211 | P a g e 1. TOYE 2017 [196]: The challenge of dual advocacy I am simultaneously an advocate of the patient and the healthcare system. I am part of a system where it feels that the cogs are not always working together. I can’t always access the services I need for my patient. Sometimes other services don’t provide what I expect. We need to work together to make this work for our patients. We need to be confident in our colleagues and respect each other as fellow professionals. HEALTHCARE PROFESSIONALS 2. TOYE 2017 [196]: The craft of pain management Clinical work is a craft gained from experience not education. At times I feel under-skilled in chronic pain management. Personal experience and maturity, patient mileage and learning from other more skilled professionals underpin craft knowledge. Although guidelines can possibly support a patient-centred approach, they tend to constrain professional knowledge and don’t facilitate individualised care. I use guidelines as I see fit. HEALTHCARE PROFESSIONALS 3. TOYE 2017[196]: Navigating juxtaposed models of medicine It is difficult to navigate between the biomedical and bio-psychosocial model. I am pulled towards the ‘siren song of diagnosis’. I exclude the biomedical before I shift to psychosocial. This shift can threaten the relationship so I try and smooth, or conceal, the shift. A diagnosis can help things to move forward, or give a sense of relief. However, I need to understand this person's suffering not just their body. I can be rewarding to get to know the patient and be alongside them. HEALTHCARE PROFESSIONALS 4. TOYE 2017[196]: Navigating patient-clinician borderland It is difficult to navigate the patient-clinician relationship. I have not given an expected diagnosis. I make concessions just to keep a good relationship I prescribe pain killers I refer for scans. I have to balance long and short term gains. I sometimes feel bullied into clinical decisions. I need to find a balance between imposing my opinion and enabling the patient to make their own decisions it is difficult to watch them take a ’wrong’ step. My short circuit is to take control. However, negotiation rather than enforcement is more effective in the long- term. HEALTHCARE PROFESSIONALS
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