Show Notes
Chewy and Jim are back - the lads were evaporating during the recording this month as the weather matched their opinions for heat… Chewy and Jim is best watched in full via the video above (so you can watch them melt in real time) or you can listen on the usual podcast players. In this recording, Chewy and Jim cover consultations from good to bad and their experiences sitting on both sides. “You can be as good medically or with your assessment as you want, but if you can’t guide the consultation and keep the patient on board and engaged, they’re going to leave unhappy and not getting what they want out of it.” - Jim
It’s a real skill to run an effective consultation and this becomes really challenging in situations of complexity or system restrictions (lack of time). Unfortunately when this skill is lacking or not applied, the whole thing falls apart and people leave disappointed and frustrated. Chewy and Jim describe stark contrasts between well run and poorly run consultations and it makes a huge difference to the experience. “The actual technical aspect of conducting a consultation is a really overlooked skill.” - Jim
Chewy and Jim get into a discussion about the variables that go into this particular skill and it is not just experience. Appropriate feedback mechanisms, training, and practice are all of vital importance to develop the ability to run the consultation effectively AND sensitively. Without appropriate challenge for poor practice and ongoing complacency that this is not a skill that requires development, variation in practice widens and can cause significant problems for those people attempting to navigate the health systems they require. “Variation in care standards can be refined. It shouldn’t just be accepted that sometimes you get the biscuit muncher and sometimes you get the brilliant clinician.” - Chewy
This is a really difficult skill to improve and we will never master it fully; different components of it require work for individuals, Chewy for example never shuts up and Jim can’t wait to end every conversation as quickly as possible… Embracing your own individuality but holding it to within appropriate professional boundaries is the balance to aim for. Never go full Chew! Jim points out that the likely training method for working on this skill is roleplay and that induces massive cringe responses in most but it is an absolute necessity in order to receive instant peer feedback and implement improvements outside of the clinic room that you can take with you. Embrace it and leave your cringe at the door: improvements in this skillset will help every aspect of the clinical consultation including the outcomes. Chewy and Jim are nothing if not desperate for these rants to be clinically applicable tomorrow… Dos and Don’ts for consultations: * Introduce yourself and explain your role/Don’t leave patients guessing who you are. * Set expectations early. * Guide the conversation without being rude/Don’t interrupt abruptly. * Don’t start the consultation distracted or disengaged. Would Chew Rather speak only in technical jargon or only in complete lay language? The answer will likely surprise you… Let us know your answer. If you have any ‘Would Chew Rather?’ or ‘Who Are Chew?’ questions put them in the comments or email them to us [email protected]
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More from MSKMag OutLoud
It always struck me as bizarre that sports medicine and musculoskeletal specialties deal with pain and dysfunction from head to toe in the human body, yet offer little health literacy or inclusion of the pelvic floor. Traditionally considered taboo and someone else’s remit, men and women with issues affecting the pelvic floor have largely suffered in silence. Thankfully, change is afoot, and healthcare is finally evolving. There is much more awareness, inclusion, and understanding of this unique body area and the role that it plays. For anyone playing catch up, the pelvic floor is a group of muscles spanning the base of the pelvic outlet in layers. While both men and women have a pelvic floor, the pelvic outlet is wider in females than in males and it also contains an extra orifice – the vagina [1]. That’s right, we went there. We said the ‘V’ word. Because just like vulva, or vestibule, the vagina is simply an anatomical term. It needn’t be embarrassing or taboo. Some of you will be long enough in the tooth to remember when the word ‘breast’ was taboo. However, with healthcare campaigns for breast cancer and breastfeeding, this term became an anatomical norm. We need to do the same for the pelvic floor and its related anatomy and physiology. What does the pelvic floor do? In both men and women, the pelvic floor serves to control the bladder and bowel (maintain continence), empty the bladder and bowel (voiding and defecation) and support sexual function (arousal and climax). In women, the pelvic floor also plays an important role in pelvic organ support. Remember that extra orifice I mentioned earlier…well this area is high risk for connective tissue laxity and defects meaning that the pelvic organs (bladder, uterus, rectum) can descend into the vaginal cavity causing symptoms of heaviness, pressure and a sensation of ‘something in the vagina’. What are the signs and symptoms of pelvic floor dysfunction? If the pelvic floor is not doing its job, any of its roles can become compromised. This may manifest in leaking from the bladder or bowel, inability to fully empty the bladder or bowel, pain ‘down there’, sexual dysfunction (compromised erection, dyspareunia, pain with climax) or heaviness and pressure in the vaginal region (for women) [2]. A full list of sex-specific signs and symptoms of pelvic floor dysfunction can be seen in Table 1. Table 1 - signs and symptoms of pelvic floor dysfunction in men and women Who gets pelvic floor dysfunction? Pelvic floor dysfunction can affect any man, woman or child, however it is particularly problematic for women, especially during transitional life events, such as pregnancy/childbirth and the menopause [1]. One in three women will experience pelvic floor dysfunction [3] and for those that engage in sport, the prevalence of symptoms varies according to the load demands of the activity. For example 61% of netballers leak urine [4], up to 43% of female rugby players leak [5], and 32% of gymnasts experience incontinence [6]. Structural changes associated with vaginal childbirth and aging, as well as lower levels of oestrogen to lubricate and bulk out the tissues can increase the odds of experiencing pelvic floor dysfunction. However, even young adolescent females can leak urine due to the load demands of their sport. For example, in athletics and gymnastics, stress urinary incontinence (the involuntary leakage of urine during activities involving high levels of intra-abdominal pressure) is commonly experienced. Yet no-one is doing anything about it. No one is screening. No one is signposting. No one is educating these younger athletes that pelvic floor symptoms are not to be expected and normalised. Or that they simply indicate that the sporting demands exceed the load capacity at the pelvic floor. If this was any other area of sports or MSK practice, would we settle for a load capacity that does not meet the demands of the sport?! Why is this relevant to every therapist, no matter their di
This is a free preview of a paid episode. To hear more, visit mskmag.substack.com
This is a free preview of a paid episode. To hear more, visit mskmag.substack.com
This is a free preview of a paid episode. To hear more, visit mskmag.substack.com
This is a free preview of a paid episode. To hear more, visit mskmag.substack.com