i realize
• 32:28
  my webcam has just decided to freeze as i'm talking it okay you keep it it'll
• 32:33
  probably sort itself out.
• 32:35
  Listening where some people who use the term attentive listening, right?
• 32:41
  Where you are, yes, looking at eye contact, the ums and the ahs, right?
• 32:48
  The kind of going on and just as I think it's the, yeah, yeah, yeah.
• 32:54
  Using your two ears compared to one mouth.
• 32:59
  But people think, and I hear this all the time. I listen to them.
• 33:03
  They told me their story. I listen to them.
• 33:05
  And that's great what comes next
• 33:09
  right because you can listen to someone and let's say matt you could open up
• 33:12
  you could tell me your tale of persistent pain your neck let's say and i could
• 33:16
  sit there and i could listen to you and i could nod along and i could look you
• 33:20
  in the eyes you're telling me you could open up to me after for five minutes
• 33:24
  and then i'll go so what makes it worse,
• 33:28
  and at that point what have I shown I've shown no compassion really I've not
• 33:35
  shown that I've understood it I've not shown that I care about what you say
• 33:41
  or that I can I've actually,
• 33:43
  have an interest in it so yes interesting is useful I'm listening sorry it's
• 33:47
  useful but there's more to it than that so to show that you've listened yes
• 33:53
  you use your ears bit and let Let them say it and give them your attention.
• 33:57
  But then after that, repeat back. So they call it a summary or it doesn't have
• 34:04
  to be word for word, but what you've heard back to them.
• 34:07
  To show that you've heard them right so it's not
• 34:10
  just a case of let's turn the story it's anything okay yes
• 34:13
  you have taken in what i've said and then
• 34:16
  this is the nature of that article about empathy patients don't know that we're
• 34:20
  empathetic we like to think as health care professionals and therapists that
• 34:24
  we are empathetic people because of our job patients don't know that they will
• 34:29
  have probably seen especially in my world and maybe probably in your world too matt,
• 34:34
  but whether it's doctors other therapists nurses whoever
• 34:38
  where they do not think they did
• 34:41
  not feel that that clinician was particularly empathetic to them and some
• 34:45
  empathy is something you have to demonstrate okay it's not just something you
• 34:49
  can emit from your presence okay yes you can be there and you can be attentive
• 34:54
  and you can listen and you can repeat back but you basically have to empathy
• 34:59
  is showing someone that you understand what they've been through or their experience.
• 35:04
  You're not just being sympathetic so you're not saying i'm sorry to hear that
• 35:09
  because that's sympathy now it's nice don't get me wrong sympathy is nice to
• 35:13
  say and it's not a problem with being sympathetic but it's not being empathetic
• 35:18
  because if i say i'm sorry to hear that,
• 35:21
  i'm not saying that i've understood i'm just sorry essentially while empathy
• 35:27
  and if anyone's ever read never split the difference by chris ross he breaks
• 35:31
  it down very nicely into basically
• 35:33
  either sounds it's something you say it
• 35:36
  sounds it seems or it looks so it
• 35:38
  sounds something you hear which will probably say most of the time looks is
• 35:41
  something you see or seems can be either of those just to mix it up basically
• 35:46
  and you add a describer to that this is in the article so if we give the example
• 35:53
  of the lady who had a husband had the affair let's say she tells Tells her story to me,
• 35:59
  repeat back what I've heard, gives a bit more information.
• 36:03
  And I might say to her, it sounds like this has been a really tough time.
• 36:06
  It sounds like it seems like you're not getting any help at the moment or it's just taken over.
• 36:11
  OK, and hopefully they'll say, yeah, well, that's right. Or something that just
• 36:16
  confirms you've got it right.
• 36:18
  Because in that, that extra sentence on the end of that, it sounds, seems, looks.
• 36:22
  And then the label is what is you basically demonstrating this.
• 36:26
  You've heard what they've said.
• 36:28
  And then the key thing with that sentence in the label is you're understanding their experience.
• 36:33
  And that is what takes a good communicator to
• 36:36
  a great or amazing one okay because we
• 36:40
  can all listen and hopefully by now i think after all the years of therapists
• 36:46
  social media and twitter and all that jazz there's plenty of posts and plenty
• 36:50
  of influences talking about listening so i think that's been said about to death
• 36:53
  by now we all know the importance of it but it's the extra stuff.
• 36:57
  That comes after it that can take it from good to
• 37:01
  great and that can be the thing that opens someone up
• 37:03
  because you could say it sounds like it's been
• 37:06
  really tough and they go yeah and you know what i
• 37:10
  i'm actually not feeling well
• 37:15
  in myself at all you know they might say something quite dark like
• 37:18
  i'm not sure if i want to be here anymore or i don't know
• 37:21
  where to turn i'm not not getting any help i need whatever it
• 37:24
  is they may then come out with that thing that they
• 37:27
  haven't told you i haven't told anyone else so far and you
• 37:31
  can be wrong with it you can say it sounds
• 37:34
  like this sounds like it's really tough and they may say well you
• 37:37
  know what it's all right because that husband having
• 37:40
  the affair may have actually been really a pain in the ass or being
• 37:44
  quite abusive she's out the house now so life is better so it
• 37:49
  was quite hard in the article to talk about
• 37:52
  the the tone of voice and the timing obviously we all focus on the words we
• 37:59
  say right but the words we say i think there's that statistic about seven percent
• 38:03
  and then there's the 21 percent new tone and the 50 about your body language
• 38:07
  there's a little video in that article about near the.
