Latest / The STA Clinician Podcast / Ep.286 'Communication Skills For MSK Clinicians Part 3: Explaining Diagnoses' with guest Ben Whybrow

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Ep.286 'Communication Skills For MSK Clinicians Part 3: Explaining Diagnoses' with guest Ben Whybrow · The STA Clinician Podcast

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You're listening to the STA Clinician Podcast, connecting clinicians across healthcare.
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Evening and really how you doing? Welcome to episode 286 of the STA Clinician
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Podcast, formerly known as the Sports Therapy Association Podcast.
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My name is Matt Phillips.
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I'm creator of runchecklive.com. And as always, this episode is being recorded
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live on the Sports Therapy Association YouTube channel and Facebook page at
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eight o'clock UK time on a Tuesday.
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So we arrive at part three of the focus this month on communication skills for
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MSK clinicians in an episode entitled Explaining Diagnoses.
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Very shortly, I will be joined by Ben Wybrow, who is clinical communication
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skills facilitator at Norwich Medical School, specialist physiotherapist in
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an NHS pain clinic, and also host of the Excellent Clinical Communication Podcast.
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It's not called the Excellent Clinical Communication Podcast,
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it's just called the Clinical Communication Podcast, just in case you're Googling
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that now. And I do wholeheartedly recommend it.
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Ben's going to be diving very shortly into the art and science of explaining
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diagnoses clearly, confidently, and compassionately, exploring key skills for you, the MSK clinician.
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Before that, I must, as always, give a huge thanks to my guest in part two last
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week, which was entitled Awkward Conversations with Richard Shorter,
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who's an expert in sports, parenting and business leadership conversations.
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Richard is the founder of nonperfectdad.co.uk.
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Amazing website and Instagram feed. I really encourage you to listen to it if
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you're into communication. Not if only you're a dad, but if you're a dad as
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well, it's going to be extra meaningful.
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And yeah, Richard supports organizations and parents in enabling them to work
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effectively together for the best outcomes of the children.
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And in the episode, Richard provides some fantastic tips on how to deal with
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the awkward conversations that can arise during clinical consultations in which
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children and young athletes are accompanied by their parents or carers.
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The episode explores the power of asking permission, fencing the conversation,
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using whiteboards, card prompts, even think lollipops are mentioned at one time,
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not for the kid, for the adults, and de-escalation techniques to help keep the
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child at the center of care, which is what it's all about.
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Available as always on YouTube and all popular podcast apps.
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And if you do watch it and enjoy it, do please leave a rating and a review just
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to help it reach more people.
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Which is what this show is all about. Right then, back to tonight's episode,
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explaining diagnoses with my special guest, Ben Wybrow. Let's bring him up.
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Hey Ben, how are you doing? I'm all right. Thank you, Matt. How are you? I'm very well.
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Thank you. Thank you very much for coming back. Not your first time on the show.
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Really appreciate it. But I'm just, Matt, I'm always grateful to spend a Thursday,
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no, not even Thursday, I'm a Tuesday.
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I'm getting ahead of myself. Tuesday evening with you.
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Yeah, very happy to speak to you. Thank you very much. Yeah,
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actually, I'm going to say it first of all.
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I'm really excited because you're coming to Therapy Expert this year,
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aren't you? Yes. Or Therapy Show.
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Yes, Therapy Show now. I owe you a great deal of gratitude for some recommendation.
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And what can I say? Very excited. This is my first time, full disclosure.
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Looking forward to the change, I think. There's big things coming this year, from my understanding.
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Tell me how it's going to look. Looking forward to all the people meeting them
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coming. And yeah, I've got to do two talks in one day, which I don't know why
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I decided to do that, but there we go.
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It'll be good. Really good. It's going to be, and I don't mean it's a sick or
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frantic way or anything, but it's going to be all the better for having you
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there and your calm, dulcet tone just grace the floor.
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Have you mentioned already what you're going to be doing? Yes,
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you have been signed up for two.
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Just to let people know, the listener is up on the screen. If you join us on
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YouTube, then you can see, well, you can kind of see what's on there.
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But you're going to be there on day one.
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Yes. Which is the 25th of November, 2026. at 10.30 in the clinical skills lab
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with how to make rehab plans that start and last.
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I did this with Ben Cormack and he was writing it down because he had no idea
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what he was doing. So he said, thanks, Matt. This is the first I've heard of
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it. So I'm sure you know already exactly what you're doing.
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And then on the same day, 3.30, get a bit of a break. We're going to be back
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in theater A for chronic widespread pain, determining differential diagnosis
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without the guesswork. Yeah.
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Liam lit up when I offered him that and said, this is this new exciting thing.
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And yes I've never seen someone go oh so much so yes that's that's the new thing
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I'm sure there's been talks about I think you may have even done them talks
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about behavior change in the past,
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so well be in the morning but yeah the new what is it chronic widespread pain
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differential diagnosis guide that's out this year then more in depth in the
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afternoon hopefully in a more exciting way than maybe other pain talks will
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be in the past we can make it more interactive etc
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so yeah i'm very excited that's really cool and
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it's nice a shout out to liam oh my
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god his surname's gone for me now oh liam liam
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liam richardson um who's the
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content manager who's back this year after a little bit of an absence hiatus
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of working behind the scenes yeah he's back so it's really cool i have been
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going on him for years to get you along and you're in so it's all good right
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then so i'm explaining diagnoses i'm interested what because we had a little
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chow offline and said, we're talking about communication, which is your bag.
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And I love everything you do on the podcast and what you share.
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And what in particular, we could have talked about anything,
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but what made you think, what about explaining diagnoses, Matt?
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Well, I think the first thing was you had multiple people coming on to talk
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about behavior change this month. So we thought, let's not go with that topic.
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I think it's something we take for granted, right? We just often assume,
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oh, I'll just tell them and then that's it.
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And in reality, And as not just you and I, but other people have touched on
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in the past, it can be a lot more complicated than that.
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There's various things that can influence how much is taken in,
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how it's interpreted, how someone feels about it.
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It's like reassurance. We are getting reassumed about reassurance when actually
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it's a lot more complicated than that.
