BHIPs and BHAGs: Do the Something You Can Do

Have you ever heard the term BHIP? No, I’m not talking about a bilateral hip issue. And no, it isn’t texting code instructing one to “be cool.” A BHIP is a Big, Hairy, Impossible Problem. I learned about BHIPs many years ago in a leadership development course, and the concept has always challenged me.

There is no shortage of BHIPs in the world at large, in health care, and even in terms of individuals’ lives. For example, issues of poverty, violence, inequality, and oppression plague people in every corner of the world. Obesity, addiction, depression and cardiovascular disease are rampant in the US. And, we have all been touched by personal tragedies that seem impossible to overcome. BHIPs are everywhere, and the nightly news seems increasingly difficult to watch.

When faced with a BHIP, it is easy to lose hope. After all, what can I, just one person, do to combat poverty when there are millions of hungry people in the world? What can I do to combat depression and teenage suicide? What could I even say to comfort the grieving family of the fallen police officer in my neighborhood? How can I make a dent in the life of the complex chronic pain patient before me, who has lost everything she worked for due to this unrelenting pain? It can be entirely overwhelming.

But before we crumble with despair, we must take heart! We need to remember that we don’t have the responsibility to solve every BHIP we encounter, globally, or with our patients. It is completely, utterly impossible to do so, and no one asks us to. What I believe humans are wired for, though, is to do “the something” we CAN do, for those BHIPs that spark a passion in us.

Clearly, chronic, complex pain is a BHIP: escalating prevalence, increasing disability, out of control costs, hyper-medicalization of individuals, skyrocketing opioid addiction and overdoses, lives destroyed…B-B-B-HIP! Pain is an epidemic, and if we simply look at the statistics, we could easily throw in the towel, curl up in the fetal position, and rock ourselves to oblivion! However, many PTs, inspired by passionate, courageous leaders in our field, are daring to believe that we CAN make a difference in terms of how pain is understood and treated. This is evidenced by the rising popularity of pain neuroscience education courses, research into pain, and a call to develop clinicians who are pain experts.

When I think of my professional “heroes,” I see individuals standing up, in David and Goliath fashion, saying, “We CAN do better than this. We MUST do better than this. We WILL do better than this. Here is how we can start.” The pooling of knowledge and resources for the betterment of patients is inspiring, and we GET TO be a part of that. As I looked around the classroom of Therapeutic Pain Specialist students at the TPS weekend intensive course this weekend, I couldn’t help but feel that spark of excitement. Therapists from all over the country are learning how to “do the something they can do” in treating their patients with complex pain. And as our numbers of Pain Specialists grows, so does our influence…

One particularly inspiring conversation restored much hope in me this weekend. I was fortunate enough to spend some time chatting with Justin Dunaway, PT, DPT, OCS (@DrDunaway) and President of Stand: The Haiti Project. I HIGHLY encourage anyone who wants to be inspired to watch this video.

Justin’s passion to jump in to a seemingly hopeless environment, an area wrought with BHIPs, was infectious. To see him come alive as he told stories of patients’ lives changed was a breath of fresh air. Much like listening to Tim Flynn’s calls to stop the insanity of over-medicalization in LBP, or Adriaan Louw’s bold and hope-filled mission to change pain in America, Justin’s optimism and relentless belief in the possibility that he can make a difference reminded me once again of what I know to be true of BHIPs: When we listen to that spark, set some BHAGs (Big, Hairy, Audacious Goals), and DO the something we can do, we CAN make a difference.

So, what BHIP ignites your spark? Do you have a BHAG? What will you DO about it?



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