April is National Stress Awareness Month. Typically, we look inward and focus on the stress associated with being an Athletic Trainer, interacting with difficult coaches, managing emergent situations and other aspects of our profession which merit discussion. However, it is not often we stop and think about how our actions and words contribute to the stress level of those we are supposed to be treating.
A common dialogue in healthcare revolves around barriers to effective treatment, and what we can do to overcome those barriers for the benefit of the patient. Stress is a barrier which becomes more prominent the moment a patient walks through the door. As healthcare providers, we immediately ask the patient something along the lines of, “Do you have pain?” However, is there really a need to ask this question or have an immediate answer? If the patient is injured and seeking help, don’t we already know the answer before we’ve asked the question? Patients will normally tell you two things: What is wrong, and how to fix it. The important part of that interaction is how well we listen as clinicians and use the information provided to improve the overall quality of care.
Pain and stress walk hand in hand and managing both of them is often difficult, especially with a patient-oriented treatment approach. Throughout our education, we are taught to gauge and track pain by using metrics such as the Likert scale, outcome measures or functional tests that may reproduce symptoms. These approaches prove to be very useful for Athletic Trainers, but are they useful for patients? After speaking with Dr. Adam Naylor, sports psychology consultant to Northeastern University Athletics, he suggests, “Constantly applying these measures, and asking these questions, can sidetrack positive progressions during rehabilitation.” As a result, our altruistic approach to treating pain can actually make our job more difficult.
The reason these approaches can be harmful is that patients are constantly being reminded they are either in pain or cannot do something specific to their sport. This results in an increased level of stress, which has been correlated with increased muscle tension, illness, narrowing of attention and loss of focus. Combine all these together and we have created an environment that contributes to a slower rehabilitation process, with a patient now prone to re-injury. Athletic Trainers skilled in listening and observation are often able to notice when their treatments inhibit pain. This spares the patient repetitive stress-inducing rehabilitation sessions where they have to constantly describe their discomfort.
So … now what? If you look hard enough, you will find something wrong with every patient who walks through the door, but I am not advocating we completely ignore pain and abandon objective testing. We need to be more selective about how often and when we include these metrics as part of our treatment approach. Additionally, it is important that Athletic Trainers be able to identify patients who cannot cope with stress and refer them to professional resources who can be allies in the treatment process.
Don’t ask patients if they have pain; ask them how you can help.