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And when we're trying to give bad news, we assume we just give it and it's again more complicated.
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So I was thinking, what's something easy that we could get our teeth into in
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an hour that hopefully gives people simple suggestions that they could then
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do tomorrow with anyone they see.
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I'm not talking about any specific joints tonight or any specific pathologies.
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This could be with everyone you see tomorrow. Hopefully, there'll be something
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you can take from tonight.
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That's great. And that's actually, that's a nice segue into what I was going
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to say, actually, because we've talked about,
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although this podcast is for all healthcare professionals, which is why we changed
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the name into the STA Clinician Podcast, there will be some people who will
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be saying, but I'm not allowed to give a diagnosis.
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I don't know how familiar you are with the fact, but it's a weird one.
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Technically according to what literature you read if you're
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not an allied health professional then you shouldn't be using the
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word diagnosis or diagnoses there was
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a there was a talk about this therapy show last year
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because some people would argue that's ridiculous it's a
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working diagnosis it's not the same as where you go to a medical diagnosis where
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the doctor says yes you've got this and so as a sports therapist although you're
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not a an allied health professional if you are kind of level four or above then
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you should be able to use the word diagnosis but in this case It's just to clarify
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when you do talk about diagnoses,
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that's not necessarily something really serious, is it? You could be talking about anything.
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Give me an example of what we could cover.
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Well, I was thinking about this earlier. It could be very specific.
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So you could be talking about a Achilles tendinopathy, right?
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You're saying, I think this tissue is, and whatever's happened in their story,
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which we'll come to, but I think that tissue is the issue, calling that.
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Or you could be vague and you could be talking about just back pain or neck
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pain. And that's, again, we know is influenced by various things and that's
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not as specific to one direct tissue.
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You know, there's certain conditions that you are saying from a medical perspective,
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you have this label of MS or diabetes or there's a specific pathology.
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But that being said, there's also tons of diagnoses out there with specific
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terms, or it is vague, right?
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Obviously, in pain service, we see lots of fibromyalgia or hypermobility-related stuff.
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You know, it's a term, but symptoms are different for each individual.
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You could apply that across the board for other range of conditions for mental health stuff as well.
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So I don't know what the actual definition of diagnosis is, to be fair.
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But it is broad and i
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think people listen to this whether you're making it or
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you may be more likely seeing someone where
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they've already got a certain diagnosis but then they've just been given this
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handout or paperwork and said you got this go and see this person well that
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was it and they may want to know more so it's a it's a it's very vague as a
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term i think I don't know all the rules and regulations,
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but I would have no problem if I sent a family member to see a sports therapist
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or someone and they said about a certain diagnosis,
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providing I thought, well, that's
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probably within their scope if it's musculoskeletal, then yeah, why not?
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That's great. Good. So hopefully that's clarified anybody who's thinking this has not to do with me.
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It could be like you say. I love the way, I must admit, inside I celebrated
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when you have got a huge amount of experience working with pain and you're a
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specialist physiotherapist in NHS Pain Clinic.
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And yet we've got you in tape now saying the issue is in the tissue,
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which I think is fantastic.
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I've got a great sound bite there. I'm always looking up in that.
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Knowing you, I'm sending that straight to Bonnie and Mark. But knowing you,
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I think that's part of you, is it?
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You are not as fixed into boxes and categories.
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You're more a case of, hold on, who's in front of me? Then I'll decide what
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language I'm going to use. Yeah.
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I mean, we have to be very careful with, obviously everyone talks about terms
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and not want to be nocebic and using the scary terms and all that stuff.
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And it used to be back in the day, we'd all have these patients
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where they've been told they have the degenerative box or torn
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this or wear and tear that and that was it and there was all very nocebic and
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doom and gloom and then over the years we have quite trying to normalize all
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that stuff you know paint a more biopsychosocial picture etc interestingly there
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is i think there is a middle ground and there's always going to be certain people where.
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Whatever term you're using, even again, even if it's influenced by various things,
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can be validating to people, no matter what it is.
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And I've found, you know, over the years, going through people scans,
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you can say they've got the normal changes for their age.
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It's nothing to, that's going to be life-threatening. It's nothing that they
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shouldn't do. We try to normalize, et cetera, et cetera.
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I have seen it in people where if you go too far with that they then start to
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feel invalidated to a degree,
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not I'm saying that's wrong but as you were trying to hint at there you're trying
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to meet the person where they're at,
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and there will be some people who we all see who for whatever reason from their
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past experience or their own knowledge or their upbringing or whatever it is
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they're more that kind of structurally biomedically minded it.
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And there will be other people who are very happy to be
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not in that box i mean we try not to
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put people in box of course everyone's you know variable we
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have our own influences etc i think
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the there's always i say it's a ton of patients but there's always this kind
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of goldilocks over these explanations between the the kind of biomedical structural
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bit if you will and then the biopsychosocial holistic bit where if i've got
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someone in front of me who's very,
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structurally minded you know let's say they have some findings on the scan how
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relevant it is up for debate but if i launch straight into about oh well you're
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telling me you know your sleep's off there and you know you're you have lots
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of stress and without acknowledging that bit first.
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I can tell at times it might not land well so
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even if there's i think there's literature
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around this particularly i remember reading in hiv of all
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things but if you do the more technical
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bit first even if it's not the major driving
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factor that at least
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then gives you some validation to then get into
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the maybe it's the bigger parts of the psychosocial elements where
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relevant of course everyone we see is going to be
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variable across some people will have big biological drivers
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we should make clear on that there will be some where there's stuff going on
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of course there's definitely not so i i think there's this we have to be careful
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everyone talks about making sure the pendulum doesn't swing too far don't they
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matt so i think it's that meeting that person where they're at with the explanation and then,
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Wherever you feel you need to go, just edging there gradually over time.
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That's easy when you're people like you and I who can see them repeatedly and we can take those steps.
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It's harder for certain colleagues who, let's say, work in a kind of a first
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contact or advanced practice or one-off role where you're seeing them once.
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And then you're going to have to break that news of whatever the thing is and the explanation.