• 38:11
  Bottom where you have to do a qr code because
• 38:15
  the the tone of your voice and how
• 38:18
  you say it will be as influential as those
• 38:21
  words you say because you can come out you can listen right you
• 38:24
  can repeat back you can say that lovely label
• 38:27
  that is correct but if i say it like to
• 38:30
  the ladies had the affair yeah sounds
• 38:34
  like that's really tough and then move on or just not look and just in a very
• 38:39
  robotic monotone tone i've said the right words but i've delivered it like i
• 38:44
  don't care like i've delivered it like i felt like i've had to say it but i
• 38:48
  don't feel it that makes sense.
• 38:52
  And the timing of it yeah let them that's why you get repeat it back to make
• 38:56
  sure you've got it right and let them add a bit more information if they want
• 38:58
  to because you don't want to be
• 39:00
  the the robot empathetic robot who just comes out someone says something sad
• 39:04
  you immediately go oh that sounds really sad when actually the situation might
• 39:08
  not be sad you need to let them tell a bit of the story and and they get going
• 39:13
  with it and then come out with it,
• 39:16
  which was hard to describe in text so i'm glad you've let me say it here.
• 39:21
  Because i think those things about the tone
• 39:24
  and the timing are as if not
• 39:27
  more important than actually what you come
• 39:30
  out and say so that was a very long-winded answer
• 39:32
  for listening important so there's so there's so much
• 39:36
  in there that people should rewind and
• 39:39
  listen back to again one of the things that stood out for me massively
• 39:42
  and i think it's really good for therapists to to
• 39:44
  pick this up is we don't realize that we're
• 39:47
  sounding like robots we might have all the intention in the world
• 39:50
  and we might think that we're doing a great job we might
• 39:53
  think that we're being really attentive and in our minds we're thinking wow
• 39:55
  this person must think i'm so i've got such great empathy my body
• 39:58
  language is amazing i'm sitting i'm copying their they're crossing
• 40:01
  their arms i'm crossing my arms you know yeah but it's only
• 40:04
  because we're not nest some people i think are born with
• 40:07
  it i think and maybe these people naturally become educators
• 40:11
  or kind of that that sort of stuff but i don't
• 40:15
  think i think a lot of the time it's skills that you need to learn
• 40:18
  like you've mentioned a few like what you do at the end for question
• 40:20
  whether you go down or up like using words
• 40:23
  like it seems it sounds things like i mean we've had guests on before i think
• 40:29
  i chatted with you before about dr gary mendoza stages of change.co.uk and i
• 40:33
  did his course which was heavily based on motivational interviewing because
• 40:36
  he worked with those guys and and i'm I'm going to open up to you now to get a few cues off you.
• 40:41
  But he came up with some wonderful things like putting your hand over your mouth
• 40:45
  when you're listening, just to physically stop yourself from trying to jump
• 40:48
  in. And I'm wondering whether...
• 40:51
  One of the reasons why we do not naturally or why we're not naturally good active
• 40:57
  listeners is because most of us have been trained to see ourselves as fixers,
• 41:03
  as people who are the professionals wearing our kind of metaphorical or real white jacket.
• 41:08
  And that's why the persons come to us. So if we're desperate to kind of say,
• 41:12
  oh, I know it's your collision, you need to do eccentric loading.
• 41:14
  I'm sorry, but let's have a go now, because you think that's your job, that's your identity.
• 41:18
  So i think that that's
• 41:21
  one of the things which makes active listening difficult does
• 41:25
  that make sense because we still see ourselves and we're taught to be fixes rather
• 41:28
  than facilitators you want to right the wrong
• 41:31
  is that right so yeah like
• 41:34
  it sounds like you know the solution to someone's
• 41:37
  problem they're not even halfway through yeah i think
• 41:40
  you do yeah yeah they're halfway through their story and you can already tell
• 41:43
  you've got enough there's plenty of people with lots of experience here you
• 41:46
  can tell from the patterns of your previous experience oh i can hear what's
• 41:50
  going on here i know what they can do i just want to tell them yeah and obviously
• 41:55
  they may already know the answer themselves they may have googled it and they
• 41:59
  just haven't got to that part of the story yet where they've told you what they've
• 42:01
  googled and what they've tried.
• 42:03
  And it is you you're right and i think this is why pain gets a bit of a bad
• 42:08
  rep and And whether it's in the physio world, because obviously in the physio
• 42:12
  world, you know, you go into it thinking someone's got a problem.
• 42:18
  That might not be an MSK issue, maybe a stroke, let's say, or they may have
• 42:21
  had a heart attack or whatever.
• 42:23
  And you want to get them better.
• 42:26
  And in pain, clinic, they don't just suddenly generally get better.
• 42:30
  It takes time. And a lot of the time they're never pain free.
• 42:34
  We can improve their quality of life a lot of the time.
• 42:38
  But there's we were talking about this earlier like the i don't think having worked as an msk,
• 42:44
  physio or therapist for five years prior to being in pain i don't think my practice
• 42:51
  is drastically different to what i was doing msk to what i do in pain now.
