Mentoring, burnout, expectations and persistent pain 

 

My husband and I went out for a posh dinner this week and the menu didn’t tell you what the dish was, it just listed the ingredients.  This is the inspiration for the title of this post, however the inspiration for the content has come overwhelmingly from my work colleagues over the past month. The dinner was delicious.  Work, on the other hand, has been a bit of a rollercoaster. 

Working solely in the persistent pain setting can be a tough slog as well as ridiculously rewarding at times.  When you reduce the number of acute presentations you see, you lose the natural ‘regression to the mean’ wins which are relatively quick, consistent and satisfying.  You reassure yourself that you were part of the process, the patients are satisfied and you see a larger variety of people and presentation which helps to keep things interesting.  In the persistent pain setting, the gains are often incredibly slow and the “failures” can be frequent. The functional outcomes don’t often satisfy the patient as much as they do the practitioner even despite the best education efforts to shift focus from pain to function. Complete pain resolution is rare and sometimes  good functional gains are viewed by the patient as  a poor second best in the outcome lottery.   

Working part time or having a mixed caseload is a great way to work in this area.  If this isn’t possible though, the frustrations around the ratio of patients making good gains to those seemingly making little change can easily lead a reflective practitioner to wonder where they are going wrong, to question if they have enough skills or if they are missing something.  I reckon I hit this wall about a month ago when the novelty of working solely in persistent pain wore off and the reality of the lack of progress I have made with some of my now long term patients started to kick in.  

Recognising that I was feeling a little disillusioned, I started very deliberately seeking out some mentoring from my work colleagues.  For some, I booked a specific time with them and discussed a few of the cases that I was particularly struggling with.  Others were brief corridor chats, lunch discussions or throwing myself into a colleague’s chair at the end of the day to have a debrief.  It was a great  strategy for me and certainly had the desired effect.  Leaning on practitioners who have worked in the area longer than I, have different insights and expertise was a winner.  

Here are some of pearls of wisdom I have picked up from this exercise: 

  • Make sure your tendency is to not to focus on the lack of change rather than the positive outcomes, even if they are small.  It can skew your view on what your overall performance and outcomes are and is a common thing for people with high expectations of themselves to do.  
  • Lower your expectations for those patients with multiple co-morbidities, very long-standing pain or pre-existing mental health conditions that had been debilitating prior to their onset of pain.  The science tells us that these predispose to pain and reduce efficacy of interventions so don’t be too hard on yourself as a practitioner working with these patients.  Sometimes you are walking with them on their journey and you may not be able to measure the impact that you are having until later in the story.  Trust that you are helping them by just being on their side. 
  • You should not be working harder than the patient (I love this one!) 
  • Its OK to say that you don’t like a particular patient or that they rub you up the wrong way.  We are human too!  Try to objectively view what is going on with your reaction to the situation – understanding why you feel that way can help you to avoid reacting based on emotions and allows you to be professional and objective.  Try harder to put yourself in their shoes and develop a sense of understanding. 
  • Further to the above point – Draw on a sense of love and professionalism but there may come a time where you need to respect your own boundaries and cease treating them, especially if you feel you are consistently not being respected. 
  • Remember that you are part of this person’s journey and you don’t get to choose where along that path you meet them.  They may not be ready to hear the messages you are trying to get across but you may prime them for the next practitioner who sings from the same song sheet to take it and run with it.  People may need a few more treatment failures to realise that your plan was going to be helpful.
     
  • Review your functional outcomes measures WITH the patient.  When they are in the situation it can be hard to see progress. Sometimes seeing things in black and white with a good dose of perspective can help them to feel more hopeful.
  • Play loud music on the way home and leave work at work.  Be with your family or friends when you are with them.  Work is only part of life and we need to practice what we preach and live a life that fits with our values. 

These words of wisdom have been incredibly helpful for me, but so too has the contact with the people who have delivered them.  Staying connected with colleagues is important to reducing burnout and keeping morale at work high.  It helps keeps us focussed on our goals and reminds us how important our role is.  A few laughs over a glass of bubbles on a Friday after work can also work wonders – I highly recommend it! 

 

A beautiful gift  with an even more beautiful letter that was given to one of our doctors  this week after a fantastic outcome .  He was gracious and humble enough to attribute the success to the whole team – leading me to create a final pearl of wisdom:

  • Be inspired by the wins of others!