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Maybe it's different to what they're expecting and you
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have to tell them because you're not going to see them again to try and work
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them up and along to that bit um what do you think i'll check you out i was
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wanting my opinion under the host mate i don't think anything this is all about
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your hour but i just but yeah that's a great answer but i just i think for me you personify,
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in the way you speak just the or you
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stand for how we do need to be a chameleon we need to react
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according to the person in front of us and it's dangerous when we have these rules and
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it just made me laugh when you said that because i can imagine other people just go ben
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why bro they're on the phone now he just said issues in the tissue can you
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come on that's so outdated oh my god that's so 20 but it explains what needed
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to be explained and it did a good job so it's it's good i can't wait to see
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a therapy show it's gonna be really healthy there for people to listen to you
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right i've got talking of not what i want to think because i've got questions
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i want to ask you but this is your,
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you've chosen to do this explaining diagnosis.
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So where should we start? Where would you like to start?
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I think there's one thing that I said this last time and I'm here as well.
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If people forget everything else and just remember, you've got someone in front
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of you and you and I always talk about ice questions, right?
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The E is the expectations.
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You always should ask someone what they expect.
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And the I is the impressions of what they think is going on.
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There'll be some people, if you ask the impressions question.
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They'll just give an answer and then you may likely think, yeah,
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that's right, probably.
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So essentially with any explanation you want to know in advance what do they
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know what do they want to know what do they need to know,
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if you've got that person who's said simple example we said about Achilles tendinopathy
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earlier so let's say they come in and say oh I think yeah it's my Achilles tendon,
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and you do your assessment and you think yeah I actually think it is,
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then you can ask them well what would you like to know about that because they already know that,
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they're right from your assessment in theory so you can ask them if they want
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to know anything else about the diagnosis but i think i remember bonnie and
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i saying this last time actually the irony of working the pain service is that i explain pain less.
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People have various things online they can look up we've got ai these days they'll
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potentially have seen other people before you so they may already have an idea
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and if it's right and if they're already on the right page then it's more a
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question of what do they want to know about it,
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there may be things they need to know but that's rare right the need to knows are more for if you're,
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offering someone certain types of treatments that are quite invasive and they're
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coming to risk and you're having to wear up the pros and cons and all that jazz
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or if you're discussing serious pathology or you know breaking bad news and
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stuff like something they need to know but in our world it's very,
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not common that there's things they need to know okay it's not it's not like
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we have essentials if it's a safety thing fine like you know the corda quiet stuff occasionally but.
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Sometimes you know we can almost over explain there's a risk that you could
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come to me with your achilles tendinopathy you've you said i think it's an issue with my achilles tendon,
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i could be doing my assessment i think yeah it probably is just overloaded it
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but i'm thinking out of my head, I could then start talking about,
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oh yeah, Matt, you're right with that diagnosis.
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What happens is that, you know, when that Achilles of yours has been over,
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you know, you stretched it quite a lot in that exercise, you did a lot more
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running than you were doing.
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And I think, you know, those little muscles, fibers, they start to get overworked
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in the cycle and I lose you essentially.
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When actually all you wanted to know is how do I get better?
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Essentially when i ask them what they want to know a lot of the time i'm not
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saying this is you know this is my gospel or anything like that but most people
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if they have an idea of what's going on and you agree they generally just want
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to know what can i do to get better you can answer any additional questions
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they have but i'll be honest with you most of the time they don't
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it's only a minority people that come with a giant list of things like so i've got this diagnosis of,
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I don't know, it's hypermobility, let's say,
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HSD, and I want to know, da-da-da-da-da-da-da, fine. But.
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I think we have to be careful and mindful of what do they really actually just want to know.
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And also remembering that there's very little that people remember from an appointment,
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right? So was it 20% if that, something like that?
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So they're going to remember very little of your explanation.
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And you and I were discussing this last week. And actually, the key thing we
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want them to take away is a feeling, right?
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Feeling of hopefully safety or hope
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or able to move forward whatever the
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feeling is reassurance something like that because they
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ain't going to remember those words there's that lovely phrase from Maya Angelou's they
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don't remember what you say what you did but they do remember how you feel how
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you made them feel so hopefully whatever we're going to do in that explanation
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if there needs to be much of one it's hopefully help them feel whatever it is
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safe reassured positive hopeful able to move forwards.
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So I just waffled there for three minutes. That was a terrible way of me explaining
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because I should be breaking it up into chunks.
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No, that was great. It was beautiful. Really nice. And it so encapsulates,
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I don't want to say a lot of what clinicians do wrong, but what clinicians could do so much better.
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I love the, do you think the fact that clinicians do go into this long explanation,
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even if they haven't been asked about it, even if the client is not going to
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remember most of it, do you think it's part of a security thing where it's part
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of this clinician seeing themselves as like a fixer, as an operator, as part of their role?
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So what's wrong with the today is? Is it part of that to make them feel more confident? Maybe.
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I don't know if there might well be literature out there on it about why certain
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clinicians feel they need to.
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It will, of course, be different for different people.
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By the time people get to me, they've often had the diagnosis.
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Occasionally I'm giving a new one, but very rare. Most of the time they've seen
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ex-professionals multiple times and they've got this diagnosis, whatever it is.
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And then they might want to know about why and how this all came to be.
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We can talk for that, use the story, etc.
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But I'm sure there are, and especially when people like are coming through early
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or may just have not been exposed to the kind of things that you and I have,
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where we might feel obliged to say, I'm the expert here, I must then show my
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expertise and my knowledge by explaining this.
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Even with the risk of potentially making them feel worse yeah so true, it's very good,
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and it can change so much like you say if you.
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Put your focus on i'm going to affect how this person feels as
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opposed to i'm going to tell this person exactly what's wrong with them
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and what the literature says then geez you're
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so much helping that person in front of you much more
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we've got david halter in the house of course david thank.
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You much for joining us david he's listed in.
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Order i want to go to his second one we'll do his first one first david says.