• 42:58
  Yeah okay the clientele is a bit different there's a few extra things
• 43:01
  that we i may do more of that i didn't do
• 43:04
  then or do less of what i did then i do now but i'm
• 43:07
  not like i've drastically changed as a person or how
• 43:11
  i am is is this
• 43:14
  something you feel that the fixed mentality in in massage and
• 43:16
  sports that matters is this something you think should change
• 43:19
  oh god yes massively i
• 43:23
  mean it's a total but it's it's it's hard
• 43:26
  because that's the identity of of a lot
• 43:29
  of therapists they do pride themselves and well they're
• 43:31
  taught these set of skills they find an asymmetry and
• 43:34
  they're taught right you're going to make this symmetrical and the pain is going
• 43:36
  to go away even though we know there's plenty of people who walk in light with
• 43:40
  one shoulder up and they haven't got neck pain you know and it's but it's hard
• 43:44
  because that's that's what they're taught a lot of people in this room the names
• 43:48
  in here the people have decided to give up their tuesday evenings like like
• 43:50
  you so eloquently suggested on your little post as well,
• 43:53
  that they're clued up because they're here and they want to learn and they want to listen.
• 43:58
  They might be too clued up for their own good.
• 44:01
  But a lot of listeners, it will come as a shock when we say that you're not fixing people.
• 44:06
  Okay, you're facilitating their recovery. And the only way you're going to facilitate
• 44:10
  their recovery is by listening to them and working with the individual in front of you.
• 44:14
  And that's a real difficult business model for them to get their heads around.
• 44:17
  So it's a big theme on this show.
• 44:19
  So it's great hearing from professionals like yourself
• 44:22
  who kind of managed to put things into perspective
• 44:25
  and and and just let us know that the great message from you this evening has
• 44:30
  been keep doing what you're doing but use it to facilitate other things like
• 44:35
  your active listening you know use that therapeutic alliance that trust and
• 44:39
  and here's how to do it oh i need to bring up some of the things you share because um.
• 44:44
  You've got a great i don't know you seem to be as active on
• 44:47
  twitter as on instagram i would say is that
• 44:50
  fair enough would you prefer one or the other no no i
• 44:52
  do i will post on both at the same time i'll be honest with my twitter following
• 44:56
  this i'm a lot better than instagram maybe i'm just not
• 44:58
  very good for instagram i think that's a physio thing
• 45:01
  i think i think twitter i think physios are
• 45:04
  keeping twitter going i think not that physios
• 45:07
  are all argumentative kind of people but i think certain and
• 45:10
  physios keep twitter going by putting things on there and physio
• 45:14
  just can't resist replying and getting angry but
• 45:17
  but both are good i mean uh yeah both are
• 45:20
  both but depending on listeners if you prefer twitter well on twitter and instagram
• 45:25
  you can find ben at b y brow which is b w h y b r o w physio all one word yeah
• 45:33
  that's on twitter and instagram and then also on twitter i don't know whether
• 45:36
  you purposely have got any difference between these accounts but there's also persuading.
• 45:41
  Patients persuading physical therapists oh no no
• 45:44
  it was what there was a plan now it
• 45:48
  will change that account at some point to something
• 45:51
  else i have it in my head but i have no idea when i'll
• 45:54
  change it away and i have no idea what it will be one day but it
• 45:57
  will change so persuaded it was supposed to be
• 46:00
  itself like this kind of educational resource for
• 46:04
  this kind of stuff that's the the original term for
• 46:07
  it but i felt like the persuasion
• 46:10
  name kind of narrowed it in a bit too much okay
• 46:13
  uh and actually the common side when i started talking to
• 46:16
  people about difficult conversations around like breaking bad news or
• 46:19
  belief change and stuff like that that went way outside of persuasion but people
• 46:24
  still found very useful interesting so that's what it was it was a tent intended
• 46:29
  to be this resource but life and things and classic creator stuff you kind of
• 46:34
  You never quite keep up with your momentum and consistency.
• 46:38
  So you can follow it. It will one day, the title of it, the logo,
• 46:43
  will all change to something else.
• 46:45
  I have no date for that i have no time for that but then when that will be i'm
• 46:49
  hoping sometime in the summer we are in 2024 right now so i'm hopeful i'm also
• 46:55
  as well as juggling a family have a blooming master to do at the same time oh it's keeping me too busy.
• 47:03
  People can follow both but maybe notifications on the stay wide for our physio
• 47:07
  yeah yeah but i want to bring out some stuff on instagram as well because you
• 47:10
  post some wonderful information it's It's classic free CPD people always going on about it.
• 47:16
  That's the idea of the podcast, introducing the people who you can follow and
• 47:19
  get some great indicators on what could help your career.
• 47:23
  So I'm going to bring up a few things which you posted. There's so much on there.
• 47:27
  So I would encourage you all to, we'll put the links in the show notes,
• 47:29
  but follow BY Brow Physio on Instagram or Twitter.
• 47:32
  I want to bring a few things up to give people an example. I'm not going to
• 47:36
  play the videos, but you do some wonderful kind of like minute,
• 47:38
  two minute videos explaining what you're talking about, which in your profession is really important.
