In the previous post in this series we discussed the importance of the application of excellent interpersonal communication skills in a clinical encounter. In this next post, we take a look at the importance of an individualised care plan for your injury or pain problem. A discussion of individualised care follows a discussion of interpersonal communication skills because a truly individualised care plan is dependent on a provider having excellent interpersonal communications skills. Having said that, it is also true that excellent interpersonal communication skills will not guarantee that a care plan is appropriately individualised. One of the few certainties within the context of assessing and treating injuries and pain disorders, is that there is much that we don’t know. The processes that underpin the recovery from an injury or pain problem are complex. And the truth is that no one has really figured it all out yet. There do exist some key elements that apply across populations but overall, your pathway back to health will likely need to be different to the next person. It therefore doesn’t make sense to apply a one size fits all approach to treatment. Given that, you would do well to be skeptical of the value of a service if a provider;

  • avoids discussion of alternative treatment options or their relative risks and benefits

  • appears uncomfortable answering “I don’t know” to any of your questions

  • avoids acknowledging the uncertainty of the relationship between his or her assessment of you, his or her treatment plan and the likelihood of a resolution of your symptoms

  • is reluctant to individualise your treatment in favour of protocolisation

An unwillingness to discuss the pros and cons of a range of treatment options, combined with an unwillingness to admit to “not knowing” the answer to your questions is a warning sign that a provider is uncomfortable with what is (given our current knowledge limitations) an unavoidable uncertainty regarding your recovery process. To place this point in perspective, there is nothing wrong with a clinician utilising a system of clinical reasoning to guide his or her treatment. A high value provider however, will be able to explain how his or her particular approach fits into a broader view of what is (and isn’t) known about the processes that underpin recovery from an injury or pain disorder. And he or she will be comfortable outlining the limitations of his or her approach, and the manner in which alternative interventions might be more or less useful for your specific circumstances. Regardless of how excellent a provider’s interpersonal communication skills are, or how much empathy or care a provider has for your predicament, if a provider appears to simply shoehorn you and other patients into a rigid or narrowly focused clinical reasoning framework, there is probably limited value in the treatment.

The value is limited in these scenarios because a narrowly framed, protocolised system of assessment is probably derived from a narrowly framed theoretical base, and will likely lead to generic, non-individualised care. Of course, as a patient, you may do okay with this approach, in the sense that your symptoms resolve. But it would remain low value care to the extent that such an approach reflects a missed opportunity to learn more about the relationship between your individual circumstances, your current symptoms, behaviours and functional capacity, and perhaps more importantly, your future symptoms, behaviours and functional capacity. An individualised treatment plan will be meaningful for you. It should be directed toward goals that you have outlined as being important to you. If your impression is that a provider is simply running you through a protocol of treatments, with no effort to shape interventions toward your goals, it would be reasonable to conclude that you could receive higher value care elsewhere.

In the next and final post in this series on identifying markers of low value care, we discuss the fifth and perhaps most important feature- that being the extent to which a practitioner prioritises the preservation of your self-efficacy.