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Kudos ben um of course we can identify oh
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he was backing up your issue i can't wait
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to send that to a clip kudos man of course we can identify obvious issues
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in the tissue stress fractures are a good example yes everyone is bps
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the blend is different in everyone listen first seek
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to understand very nice and then with regards
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to what we were saying just now i think david's put it
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very nicely as he does people always remember how they felt
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listen be responsible to them not for them
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there's a there's there's a t-shirt in the making be responsible to
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them not for them nice very cool
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i like that david thank you very much and nicky mansfield has
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all you got people talking now nicky mansfield has also added
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here i'm sure i've lost a few clients at their first appointment intending
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to help them move past some of the civic paradigm they've been
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told in the past but it hasn't landed right and i've invalidated their
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stories yeah i mean can i give you an example yeah
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i remember seeing someone fairly recently who you
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know had some changes on their scan that you might expect
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but they'd been given this
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impression from a someone not
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in my service to elsewhere but had a much
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more senior title than me much more qualifications you know very specialist
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etc more long more qualified than me and this person had already been through
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the mill with their pain and not getting anywhere and this person then turned
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around and said you know what yeah your bones here They're bone on bone.
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We just need to replace everything, basically, in a surgery.
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And I could easily, if a person comes in to me, we do this, you listen,
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as you do, you take the story, you go for all the usual things.
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And I could try and edge into about mentioning one of these other factors at
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play that I think people have tried to mention.
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But again, we were talking about earlier, where are they?
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Are they at one end of the kind of line to where you are thinking?
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This person then has this offer of a surgical thing
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that will well that's been potentially sold to
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them as it will cure right will solve their
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issues even though the evidence and everything else was not the
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best idea and i could
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touch on a few things but i know that if i went
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full-blown how can i call this biopsychosocial addressing
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all the elements is that person in
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of me really going to a want to take it
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in or b care if they've been then given this option earlier
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of it's all right have the surgery you'll be
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fixed so this is
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the unspoken of explanations everyone talks about using analogies
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and making it simple blah blah blah which is
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true but the thing we don't talk about enough of
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is timing of it because we're
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given a couple examples already there where you can be right
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scientifically evidence-based right but wrong in their eyes that makes sense
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because beliefs of course go across the whole spectrum you know we all have
24:37
different beliefs of different things some which are backed by data and some which are not.
24:43
And i think you know we have to we said earlier meet them where they're at i
24:49
could have gone into a whole,
24:50
if I wanted to be that person you talked about earlier, the clinician who feels
24:54
need to explain everything to show off their expertise, try and get that person
24:57
to buy in potentially, right?
24:59
I could have gone into the whole explain pain spiel.
25:03
And I didn't do it, so I don't have the foresight to know what would have happened,
25:07
but I can predict in my mind that it probably wouldn't have ended well.
25:11
So we have to be mindful, not just of, yes, the words we say,
25:15
we don't want to be scared, scared with the words, make sure it's all safety.
25:18
But we want to make sure it's the right time for them.
25:23
You know, this is where the validation bit comes in.
25:26
And even if you want, you know, you're right,
25:30
it doesn't always mean that telling them the right stuff, not the right stuff,
25:36
but what's evidence-based, you
25:38
know, what should in theory be correct and helpful might not always land.
25:45
Very cool. Definitely makes sense, the timing. Okay, so far, this is great.
25:50
It's just turned hard past. So excited we got in a half hour.
25:53
So we've looked at, don't, for want of a better word, just vomit out everything
25:57
you know about the diagnosis because it's not what the person in front of you
26:02
might need to hear. It could make them worse.
26:05
And also, yeah, that links in with the timing as well.
26:09
And even though you know you're right inside, I think a lot of therapists who
26:13
kind of want to be evidence-informed and they feel the need.
26:16
I know I did in the early days of, you know, your goal in this life is to correct
26:21
the patient when they say something wrong because you believe it's going to hurt them.
26:24
But yeah, you could be hurting them by focusing on what you want to say instead
26:28
of them. So that's cool. Very cool.
26:30
Okay, what's next? What next have you got on your list? Some of the obvious
26:34
things we've touched on there.
26:36
Many people have said before, keeping it simple, right?
26:40
A simpler explanation, generally the easier it's going to be remembered.
26:44
Now, simple is variable.
26:45
What simple is to you and I is different to someone else, different to another person.
26:50
So you can go more technical if you think they want it.
26:54
You can literally ask them. We've got this basic information, but we have it more.
26:59
We can go more technical if you'd like. I would say if they are already coming
27:03
in using technical language,
27:06
You can try, but that doesn't always guarantee they actually know what it means, necessarily.
27:11
They may have looked stuff up on AI or whatever, and they're trying to use big
27:17
fluffy words to potentially give the impression that they know a lot.
27:22
But in reality, they might not.
27:24
But generally, the general rule of thumb is, and plenty of people have said
27:26
this before, the simpler the better.
27:28
People talked about analogies before, right? But the key thing with analogies
27:32
is it needs to be relatable to them.
27:37
There's no point using an analogy that you love if they don't know what it means, fundamentally.
27:45
So just make sure that whatever analogy you're trying to use to achieve the
27:50
feeling of safety or positivity or hope or whatever it is, they need to be able to relate to it.
27:58
I think it's completely unrealistic for people to have 10 000 analogies in their
28:03
back pocket that whenever you have a builder or an electrician or whatever to
28:06
come in front of you you then,
28:09
pull out your relevant i don't know jockey analogy
28:12
and use that that's not cool but ideally something that most people can understand
28:18
that's why the good old alarm analogy of pain most people grab because everyone's
28:22
got a house alarm or car alarm right so generally the more general and easier
28:28
to understand the better.
28:30
And plenty of people have also said this before, that the analogy needs to be
28:35
not scary, not nocebic, things like, well, I say this, but hopefully not that
28:42
people say the jam donut analogy for discs too much anymore.
28:46
Or other ones, I don't thankfully hear too many things that make me cringe these days.
28:51
But just whatever it is, it needs to be an analogy that has a positive feeling attached.
28:58
Yeah, what do you think?
29:01
I'm trying to back to you. Well, you know what I'm doing there,
29:05
Matt. I know exactly what you're doing.
29:10
Analogies. So, could you give me an example of where you are trying to explain
29:15
a diagnosis and you think an analogy would help, first of all?