• 47:43
  But I'm going to bring up a few here, for example. Now, obviously,
• 47:46
  people listening to the podcast, you can't see what's on the screen.
• 47:49
  If you want a visual, then go along to YouTube.
• 47:51
  All of these are recorded on YouTube and Facebook, so you can watch the video.
• 47:55
  So Ben is going to have to kind of read out what's on here.
• 47:58
  I'll read out then. So it says, for those that are listening and not watching,
• 48:02
  so if you want someone to do a new behavior, then tell them what they will gain by doing it.
• 48:06
  But if you want them to stop or avoid doing something, then tell them what they
• 48:10
  will lose if they keep doing it.
• 48:12
  So there's a very fancy term in psychology called loss aversion,
• 48:16
  which basically means we as humans are more likely to do something if we're
• 48:22
  going to lose, so that's a.
• 48:26
  Compared to then gaining something so there's a classic study of
• 48:29
  the 10 pound bet where if i
• 48:33
  gave you a bet you're going to give me 10 pound and it's
• 48:36
  50 50 chance either you bet
• 48:39
  10 pound and you lose it or you bet
• 48:42
  10 pound and you get an extra 10 a back do you
• 48:46
  want to take that bet matt 50 50 you lose your money or
• 48:48
  you get double is it worth it oh not
• 48:52
  for me but hey i'm not a gambling person so that's
• 48:55
  the same for most people for most people the
• 48:59
  number needed what did you think for the average person the number
• 49:02
  it would need to be to gain for them to take the bet oh
• 49:05
  what so either lose the tenner or i need to gain oh
• 49:08
  i'd need four to one i'd need 40 pound back if i won yeah
• 49:11
  okay so you're so the average was 23 so
• 49:15
  they'd need to gain additional 23 pound back to
• 49:18
  make it worth it if they lost 10 yeah so and there's
• 49:21
  a study i haven't got it up in front of me i could
• 49:23
  probably quickly find it but it's on shoulder surgery for people
• 49:27
  who are going to have a rotator cuff i think it's repair and before
• 49:31
  they went and saw the consultant half the patients going in got
• 49:34
  given a card one of the cards said in 75
• 49:38
  percent of patients going through the
• 49:41
  surgery the the repair
• 49:44
  will last the other half got given
• 49:47
  a card that said in 25 percent of people
• 49:50
  going through the surgery the repair will fail now.
• 49:54
  It doesn't mean they won't get better it just
• 49:57
  means that the surgery where they've repaired it breaks again they
• 50:01
  then ask the people once they went through the consultant do you want to have the surgery and
• 50:05
  very interestingly i think i can't remember the
• 50:08
  exact stats but it was about of those
• 50:11
  that given the card about 70 75 will not
• 50:15
  fail will stay i think it was
• 50:18
  something like 40 out of 50 chose to have the surgery
• 50:21
  those that got told 25 will tear
• 50:24
  i think it was only about something like 18 or
• 50:28
  20 out of 50 chose to have the surgery so the
• 50:31
  information the lose had a big
• 50:34
  influence so they avoided having the
• 50:37
  surge in this case the book i wrote there at the bottom is called the inferential
• 50:41
  mind by tally shallot but we the common therapist thing is say well if you don't
• 50:49
  get moving you're going to get stiffer you're going to lose your ability to
• 50:53
  do something right yeah but,
• 50:56
  that's a reason it doesn't work okay because that's
• 51:00
  great if you want someone to stop doing something or avoid
• 51:03
  it right if you want someone to do something then actually need to tell them
• 51:08
  what they're going to do game or movement you'll get you back to doing things
• 51:11
  with your kids being able to play more golf play more football do more work
• 51:17
  and then whatever it is okay they need that.
• 51:21
  Incentive internal incentive to do more so if
• 51:24
  you want to yes do some add something or do something
• 51:27
  new and what will they gain if you want them to
• 51:30
  stop or limit then what will
• 51:33
  they lose if they keep doing that behavior so yeah
• 51:36
  the classic the smoking is well you may not
• 51:39
  have as many friends and because they're quitting or you
• 51:42
  know you won't live as long you see we all see those things on
• 51:45
  the packets of the cigarettes right which there's
• 51:49
  some reason why they put that on there because people may
• 51:52
  more like to focus on what they'll lose
• 51:55
  if they keep doing it rather than what they
• 51:59
  might gain excellent and again this this is not what comes out of my mouth my
• 52:04
  the best intention in the world if we use these terms incorrectly then you know
• 52:09
  the research shows that we won't and achieve what we think you know we're going
• 52:12
  to get these patients to do so it's choosing your words carefully and it doesn't
• 52:16
  come naturally to you you might need to change the habit of a lifetime
• 52:19
  and this is where sometimes mi and stuff cannot just change your you know relationship
• 52:25
  with patients it can change relationship with family friends and everything
• 52:28
  you know because it's all kind of the same thing isn't it being an activist
• 52:31
  that can help in all sorts of different ways not just with patients which is
• 52:34
  interesting can i pick up on cecily's comment without a doubt let me go It's a great comment,
• 52:39
  which I just wanted to say I agree with.
• 52:42
  I hope I've got this right, Sesti, if I'm wrong.
