In the previous post in this series we looked at the importance of finding a practitioner who provides you with an individualised plan of care. In this, the final post of our series on identifying features of a low or high value consultation for an injury or pain problem, we take a look at self-efficacy. Specifically, we consider ways in which you, the patient, can identify whether a practitioner is (or has been) prioritising the preservation of your self-efficacy.

Self-efficacy is your individual, underlying confidence in your ability to achieve goals.

A low value service should be suspected if the overall message imparted to you from your healthcare provider has the effect of diminishing your self-efficacy. What does that mean? A patient with low self-efficacy will have a reduced sense of self-reliance and a greater risk of developing a dependence on ongoing healthcare services or external “fixes” to manage his or her health. Essentially, a person with low self efficacy will answer “no” to the following question- Can I get “x” done on my own, where “x” equals strategies for better managing, recovering from and/or minimising the risk of a recurrence of an injury or pain problem. If your self-efficacy was diminished as a result of a bout of treatment, it means that your belief in your ability to manage your injury or pain disorder “on your own” has been negatively impacted. This is perhaps the most important of all considerations in determining the true value of a proposed (or already received) course of treatment.

How could you tell if your self-efficacy is at risk of being impinged upon? It’s an interesting question because the bottom line is that there isn’t a way to fully mitigate this risk. The very act of seeking help from a health professional for an injury or pain problem is an admission of one’s limited capacity to recover from an injury or pain problem “by one’s self”. The action of seeking help for your problem constitutes a handing over of your self-efficacy. And given that, the important question becomes, to what extent does your provider prioritise the preservation of your self-efficacy during the planning and implementation of a treatment plan? Or stated in more dramatic terms, to what extent does your provider take steps to avoid abusing your self-efficacy?

The clues lie within the content and delivery of the explanatory narrative around which a treatment is framed, and ultimately in how it affects your understanding of who or what you must rely upon to be well and stay well. Or stated more plainly, the clues lie within the “sales pitch” a provider offers at the initial assessment and subsequent treatment sessions. The explanatory narrative will typically contain an explanation of the treatment’s “mechanism of action”, and by inference speak to a purported cause and solution for your injury, pain problem or related symptoms. The explanatory narrative forms the basis of what you learn from your interaction with a provider and shapes your central take home message.

It is doubtful that any healthcare provider intentionally sets out to “abuse” a patient’s self-efficacy. It’s possible that an unscrupulous provider might deliberately misinform a patient for the purpose of securing better profit, but it is far more likely that when a provider’s explanatory narrative disempowers a patient, the provider in question is ignorant of the unhelpful, or potentially harmful impact of his or her words and actions. It follows then, that when a provider explains the links between a patient’s symptoms, proposed treatment, expected outcomes and future management options in a manner that diminishes a patient’s self-efficacy, it is likely done unwittingly and without malice. In such a scenario, a provider may have good intentions and may already have met the other criteria we have already outlined as indicators of high value care. Identifying the explanatory narrative as low value care would therefore be very difficult.

There are however, some indicators to look out for. You can be reasonably suspicious of the value of a proposed treatment plan if the plan leaves you feeling that a full and sustainable recovery is dependent upon you participating in;

  • paid treatment services ad finitum

  • activities that you cannot complete independently

  • activities that are not meaningful or that you do not value highly

  • activities that are painful or provocative of symptoms

  • activities that in your view are ineffective

  • complex evaluation / assessment processes that only the practitioner can action or interpret

If some of these ring true of your experiences with a practitioner, we encourage you to ask questions. Ask why your condition requires paid treatment services ad finitum. We encourage you to ask why you haven’t been shown activities that you can do on your own. We encourage you to ask why you haven’t been shown activities that are meaningful to you. You should ask why a full, sustainable recovery is dependent upon you carrying out painful or symptom provoking activities. We encourage you to ask why the success of an intervention or prescribed set of activities can only be determined by way of an assessment protocol that is too complex for you to understand or verify. Surely you can decide for yourself whether a treatment is proving effective. These are reasonable questions to ask, and the manner in which a provider answers them will likely reveal a great deal about their capacity or willingness to provide you truly high value care.