29:22
So, the one we use, when people often ask us,
29:26
I wish I had a question for you, what people often ask us about well with this
29:32
pain they've got they say about what's going on they'll have this label whatever
29:37
the pain is so we'll use an example of fibromyalgia here they've got this label,
29:43
got an idea of what the symptoms are because they have them and someone's gone
29:46
through the screening criteria, asked them the questions, they've gone, yeah, yeah.
29:50
So they have an idea of what the condition is, but they may not know why.
29:56
So if I roll this along with you, Matt, let's say you've been given the label and you want to know why.
30:02
And there's been bits of talk from
30:05
other people you've seen about the nervous system and about it being sensitive
30:08
and a bit alert right and you've got this message about you know things giving
30:14
us messages when they should and etc but you turn to me and say well why right
30:21
why is going what's happened to cause all this,
30:24
so something i will use and we do this in both individual and with our group
30:29
programs is something i call the cocktail analogy and i'll literally draw a cocktail glass,
30:38
on a board or on a piece of paper and i'll
30:41
ask them what's your favorite cocktail so matt what is your favorite
30:44
cocktail if you have i think what someone did
30:47
make me the other day i don't normally drink but if i'm on a mission because
30:50
it's something like new year's eve and i need to numb myself against social
30:53
anxiety then i think i'll go for what's it called an old-fashioned is it an
30:57
old-fashioned i wasn't an old-fashioned oh no it's history right who's here
31:04
i'm nicky Nikki, you can tell us what an old-fashioned display is.
31:06
I think it's a mixture of whiskey and rum and bitters, and then you set light
31:11
to it and make it smoky or something, yeah. Fine. So...
31:16
Let's take that old-fashioned. Sorry, you did ask me. No, no,
31:19
no, no. I should have said margarita. You could have said sex on the beach.
31:24
That's another story we'll say. So the old-fashioned, I'll draw the cocktail
31:29
glass and put those ingredients into the whiskey and the rum.
31:32
And next to that, I'd write activity levels, sleep, work, and then a few other
31:39
ingredients there that are in part of your life.
31:43
Now matt if i could give you anywhere
31:44
in the world to go and drink this old-fashioned where would you go.
31:49
Does it have to be a place? This sounds such a bad person to use role play with.
31:55
Okay, now just say something simple, Matt. Okay, I will. I'm probably in a nice
31:59
Tudor-style hotel in the country somewhere in the evening.
32:05
It's quiet. So you're in your Tudor-style country fancy hotel.
32:12
It's 6 p.m. in the summer. Sun's out, slowly going down, but nice and warm.
32:17
Waiter comes out with the old-fashioned puts it down in front of you little
32:21
umbrella there on top glistening you're about to go drink it and this is going
32:26
to be your cocktail of life,
32:29
but just before you do i'll come along and i'm going to add some salt some sambuca,
32:39
add some um let's go for ginger beer
32:42
as well how's that
32:45
going to taste i'm sorry who are you what you do in my
32:47
hotel to start but you just let's say it's not good yeah
32:51
i'm not happy might even harm you potentially i
32:54
don't know so the then what we do is i'm right next to those new ingredients
33:00
i've written there so the pain itself there might be the less social interaction
33:07
you've had because your pain not want to go out as much there may be what i
33:11
call nocebic effect We said about that earlier,
33:14
but iatrogenic effects, which is where you go to see a healthcare person and
33:17
they make you feel worse. Yeah.
33:21
But all that in turn might then affect your sleep, which might affect your workability,
33:24
might affect your activity levels, etc., etc., etc.
33:28
And at the same time, I would draw this. So I haven't said this yet,
33:31
but visual is an excellent way to help someone understand something as well.
33:39
Because probably I think it's the least effective way of learning something
33:42
is by sitting down and someone just talking at you.
33:45
Most effective way is to learn it and teach it back.
33:48
But adding at least a visual that could be
33:51
i'd like to draw it could
33:54
be a relevant picture where again it's not scary okay
33:58
not of like some you know
34:01
you type into google sometimes you just want to look at a bit
34:04
of say about knee arthritis you see these bones coming together
34:07
and they're rubbing all that stuff you don't want that so a
34:10
relevant and hopefully appropriate picture videos
34:13
again same thing but with a bit of a visual because
34:16
you know what's that phrase a picture's worth a thousand
34:19
words or something so i draw that
34:22
at the same time with the words together that
34:26
gives the impression it's all these factors together
34:29
that are then influencing each other and a cocktail if
34:32
we all think of a cocktail it's this mix of ingredients right most people
34:35
can relate to a cocktail or even if they don't drink they like tea
34:38
hopefully or a mix of something so it's this that's one example we i use with
34:44
both individual and group it takes a bit of time as you heard me say there but
34:51
if i can draw it and use their personal things that they've said along the way.
34:58
So you may have told me in your story that you went to see someone and you didn't
35:02
feel listened to well i put that in the ironic bit you may tell me your sleep's
35:06
rubbish i could put that next to that you may tell me you're feeling more stressed
35:09
or your mood's not as good so i can put that in as well.
35:14
And that's just one example that I think, not that I've had any direct feedback
35:19
after I've done it in written form, but from my understanding,
35:23
what I can see, they seem to get the concept, at least.
35:27
I'm just trying to give the feeling of, it is influenced by multiple things.
35:32
Okay, this is more than just my back, or it's more than just my joint,
35:37
or just my nerves, or whatever it is. trying to give the feeling of okay there's
35:42
more to this than just you know what's in my body,
35:47
Very nice. No, that's great. And for me, even though I knew kind of,
35:53
obviously I know you're setting me up for something, I couldn't help but feel
35:56
drawn in because you involved my, you invited me to create the story with you.
36:02
Yeah. I was thinking of what I do actually like, so suddenly all my senses are
36:05
like thinking, oh, that tastes nice and my ears are open.
36:07
So that's a really good idea. Have a generic one, but which you can make personal. Yeah, very powerful.
36:14
I like it. And Nicky, I'm like Nicky thinking you used to manage a pub or something,
36:18
didn't you, in another life? But yeah, she says, that's right, Matt.
36:21
Fireworks optional, though you must have had a posh one. I made that up.