• 52:45
  But trying to be empathetic sometimes, saying, oh, I've experienced that. It will be okay.
• 52:52
  I'm more it's one of those things i'm always a bit like should you give a simple
• 52:58
  example without one of a couple of children my wife had a c-section now i could have got various,
• 53:06
  physios from where i work nurses whoever it's coming to speak to
• 53:08
  her and say i had c-section too it was fine you'll
• 53:12
  be okay but the situation is different
• 53:15
  me being a healthcare professional i know the hospital i know what all the bells
• 53:19
  and whistles mean i know what people do i'm used to that environment my wife
• 53:24
  is not medical it's a scary environment we often forget that hospitals or medical
• 53:29
  places are not the most appealing places for people that aren't medical professionals,
• 53:34
  they don't generally want to be there and they can be scary and you know people's
• 53:39
  situation is different you may have you may have someone who's come in with
• 53:42
  let's say an acl tear right and you could say i've i taught my acl and it got
• 53:46
  better but your situation is different you may have been
• 53:49
  a sports therapist or some form of
• 53:52
  therapist at the time and you knew what the
• 53:55
  surgery may involve what your options were how to rehab it
• 53:58
  or this other person's completely in the dark you know they may have very different
• 54:03
  thoughts their needs are different they're you know how it's going to affect
• 54:06
  their life is different to yours so this is why you know getting to know their
• 54:10
  story it's much more important than just yes you can share a bit but don't egg on about it.
• 54:18
  She and she's put about i think the last sentence about what we can understand
• 54:21
  about our clients yes help fill in those blanks this has been in my mind while
• 54:25
  i've been talking about empathy.
• 54:28
  Saying i understand.
• 54:31
  One of the worst things you can say which should be a bit maybe controversial but a simple example,
• 54:39
  let's say i'm a male gp i've got 20 year old female walks in starts telling me about,
• 54:46
  period pains and i tell them i understand right do i understand no no of course not okay and,
• 54:56
  one of the lectures i teach that he does that at
• 54:59
  the beginning of one of his empathy sessions just to make the
• 55:01
  point that you can't most of
• 55:04
  the time truly understand you and say
• 55:08
  for yourself you can listen to them and hear their story
• 55:10
  and try and repeat back to them what you've heard to then demonstrate you're trying
• 55:13
  to understand but the phrase i understand especially
• 55:16
  said robotic like we said earlier can often
• 55:19
  make the situation a lot worse rather than
• 55:22
  better you can say i understand that this has been
• 55:25
  quite difficult or i understand that sounds like you don't know
• 55:28
  where to go with this but don't just do the i understand
• 55:31
  because it doesn't help most
• 55:34
  of the time definitely great point cecily thanks for
• 55:37
  bringing that up i think sometimes maybe because
• 55:41
  i really believe that a lot of therapists do say what they say with good intentions
• 55:45
  gone through a similar experience to their patients or clients they think that's
• 55:53
  what empathy is they think empathy comes from having having experienced what
• 55:56
  the patient is talking about, it's not that at all, is it?
• 56:00
  Case of listening and showing that you're listening and giving them time to
• 56:06
  get that sympathy isn't it you don't have to experience what someone's experienced to show empathy,
• 56:10
  yeah absolutely do you want to talk about ice questions as
• 56:13
  you got it up let's bring it up are you okay for time it's
• 56:16
  nine i'm fine for time everyone else in the
• 56:18
  house is asleep but we will shortly be giving you what you
• 56:22
  need to do in order to get free three month subscription
• 56:26
  to msk mag okay i will remember that but for
• 56:28
  the moment i just want to bring up there's so many things on ben's.
• 56:32
  Account that you need to check out but i want to bring up this one as well give you another example
• 56:35
  and let's put it on full ben if you can we love an
• 56:37
  acronym so what we got here ice ice is if
• 56:41
  there's a thing that medical students will always remember
• 56:44
  to say in their oskies uh they'll
• 56:47
  always remember that even if they don't need to say the
• 56:50
  ice they'll still say ask the ice questions um
• 56:54
  so i don't know if this is taught
• 56:56
  in do you think this is taught in sports therapy degrees
• 56:59
  at the moment matt degrees we've talked with guests depends
• 57:02
  very much on the university and who's teaching you
• 57:05
  it's i i must admit i
• 57:08
  haven't come across it i don't think it was on gary's
• 57:11
  course but then there's so many of these acronyms out
• 57:14
  there but hey people who are listening maybe if you've heard of this acronym ice
• 57:17
  the ice questions let us know talk us through it so i so
• 57:20
  basically i i said these questions you ask
• 57:23
  the patient that in theory that you should
• 57:26
  ask at every assessment and regarding their problems
• 57:29
  so ideas what do you think is going on very simple
• 57:32
  or what do you think the problem is because that
• 57:36
  will then influence what you're going
• 57:39
  to do later on because they may have been told things that are not true so for
• 57:44
  example the other day i had someone who had the belief that she didn't have
• 57:48
  an L4-5 disc anymore and then I was never had to do this before bring up her
• 57:54
  MRI scan and very clearly show her her L4-5 disc was very much there.
