213 | P a g e 5. TOYE 2017[196]: Personal costs It is an emotional challenge for me to treat patients with chronic pain. First, the biomedical model makes me feel like I am a professional failure because I cannot fix things ‘how did I fail them?’ If I get to know my patient this can incur a deep sense of personal loss. I have to balance being too close to my patient or too distant. HEALTHCARE PROFESSIONALS 6. TOYE 2017[196]: A sceptical cultural lens Society is sceptical about chronic non-malignant pain. At times I have to decide whether the pain is ‘real’ or imagined. What they say and what I see don’t match. I am ‘on guard’ against exploitation from fraudulent claims. There are good and bad patients: easy/difficult patient explained/not explained, local/diffuse pain adherent/non- adherent stoical/weak motivated/unmotivated accepting/resisting non-complaining/complaining deserving/non-deserving. However sometimes my judgements are wrong. HEALTHCARE PROFESSIONALS 7. GARDNER 2017[192]: Treatment orientation I focus on the biomedical (chronic back pain) and lack confidence in my ability to use the biopsychosocial model. I don’t like treating 'difficult patients' and am not confident in my skills, or outcomes from treatments. It is not my job to assess psychosocial factors. HEALTHCARE PROFESSIONALS 8. GARDNER 2017[192]: Patient factors I am influenced by patient and their beliefs and expectations when deciding on treatment. I tend to choose an intervention that promotes a good relationship. I make decisions based on my judgement of how 'passive' the patient is and how likely they are to engage in treatment and/or self-management. I individualise my treatment choices for each person. HEALTHCARE PROFESSIONALS
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