36:24
I've never been in a Tudor hotel with somebody serving me old-fashioned.
36:28
I just needed to give him this answer quick.
36:30
Yeah, very nice idea. Thank you.
36:32
Brilliant. Maybe that's an idea for the summer.
36:35
Say again? Maybe that's an idea for your summer holiday. I think it's an idea
36:39
for Thursday night at a therapy show.
36:42
I think that's what we're going to find now.
36:45
Wonderful. This is great. It's giving people so many ideas. Don't forget,
36:48
I'd also, if you have joined us live, then maybe if you've had a problem explaining
36:52
a particular diagnosis,
36:54
or maybe you're working on something at the moment, thinking I've got to tell
36:57
this person, I'm not quite sure how they're going to react this way,
36:59
then feel free to put some questions in.
37:00
And that includes if you listen to the podcast let the i always say
37:03
let the conversation continue even though the live recording is over if there's
37:06
any ideas and you're watching this episode maybe on youtube or listening to
37:09
it jump over to youtube and stick it in there and i personally have a look at
37:12
those threads and i will pass something on to ben and see if we can get some
37:16
feedback so let the conversation continue right then what next do you want to
37:21
say about well what i have been doing
37:23
and you've but you've thankfully been without me even having to do it that much
37:27
is checking your understanding along the way.
37:31
So it's all very well and good to whatever however much you are or not going
37:37
to save your explanation you're,
37:40
checking their understanding of what you said you
37:43
don't literally have to be like right repeat back exactly the
37:46
words i've said blah blah blah because they're not going to and that's
37:49
a bit weird you can do the kieran
37:53
o'sullivan test many people have talked about you say after
37:56
you've finished i know you're going to go home and speak to your other half
37:59
later what will you tell them from what we've discussed today that's fine but
38:05
an easy one really and again it's more about the feelings then the data is we've
38:12
said it a couple of times what are your thoughts right,
38:16
because fundamentally they're not going to remember most of the words you say,
38:20
that cocktail analogy you use they're not going to remember most of the words
38:23
that I've written up there all the ingredients blah blah blah.
38:27
But if you ask them about their thoughts well yeah I can see that that's related
38:32
to me then that might give you the impression that they're you're getting some
38:34
empathy at least that you're showing that you're understanding what they're going through,
38:38
it may also give you an impression that if they don't agree with you and that's
38:42
fine too because you get an idea of how they feel about it.
38:48
Some people just go, yeah, fine. And that's fair enough. You can't force people to...
38:55
You know, give their full thoughts. But some people will say, oh, yeah, I get this.
39:01
And I'll do about that. And they'll kind of keep the convo going, so to speak.
39:06
So checking understanding, please don't do the drill, Sergeant, of does that make sense?
39:13
Because you will always get, yeah, sure. And it doesn't make sense.
39:17
That's really nice. That really fits in with, although it's not kind of like
39:21
solely motivational interviewing, but it fits in with what Ola was saying.
39:24
And even rich last week with open-ended questions
39:27
and things if you really want to give someone a chance to say
39:30
how they feel about it then it needs to be a how or why or when
39:33
and who and that sort of stuff rather than like a closed-ended question like
39:36
you just said do you understand does that make sense and it's weird isn't it
39:39
because i think again it kind of ties in with how you started off with clinicians
39:42
who are feeling that they're getting the money to deliver information and the
39:47
more i can talk to you the more i'm going to give you the more i'm worth my money when really,
39:52
the money they're paying is for you to go how do you feel
39:54
about that and then just shutting up yeah for a minute or two depending on you
39:58
know what your goal is and i think clinicians need to realize that your worth
40:02
is when you're not talking sometimes and that's a real foreign kind of concept
40:07
for some clinicians to get well that what you're saying how do you feel about that,
40:13
they may have grasped the diagnosis already they may know what is going on they've
40:19
looked it up they're fully on board, you know, they've got the concept. Yeah.
40:24
But how they feel about it may be very different. You know, you can clarify
40:30
what they know. They may know a lot about their condition.
40:34
They may have looked up in advance and someone just said, yep, that's right.
40:37
But that doesn't mean necessarily they feel they can manage it or that they
40:42
feel empowered or that they can trust you, whatever it is.
40:46
Because it's those feelings that will dictate the future, not just how well
40:52
they understand it or not.
40:54
You know you could give someone all the again i'm saying this from a pain side
41:01
but you give someone all the kind of understanding pain neuroscience stuff right
41:05
and all the facts and they can you can force them to sit down and learn it until
41:08
they can score perfectly on a test,
41:11
that does not mean they're going to feel that they can manage their condition
41:14
better it just means they know some facts facts don't change feelings necessarily.
41:21
If it did our world would be a very different place i'm sure we wouldn't have,
41:25
people doing half the things that affect our health.
41:30
So this is really, I guess, one of the key things from all this.
41:33
Apart from, you know, knowing what they know first, what do they really want
41:37
to know, how can we influence those feelings from the explanation?
41:42
And as you rightly said, that may be saying very little.
41:47
They may just want to vent that they've been given this diagnosis and they ain't happy about it.
41:54
Doesn't mean they think it's wrong necessarily. They may think, yeah, I can see that.
41:58
I can see what's just happened, but they may be, you know, just need some time.
42:02
We talked about timing earlier.
42:04
You don't, if they've got it, is it then the right time to actually even try
42:09
and help them manage it if they're still in this potential grief phase, depending on what it is.
42:13
If it's a very big diagnosis, that could be life-changing or different to what they thought.
42:18
Are they so focused and,
42:20
how can I say, absorb with the feelings of that, that actually they need to
42:25
go through that first before they then try and move forward with explanation
42:29
about how they can actually manage it. Might not be the right time for that.
42:33
Very cool. Very good. I'm just going to ask you as well to stop juggling with
42:37
your microphone. Sorry.
42:39
I'll hold it. It sounds like you're kind of sitting there. I can't believe a
42:42
man of your professionalism is still... I remember the last time you joined
42:45
us, you were holding this microphone in your hand. I'm still holding it,
42:47
yeah. Yeah, I need to get a stand. I know what to get you for Christmas.