• 57:59
  Or they may have a completely correct idea
• 58:03
  about what's going on so they may have been diagnosed with
• 58:06
  a condition already and you can say and you can think
• 58:08
  well you know what that's right actually and actually that saves you
• 58:11
  time because you then don't need to go into a long explanation about the problem
• 58:15
  so it gives you an idea of what you're going to suggest because you're going
• 58:18
  to be formulating your hypothesis about what's going on as you're going through
• 58:22
  it and then you can get an idea of how they're going to react to that when you
• 58:27
  come to the explaining bit later on
• 58:30
  about what's going on and sometimes any
• 58:35
  beliefs that you may need to shift like that lady who thought she didn't have
• 58:37
  the l45 disc i sometimes like to phrase it because with our patients they've
• 58:43
  often seen various people before us and again it may be the case for you in
• 58:47
  sports and massage therapy that you could say you've seen the let's say gp.
• 58:53
  They've said that you've got hip osteoarthritis what do you think and it may
• 58:59
  now the hip oa diagnosis you may have already clocked from the information you've
• 59:03
  got that and that is correct,
• 59:06
  but the patient may not agree with that okay so
• 59:09
  again it's what am i got to work with here to get this
• 59:12
  person on board so that's a very key question c
• 59:15
  concerns what concerns i often ask what's
• 59:18
  your your biggest concern about this um so
• 59:21
  if they have people have all sorts of concerns and it
• 59:23
  may not be related to what
• 59:26
  they're seeing you for so they're
• 59:29
  bigger they may tell you what they think you want to hear so
• 59:32
  for example with a knee pain i may i'm worried oh i may not be able to get back
• 59:37
  to football anymore but the concern is actually oh i'm worried i can't work
• 59:43
  or actually i'm not worried about this knee pain i'm worried about my son who's
• 59:49
  not doing too well at the moment,
• 59:50
  i always ask with that are there other concerns you have because they may not
• 59:54
  tell you the biggest concern straight away they may tell you what they think
• 59:57
  you want to hear but i always ask people.
• 1:00:00
  Any other concerns you have what other concerns and you go
• 1:00:03
  down this so lady the other day said to
• 1:00:06
  me i'm very tired big concerns falling okay any
• 1:00:10
  of the concerns yes i'm worried about my husband may
• 1:00:13
  not be able to cope much anymore okay any other concerns yeah
• 1:00:16
  my daughter's having a another
• 1:00:20
  child we may not be able to cope and it goes on
• 1:00:23
  and she's eventually got to the point where she's actually admitted yes she was afraid of
• 1:00:26
  dying so really you ask these
• 1:00:28
  questions and the truth will eventually really come
• 1:00:31
  out and then so it
• 1:00:34
  gives you an idea of what you need to reassure about if you've been maybe breaking bad news
• 1:00:37
  and then expectations what do they want to expect from you and your service
• 1:00:42
  and that may be as a massage sports therapist they're expecting a massage right
• 1:00:47
  or they're facing some exercises or to be told what's going on or something
• 1:00:51
  and it gives you a good idea again if if you're going to be delivering what they expect then great.
• 1:00:57
  If you're not going to be delivering or if you're going to say something different
• 1:01:00
  to what they expect and again it may mean you need to address some barriers
• 1:01:04
  first challenge and beliefs whatever
• 1:01:06
  it is it's basically helping you be prepared for
• 1:01:09
  that bit after you've done the objective assessment so you
• 1:01:12
  know what what how well what you're going
• 1:01:15
  to be doing saying and suggesting is going to go down
• 1:01:18
  and it just makes that whole appointment so much easier there isn't sometimes
• 1:01:26
  people ask about the timing of it it depends how long you have if you go to
• 1:01:29
  your gp they're going to ask you within the first two or three sentences they might ask what's wrong,
• 1:01:36
  then they may say okay so what do you think is right me i get an hour with my
• 1:01:40
  patient for a new patient so i they will go through their story and past medical
• 1:01:45
  history and all sorts of things and then we'll get to it they may say it as we go along.
• 1:01:50
  But it should be there at some point. I would say when you ask,
• 1:01:54
  it will depend on how much time you have.
• 1:01:56
  I think you were talking earlier, sports massage therapist, about an hour. Is that right?
• 1:02:00
  Yeah, the advantage of working in the private sector is, yeah,
• 1:02:04
  you generally get longer, so you can give a much more detailed subjective.
• 1:02:07
  You have to read your client carefully and maybe ask the, what are you expecting
• 1:02:12
  from this session earlier on?
• 1:02:14
  So if they do just want to come here for a massage and get 60 minutes, then they don't want to.
• 1:02:18
  If you give them 30 minutes of chat and then you say right half an hour
• 1:02:20
  massage they'll be i haven't paid for that i paid you for an hour massage so you
• 1:02:24
  need to really read your patient or your client well but yeah
• 1:02:27
  we get longer so i mean this is a great acronym for
• 1:02:30
  subjective it's really important and the lovely thing is it's all
• 1:02:33
  second person it's all you your questions are based
• 1:02:36
  around your client or your patient rather than i
• 1:02:39
  i'm going to do this i think this i've got this certificate
• 1:02:42
  on my wall i can do this you know that's something which a lot
• 1:02:44
  of a lot of therapists struggle with it
• 1:02:47
  is all about the patient so a great acronym and
• 1:02:50
  i mean i i don't think i've heard it before i haven't
• 1:02:53
  used it when i'm teaching massage but i will do so in future and i'm sure a
• 1:02:56
  lot of other people will mention as well really useful i should be clear it's
• 1:02:59
  not my acronym it's been around for decades i think i'm very honest of you but
• 1:03:05
  patient i should also add patients really value being asked because you're asking
• 1:03:11
  for their opinion and again as you just said there,
• 1:03:13
  it's making it about them, not you.
