Social media in the PT world has been buzzing recently with the news of Tiger Woods’ 4th spinal surgery and Steve Kerr’s comments on his past back surgery. As PTs, we often urge our patients to avoid going under the knife–especially for the treatment of persistent pain. But what happens when the patient comes to you with a strong expectation and belief that surgery will help? That surgery is the right option and was developed from another healthcare provider that they trust? Do we adamantly educate the patient against this option?
I have to say that my immediate reaction is to shout from the high hills to run away and don’t ever look back at the option for surgery. However, we need to look at the patient’s perspective. It is important to consider if the patient is ready to change their beliefs/behaviors. This brings me back to a recent blog post by Jessie Podolak where she discusses the different stages of behavior change which I feel can relate to the different stages of belief change. Are we assessing where the patient stands on their ability to change their beliefs? If a patient comes in and is ready to hear other options besides surgery, this provides an open window for us to potentially shift their stance when surgery might not be the best first line of treatment (i.e. persistent back pain). But what happens if the patient is dead-set on having surgery? Do we even try to change their mind?
Again, my immediate thought is to ram information down the patient’s ears on why surgery may be the worst option for them. However, I have had to take pause in this mindset. Will I truly be able to change the patient’s beliefs if I go about communicating in this way? I think we need to recall Louw and colleague’s work on pre-surgical pain neuroscience education (PNE) (1 year follow-up study here) and (3 year follow-up study here). The authors found significant healthcare savings and positive beliefs about their experience with surgery with only one 30 minute session of PNE. This reminds us that although a patient may go on to have spinal surgery, we can still have downhill effects if we intervene before that procedure. Imagine what could happen if you had more than one 30 minute session with someone who is dedicated to having surgery.
The idea of this pre-surgical interaction reminds me of a comment made on Kory Zimney’s blog post from last month. John Ware commented on this blog where he brought up a great analogy stemming from Lorimer Moseley that I think we must consider for those that may be set on surgery:
“I also use Moseley’s analogy of “preparing the soil” so that movement takes place in a new, rich and fertile environment where new behaviors can be allowed to grow and flourish. But you still have to tend to the garden, and you’ll have to pull some weeds from time to time. You also may have periods of drought or storms that require you to replant. But, at least you have the soil there for behaviors to grow again. At the very least, you have the knowledge of how to rejuvenate the soil to make it rich and fertile again.”
Those storms may in fact be surgery–dare we say that surgery is OK? We may not be able to change everyone’s stance on whether their invasive procedure is the right way to go, but we need to plant those seeds in the hopes of growing belief/behavior change. They may grow in one visit. They may not. The patient may go in a direction that we don’t agree with, but we must keep our arms open for them if (and when) they come back to us. We have to be ready to tend to the garden when the flowers begin to grow.
To learn more about pain neuroscience education (PNE) and how to use it in your clinic, check out our course today!