42:49
I think it's also worth pointing out that clinicians really don't appreciate sometimes,
42:55
that even though your client or patient is looking at you
42:57
and kind of nodding in their head
43:00
especially if they're in pain they're not listening to
43:03
them watching your mouth and just thinking oh I'm going to do this evening I'll
43:06
tell you what I'm probably going to do is take two paracetam and they're not and
43:09
they're not listening so I think giving them that chance you're
43:12
not trying to catch them out but giving them identifying that is
43:15
so important as a clinician and it doesn't the other important thing
43:18
i wanted to add was if you do check for understanding and
43:22
you realize they haven't been listening to you at all then you've
43:25
got to avoid the anger yeah i think it's a natural human reaction of yeah i
43:30
can't believe i've just given you such a great whole cocktail thing and you
43:33
didn't need a word so how i'm interested in how i'm sure that's happened to
43:37
you before you've had people just staring at you and then they haven't been
43:39
listening to you haven't taken any in yeah and you realize it how would you
43:43
react if that happened should you react,
43:47
i guess what you don't want to do is exactly what you said there and be like
43:50
come on i just explained this to you so don't notice that you know the einstein
43:55
quote is you know doing the same thing expecting a different result is the insanity
43:58
isn't it so don't just do the same thing over again because we didn't land the
44:01
first time i ain't gonna land the second time.
44:05
I you know if you've if you've asked them what are your thoughts and actually
44:10
get the impression and haven't really heard it or actually the focus has been elsewhere.
44:18
It's a good question because,
44:20
I'm trying to think of a time that's happened and nothing has come into my mind,
44:24
but what would I do if that happened?
44:26
Maybe I'd say, if that's clearly not landed, maybe they're not interested.
44:31
They're not going to magically become interested if you say it a different way, probably.
44:34
So I might almost try and move it along a bit. So what else would you like to
44:37
know? What else would you like to discuss?
44:42
Because none of us, unless there's a tiny amount of clinicians on stage that
44:47
can be very entertaining, but in a clinical environment, No one's so entertaining
44:51
that we can, you know, graph someone's attention like they're watching a movie. Okay.
44:56
You know, we may just mean that they've.
45:01
Weren't interested in that necessarily or other thoughts
45:04
had popped up and actually would they like to discuss something else
45:07
or you know it's an
45:11
interesting one because i always answer i'm trying to literally think i mean
45:14
i did put your thought of it i mean for me the reason i ask it
45:17
is because i do a lot of work i work with neurodivergent individuals
45:21
and i've got the facebook group and one of the traits of
45:24
being new divergent is if you
45:27
do if you're having a problem assimilating the
45:30
information going in it could be because you're focusing on someone else i
45:33
do speak to individuals who have these problems conditions where they're it's the
45:36
other way around the patient is talking and and the individual
45:39
is basically just looking at maybe a little on their cheek and staring
45:42
at him yeah and then suddenly the client stops
45:45
and you're like and so it works both ways but you
45:48
might have a patient as well who just really is
45:51
not at this current moment taking what you're saying the things
45:54
we talk about is if that happens you've got
45:57
to realize that it's probably to do with
46:00
the environment something to do with the environment an external factor
46:03
is not making this a nice place for
46:06
this patient to assume its information so it could
46:09
be something's going on rather than getting angry so you need to change the
46:12
environment maybe or think is it the wrong time yeah or do we need to get on
46:16
with something else maybe to have this conversation while we're doing some movement
46:19
or something needs to change so it was a bit of a loaded question for you i'm
46:22
sorry about that i just about you saying about the neurodivergence something I've done a few times now.
46:29
Which I think has helped if you have someone who's come in who's got the diagnosis
46:33
or thinks they have the diagnosis.
46:36
I've usually asked before we've even finished the subjective part.
46:41
What's the best way to help them if we need to explain things or discuss things
46:44
what's the best way for them to take it in or for them to try and grasp it usually
46:49
a lot of the answer is just say it simply and to the point but I find that helps,
46:55
with that just you know in advance rather than kind
46:58
of trying to judge it off them and their character etc i
47:02
think it's something i've found more recent that just and i think they like
47:06
being asked as well so yeah that's just a quick thought about because you said
47:11
that's great and you had an amazing conversation not long ago with rosie section
47:15
which was a really good episode that was part of the clinical communication
47:19
wasn't it yeah i can't remember what number it was.
47:23
I mean all of your episodes on clear communication are marvelous
47:26
and in actual fact what i quite like is
47:29
again i don't know if i'm being on the spot but have you had any
47:32
particular either recent conversations on the podcast that
47:35
have really had an impact on you or you've got favorites of all time and
47:38
please don't say when i was on just be a lie but is there
47:41
any which kind of as a professional communicator educator
47:44
yourself is there any which stick in your mind which you think wow that was
47:47
just such a valuable episode i think
47:50
the ones that i've done that the one
47:53
that has done the best by far and it
47:57
probably is because peter o'sullivan shared it is from last year with ian cowl
48:02
and we discussed about reassurance and that i think because it was no it's reassurance
48:09
is one of those things that again we just assume we've done in a way like we,
48:16
it's under it's under researched even compared to things like therapeutic alliance and,
48:23
empathy and stuff like that there's not a lot out there on reassurance in general
48:28
so I think that was kind of,
48:30
valuable i also what was surprised me and again i whether it was again because
48:38
it's quite a novel thing it's growing more talked about these days but kate's
48:44
surname who's gone from me my top of my head at the moment but we did a how to teach episode.
48:51
And that was actually the fifth most downloaded of the year and there was no video,
48:58
and we're going to do How to Teach 2 soon. But it surprised me how many people
49:04
were interested in that.
49:08
And I thought, well, we'll do this, but I did that more for my own personal
49:11
interest and thinking, oh, you know, this is teaching, but most people just
49:16
want to know about the conditions and whatnot.
49:18
But no, that one did surprisingly well. It had no video. Compared to most of
49:23
them, it has some video that goes out too.
49:25
That's really cool. That was episode 44 with Kate Purcell. There we go.
49:30
I think I caught that. Yeah, really good. And it's something we've talked about
49:33
on the podcast as well. On our courses as healthcare professionals,
49:36
we're not taught to teach.