• 1:03:16
  And again, it may be one of those things like that lady who said actually she's afraid of dying.
• 1:03:21
  That may bring up the thing that they haven't told anyone else.
• 1:03:25
  And you could probably ask them certain people with certain questions while
• 1:03:30
  you are delivering some form of massage or exercise, whatever.
• 1:03:34
  You don't have to bang them out in order.
• 1:03:37
  You may find there's a right time to ask it, as you said there. So, yeah,
• 1:03:42
  asking them can really get more information that again as we said earlier could
• 1:03:46
  just be that key and i think i think becky said it earlier that could really
• 1:03:50
  just get them somewhere but actually they hadn't got before i think she was
• 1:03:55
  talking about with a counselor,
• 1:03:57
  yeah yeah yeah no becky does tend to come up with some gems no it's great and and it's and again,
• 1:04:03
  it's it's using the subjective to create a hypothesis and then using your objective
• 1:04:08
  to test the hypothesis and sadly the problem is a lot of courses in soft tissue therapy are still,
• 1:04:15
  presenting the objective to then create a hypothesis you
• 1:04:18
  know so you're doing your postural analysis you're checking out their
• 1:04:21
  psis and seeing if one's higher than lower and then you're thinking all right
• 1:04:24
  i think that what's going on here is which is which is terrible it needs to
• 1:04:28
  be do your subjective then work out what you think's going on maybe it's a combination
• 1:04:32
  of the lack of sleep the worry about this the fear of this or maybe it's not
• 1:04:35
  any of that maybe Maybe this person is just happy, go free. Nothing's going on in their life.
• 1:04:38
  In which case, maybe I do need to concentrate on what's going on in the bio
• 1:04:41
  a bit more, you know? So it's so important. Really cool.
• 1:04:45
  Listen, we could talk about this forever. I think Becky has summed it up.
• 1:04:49
  Becky Carroll has said here, what a brilliant episode. Plenty of golden nuggets to take away.
• 1:04:53
  Becky, I was planning on so much more. Believe me, this guy has got so many nuggets.
• 1:04:57
  Yeah, check out Instagram, B-Y-Brow, which is B-W-H-Y-B-R-O-W,
• 1:05:04
  physio, on Instagram or Twitter.
• 1:05:05
  And you'll and you'll love it becky you'll be there for the next hour so make sure
• 1:05:08
  you do get some sleep get your sleep right okay now
• 1:05:11
  before i forget i did promise you that there is
• 1:05:14
  uh obviously we found ben or i found ben thanks to physio mag so what's it called
• 1:05:20
  msk mag msk matters too yeah that's how i found them so there you go and there's
• 1:05:24
  plenty more there you'll recognize some of the names on there for people who
• 1:05:29
  are familiar with physio matters podcast in particular
• 1:05:32
  i think i had a magazine cover of january up here just
• 1:05:34
  to refresh my memory here we go so even on this oh i
• 1:05:37
  can't see with my eyes but people like joe turner who is a
• 1:05:40
  fantastic thinker in the world of pain experience and
• 1:05:43
  everything is works with them and there's plenty of guests who have had on the
• 1:05:47
  show who are writing articles for them so yeah it's something that you should
• 1:05:51
  maybe check out maybe dip into and this is the perfect opportunity because they
• 1:05:56
  are graciously giving one of you listeners the chance to have three free months of access,
• 1:06:03
  which not only gives you free access to all of the articles in the magazine,
• 1:06:06
  but also to the Physiomats podcast and everything new they're doing there.
• 1:06:10
  How are you going to get your hands on this? Well, all I need is for you,
• 1:06:16
  the listener, to create a post on social media. It could be Instagram, it could be.
• 1:06:23
  What's the other one facebook tiktok do i i don't
• 1:06:26
  think sta is on tiktok no there's a
• 1:06:29
  marketing opportunity matt believe me i'm on
• 1:06:32
  there for one chat live you get like a thousand views in
• 1:06:36
  10 seconds but how many there are anyway but yeah so
• 1:06:39
  facebook but because what you do have to do is you've got to tag in the uk underscore
• 1:06:42
  sta across social media um sports media association it's got the same name it's
• 1:06:47
  just uk underscore sta so you need to write a post on any of the those three
• 1:06:52
  social media you need to tag in uk underscore sta and you've got to say.
