1. Package WHO ARE THE PARTNERS: Whose rights and voices do you plan to focus on?
I want to concentrate on patients with chronic pain. I'm aware that these patients often fall through the cracks of specialized treatments. Loeser's conceptual model can be used to assess a patient's perception of pain. According to this model, when a patient experiences the so-called 4th level of pain, their behaviour changes and is often wrongly interpreted as complaining by healthcare professionals. This is particularly common when the healthcare professional assessing the patient is experiencing burnout. As a result, they may blame the patient, disbelieve them, or think they are exaggerating and being a nuisance. This often occurs because the professionals feel helpless and emotionally distanced from the patient. This creates a vicious cycle, exacerbating the chronic nature of the condition and altering the professional's perception of the patient, who becomes an object to the professional. These patients want to share their experiences and personal stories, but the system doesn't allow them to be heard; instead, they are only given quick advice. Research indicates this is the main reason patients seek help from alternative medicine.
Professional literature often discusses patient empowerment, but in reality, patients are only offered passive treatments like painkillers and "passive therapies" (MT, physical therapy).
A multidisciplinary network of health and social care professionals should be created to establish a reflexive participatory partnership with the patient. Moseley's biopsychosocial model of care is often used for individuals with chronic pain. As mentioned, the team should involve specialists, including physicians, physiotherapists, psychotherapists, and social workers, to address their medical, social, and spiritual needs.
2. Package MOTIVATION
I will divide my motives into intrapersonal, interpersonal, and sociocultural levels. Interpersonally, I'm primarily focused on understanding the context and learning how to help the person by utilizing the perspectives of other group members. I find their different viewpoints on the issues enriching. I'm interested in gaining insight into the complexity and interconnectedness of various factors in developing chronic pain through the perspectives of other disciplines. I also want to become aware of my own emotions and opinions through reflexivity and share my concerns.
Interpersonally, I want to learn how to identify correlations and engage and empower patients in the solution to learn from each other. I aim to explore the most significant and open gateway to change a patient talks about. I want to learn how to manage conflict without winners and losers with the patient and other partners. Health professionals can learn to communicate with patients by removing their usual role as "fixers." Social workers can learn how to map and see "red flags" in a patient's condition, which can also help prevent burnout syndrome among participating professionals.
From a sociocultural perspective, I want to use the social workers' know-how and apply it to physiotherapy. This is not a common approach in the Czech Republic. I aim to overcome the dichotomy of "them and us" and the roles of social worker vs doctor vs physiotherapist, etc. I believe in unity and the humanity in each of us, placing the "I, the person who happens to be a physiotherapist" at the centre instead of the "I, the physiotherapist." This presents an opportunity and a challenge but can also be a threat if it fails, particularly when the hierarchical setup in the healthcare system is perceived as a threat.
3. Package OWN POSITION
My perspective is strongly influenced by my experience of interprofessional collaboration in a master's programme. In this programme, social workers and health professionals, including physicians and psychotherapists, study and learn together in an atmosphere of great collegiality and creativity. Additionally, my understanding of this subject is shaped by studying supervision studies, which focus on supporting and developing reflexivity in groups and teams. My position is, in fact, three-pronged: as a supervision student, a physiotherapist, and a human being.
From my role as a physiotherapist, I aim to build a network with other disciplines based on these experiences. Due to my studies, a group has already partially formed and meets regularly in supervision sessions I conduct as part of my supervision practice. We have been meeting in this manner for six months, and I see this as an opportunity to expand the meetings to include sharing experiences of caring for a typical patient. I also want to discuss the topic with a top expert in the field of medicine.
The most significant risk I see is the time commitment and the inability to provide financial rewards to participants to keep them motivated. On the other hand, my supervision can be extended, possibly through individual case supervision with my classmates. Another risk I see is sharing sensitive patient information. Communicating with and about patients outside medical structures must adhere to confidentiality criteria. I view this point as a risk I want to discuss within the group.
4. Package CONTEXT
I work within a "hedonistic" healthcare system, where, according to Vácha, the ultimate ideal is an immortal and pain-free human being. The current trend of contrasting evidence-based vs eminence-based approaches, i.e., evidence-based vs authority-based therapy, creates a framework that discourages innovation and partnership. Our professional roles often establish barriers to interprofessional collaboration. We need to break free from this context.
Therefore, it's crucial to remind ourselves of the objectives of partnerships, ensuring they don't lose momentum and that conflict doesn't become the primary focus. A potentially helpful guide within this context could be insights from neuroscience, which emphasize the connection between social status and health.
5. Package HOW TO CREATE A SAFE ENVIRONMENT?
The safe environment was created as part of my ongoing teaching in the Master's programme, which I am familiar with. It is characterized by setting rules together, meeting on neutral ground, being aware of and naming risks and challenges early on, and trying to shed our masks and roles. We may consider inviting an external supervisor or facilitator. Other sources of safety can be reminding each other of our motivation and voluntary participation, respecting personal boundaries, and setting milestones and deadlines.
6. Package WHAT WILL FOLLOW?
Establishing boundaries and defining expectations for what we consider success is crucial. Unnamed expectations can become obstacles, and there's a risk of mirroring the chronic pain patient's situation, as one factor of chronic pain involves unnamed expectations. According to scientific research, patient empowerment should help reduce pain. Therefore, at a minimum, we can discuss the placebo effect, which is comparable to many prescribed painkillers today.
Additionally, by identifying strengths and offering insights into what the patient can change, we can expect to break away from a certain mechanical cycle of care. I anticipate collaborative learning between disciplines, avoiding the formation of rival groups often seen in scientific fields. These groups typically form to increase the likelihood of receiving grants but work in parallel without sharing results.
Lastly, I aim to cultivate a culture of cooperation and humanity within the group.
Butler, David Sheridan, and Moseley, G. Lorimer. Explain Pain. Kokosové ostrovy, Noigroup Publications, 2013.
ROKYTA, Richard a Cyril HÖSCHL, ed. Bolest a regenerace v medicíně. Praha: Axonite CZ, 2015. Axonite review. ISBN 978-80-88046-03-5.
VÁCHA, Marek Orko, Radana KÖNIGOVÁ a Miloš MAUER. Základy moderní lékařské etiky. Praha: Portál, 2012. ISBN 978-80-7367-780-0.