49:38
We're not taught how to be educators. We're not taught to recognize things like
49:42
that. We are taught still to be fixers, basically. Things need to change.
49:45
But yeah, massively important. So it's not surprising if you are looking for
49:48
CPD, then somewhere along the lines of communicating or teaching would be a good place to start.
49:53
Don't just look for more ways to do things to people. You've probably got loads of them.
49:58
Okay, that was a good one. Okay, thank you for that. Right, it's five minutes to the hour.
50:05
We've already talked about you coming to a therapy show, so we're really looking forward to that.
50:10
Just in case you have joined us and you've missed the beginning of it,
50:13
then if you are coming to a therapy show this November 25th and 26th,
50:18
then Ben is going to be speaking on the 25th, 10.30, in Clinical Skills Lab,
50:24
and then at 3.30 in Theatre A. So do catch Ben then.
50:30
Anything else going on in your life in between now and then,
50:32
Ben? What have we got going on?
50:34
Anything you can talk about? That I can talk about? Yeah. There's a surprise
50:38
next month, but that's a surprise. I can't tell you about that yet.
50:40
I thought you made a face of.
50:42
Never play poker. But that'll be it. Once you see it, there'll be no people
50:46
know what it was, know what it is. But otherwise...
50:50
I've got to do another, the Northeast Musculoskeletal Society Conference.
50:54
That's in the end of September in Durham.
50:58
I've got a couple of webinars tomorrow
51:00
on the widespread pain differential diagnosis with clinical physio.
51:06
And just that guide that we talked about at the beginning, that will become
51:12
an article at some point.
51:14
Let's send it somewhere. and
51:17
otherwise just trying to spread the
51:20
good word matt just like you are i do a grand job in
51:23
that as well in fact i saw if anybody's interested
51:26
in just stimulating thought and having something to
51:29
think about during the day your your feeds are fantastic i think
51:31
the last one i saw today was the therapist explained
51:35
to the guy about how much he should be drinking oh which is
51:38
really cool i mean you put some wonderful material out there and you
51:41
just and you don't again you're you're delivering what you've said in
51:44
here you're not giving people the answers you're just saying to people what do you think
51:46
about this yeah you know and it's it's um some
51:49
really good which leads me into if people do want to follow you and and
51:52
contact you is i know you're on instagram yep um is that a good place people
51:56
to follow you yeah instagram and then linkedin i do have the x account but like
52:02
a lot of people it's just not being used that much anymore yes that's weird
52:07
isn't it instagram and And Instagram,
52:10
you are B-Y-Brow Physio.
52:12
So that's B-W-H-Y-B-R-O-W Physio.
52:15
And then on LinkedIn, it'll be your name. And then the Clinical Communication
52:18
Podcast available on all popular podcast apps, including Apple Podcasts and
52:23
Spotify and all that kind of jazz.
52:24
So definitely worth checking out. Some really great episodes on that.
52:28
Some really interesting conversations.
52:30
Right, Magic. So thank you so much, Ben, for giving me the time. That kind of flew by.
52:35
Next week, people, thank you for everyone who joined us live as well. I really appreciate it.
52:39
Next week, if you're listening to the podcast and want to join us live for the
52:41
final episode of this series on communication skills and mental conditions,
52:45
my special guest is going to be Serena Simmons, fantastic educator, psychology school.co.
52:50
She will be introducing us to the psychological patterning process.
52:55
Which I imagine is quite a new thing that she's come up with after years and
52:58
years and years and years of specializing in behavior change.
53:03
She's now suddenly realized, hold on, hold on, hold on, we're missing a little bit here.
53:06
We're jumping into trying to change someone's behavior, and we might be missing,
53:09
not with all clients, but with some clients missing something else,
53:12
which she has come up with as psychological patterning process.
53:14
So it's going to be a nice end to the episode. I'm looking forward to it.
53:17
If you do want to join us live, I recommend it. Serena's a fantastic educator.
53:20
We had Serena Simmons at the Exmouth ST School Conference,
53:24
and we're so well received such a fascinating character who also has a side
53:29
hustle of forensic or psychology forensics for serial killers which is always
53:34
a conversation at the pub afterwards,
53:37
so yeah join us for that if you fancy that will be again as always on YouTube
53:41
and on Facebook at 8 o'clock UK time and this case Tuesday May the 26th we'd
53:46
love to see you some of that thanks to everyone who joined us live David Poulter
53:49
thank you for your words of wisdom as always I think he's what country has Dave joined us from today.
53:54
There should be a little piece of advice. Isn't it Aziz? Where's the Aziz?
53:57
From the Azores. Brilliant Chan Inver.
54:00
Azores? Sounds Spanish, maybe. Maybe Spanish. Or maybe South American.
54:03
Or could be French. I don't know. I don't know. I'm sure we'll find out very quickly.
54:06
But David says, Galician should strive to be good receivers,
54:09
not transmitters. It's great. It's good analogy in itself, isn't it?
54:13
Most have it the wrong way round. He also told us it was Kate Purcell.
54:17
He's just so on the ball. He doesn't stop. And he's probably doing this after
54:19
a 100-kilometer ride on the stationary one.
54:23
Amazing. Nicky Manson says, Smashing chat. Smashing chat. Thank you, gents.
54:28
Gary Benson says, Thanks, Ben. Looking forward to meeting you at the therapy show later this year.
54:33
And thank you, Gary. And thank you for coming back already with,
54:35
yeah, we know it's called the Azores, Dave. We don't know where it is. It's in Portugal.
54:39
Is it Portugal? I've just looked it up, yeah. Oh, well done.
54:43
It all seems too far off. All right. Thanks, everyone, for joining us live.
54:46
I really appreciate your time.
54:48
Thank you, Ben. Thank you. I'm sure we will talk before November,
54:51
but again, we haven't met in person before, have we? I don't think no no no
54:54
fantastic I'm looking forward to meeting you so cool but yeah we'll talk again
54:58
soon thanks again likewise,
55:00
Everybody, join us next week if you can. Until then, make sure you take care
55:04
of yourselves and take care of each other. We shall see you later. Bye-bye.