• 1:06:56
  I'd love to win three months of free subscription to msk
• 1:06:59
  mag because and then just make up something funny or amusing
• 1:07:02
  okay so it's got to be that to show that you've got it
• 1:07:05
  from this podcast i'd love to win three months of free subscription to msk
• 1:07:08
  mag because and then what we'll do is next week
• 1:07:11
  i'm going to have our guests say a number between
• 1:07:14
  one and however many posts we see and then one of
• 1:07:16
  of those people will win three months free
• 1:07:19
  subscription which would be a great it'd be so much for you to look through this
• 1:07:22
  really is quite a quality mag and it's even though it's called physio matters
• 1:07:25
  i mean the jack chew physio matters started physio matters
• 1:07:28
  back in 2013 i think
• 1:07:31
  so it's a long time ago when when most of
• 1:07:34
  the great thinkers were coming from the physio camp we've evolved a
• 1:07:37
  lot now but originally it was thanks to jack and people like that
• 1:07:40
  and the early people in on the physio matters podcast who really started
• 1:07:43
  creating a multi-disciplinary kind of media approach so don't be put off by
• 1:07:48
  the fact it's by the physio maps team i know it sounds a bit antiquated but
• 1:07:51
  hey that's the brand and there's no way jack could change that now it'd be it
• 1:07:54
  would be nightmare it's very inclusive and yeah i would check it out right look at the time.
• 1:08:02
  What's coming up next week? Well, you might have noticed that Joe Gibson is
• 1:08:06
  not speaking on this podcast.
• 1:08:08
  Joe has not got the burly, deep voice of Ben White-Brown. No,
• 1:08:11
  far more feminine with a delicate. The first person to have a deep voice.
• 1:08:16
  And you're definitely not Scouse. So Joe couldn't be here tonight,
• 1:08:20
  which is why Ben graciously stepped in rather than coming in three weeks time.
• 1:08:24
  But next week, we do start our two-part shoulder assessment episodes.
• 1:08:28
  So next week, it won't be Joe. It will be Ian Horsley.
• 1:08:32
  And anybody who's into the world of shoulder assessment will know Ian.
• 1:08:36
  Names really don't get much bigger than Ian when it comes to sports injury education.
• 1:08:39
  He's currently lead physio, technical lead for the Northwest,
• 1:08:42
  the English Institute of Sport.
• 1:08:43
  He was a physio for England Rugby Union for some 14 years. He had a PhD in 2013,
• 1:08:49
  examined issues around shoulder injuries and professional rugby.
• 1:08:52
  And he published several articles in peer-reviewed journals,
• 1:08:55
  contributing chapters to several books on sports injury management.
• 1:08:58
  He's currently a consultant physiotherapist for England Football as well.
• 1:09:01
  So it's a fantastic opportunity.
• 1:09:03
  I can't really big him up enough. I'm an amazing opportunity for you guys.
• 1:09:06
  If you can to join us live, you can ask questions directly in part one of the shoulder.
• 1:09:10
  Like I say, the wonderful Jo Gibson will be with us the week after,
• 1:09:14
  recorded live April 30th, which will be treating the shoulder steps to success.
• 1:09:18
  A hugely respected both nationally, internationally, our Jo is for her shoulder
• 1:09:22
  rehab lectures and courses.
• 1:09:24
  She's also a clinical specialist at the upper limb unit at the Royal Liverpool Hospital UK.
• 1:09:28
  Case it's going to be a massive two weeks of everything and anything to do
• 1:09:30
  with the shoulder which i encourage you to try and tune in live
• 1:09:33
  if you can but if not then all of all episodes
• 1:09:37
  will as always be downloaded or uploaded to podcast
• 1:09:41
  apps or you can watch it on the recording on youtube so that's what's coming
• 1:09:44
  up thanks people who joined us live as well some lovely gratitude coming um
• 1:09:49
  through for the people who did join us live you make it all very special we
• 1:09:52
  wouldn't do it if it wasn't live cecily hisop says ben you've hit the nail on
• 1:09:54
  their head so he says ben and matt Matt, this has been excellent.
• 1:09:59
  Sally martin says love the seams sounds looks
• 1:10:02
  it is great i mean that's another nugget isn't it three words
• 1:10:06
  which you use it might sound artificial to you
• 1:10:08
  in the beginning but once you do it a few times it'll start coming
• 1:10:11
  out naturally and it's just bad i'm not going to take credit that's chris ross's
• 1:10:15
  idea but if i'm mine i just being so modest you don't have to say that and also
• 1:10:20
  facebook user and the reason you're coming up as facebook users because you
• 1:10:23
  just haven't clicked the link but facebook user whoever you are thanks for joining
• 1:10:26
  us says thanks brin and matt taking lots away from this episode it has been
• 1:10:29
  a great episode thank you so much ben for joining us,
• 1:10:31
  right that's it apologies for keeping you ben for an
• 1:10:34
  extra 15 minutes thanks for listening to me twins haven't
• 1:10:37
  woken up there that's good no no once
• 1:10:40
  they're down they're down so we're fine that's good to hear right and
• 1:10:43
  somebody did call for part two i'm not going
• 1:10:46
  to hold you to that now but there's so much i'll agree
• 1:10:49
  to that oh well there you go you got it recording now got it
• 1:10:52
  and that'd be amazing there's so much more we could talk about remember people
• 1:10:55
  if you'd like to hear more about ben then i
• 1:10:58
  do heavily recommend that you follow him on instagram or twitter and that is
• 1:11:03
  at b y brow which is b w h y b r o w physio follow him now loads of this i mean
• 1:11:10
  right thanks everybody um hopefully we'll see some of you live next week and
• 1:11:14
  as always take care of each other.
• 1:11:18
  Music.