Clinical engagement

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Clinical engagement

• Dr Alf Collins
• Consultant in Pain Management Consultant to PTW
  Programme
• Somerset

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My clinical work pain management
Managing life with pain
Managing pain
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Our service we are not perfect!

• A musculoskeletal interface service that sees
  6,000 new clients per annum
• All people initially seen by a physiotherapist
• Close collaboration with an orthopaedic
  department of 10 consultants

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The underpinning philosophy

• To ensure that the people we see
• are empowered to live as fruitful and independent
  a life as they would wish
• share decision making re the treatment or
  support they receive, informed by tailored,
  helpful information

I went to the doctor with a problem. I came
back with a disease
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Goal-driven recovery growing confidence

• Reasonable goals
• Self-adjustment (response shift)

Self-management skills acquisition
Acceptance Readiness to change
Best evidence disease/ symptom management
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The psychology of living with a LTC
Ongoing health-related suffering despite optimal
medical management
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The psychology of living with a long term
condition
thoughts
feelings
Social roles
beliefs
Actions/behaviours
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The psychology of living with a long term
condition
impairment
thoughts
Symptoms,
context, meaning
feelings
Afferent input
Social roles
beliefs
Actions/behaviours
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Fear and avoidance behaviour
Culture, development
symptom
Anxiety, fear
Worse symptoms at lower thresholds
Illness beliefs
Doctors
Experience, conditioning
Disuse, Disability, Depression
Activity avoidance
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Cellular pathology
Organ pathology (impairment)
Symptoms
Disability
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Impairment and disability
disability
impairment
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Impairment and disability
disability
Disabling conversations
Enabling conversations
impairment
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All this can be very difficult for some
clinicians

• Challenges supremacy of disease theory
• Compartmentalises biomedicine into just one
  aspect of an individualised care plan

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The therapeutic imperative a matter of
expectation
Of course Ill order another test
Please help me
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Being a frontline clinician
Needs of DH/SHA/Trust
Needs of individual patients
Needs of service
Need to maintain professional standards
Need to nurture self and family
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How can we help you to align these needs, so
they dont compete and so your life is easier?
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Co-create services

• Support clinicians in working with patients
  as partners in service redesign

Clinical evidence and expertise
Patient experience and expertise
Co-Created services
What skills or training do you feel you need to
be able to work in this way?
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Co-produce outcomes

• Support clinicians in working in partnership with
  patients to share decisions about desired
  outcomes from all clinical encounters

A meeting of 2 experts
Shared decision making
Co-Produced outcomes
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What are the wins for clinicians?

• Co-created services
• Needs of individuals and populations are aligned
• Freshness and vitality of working strategically
  with patients as partners
• Shared decision making/co-produced outcomes
• Shared responsibility, shared risk, shared work!
• Difficult patients (difficult consultations)
  become rare indeed
• Less stress all round

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A challenge

• The professional agenda
• Evidence based care/treatment
• Professional guidelines
• Systems and pathways

• The agenda of a person with a LTC
• Individualised care
• Values and beliefs taken into account
• Mental model for condition may not match the
  medical model

PCP
Communication skills healthcare partner and
navigator
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What is the key to engaging clinicians?

Engaging patients total collaboration. The
Wanless fully engaged vision