We live in a fast moving world, where speed and efficiency are highly regarded and used as a measure of success. Where time saving devices and innovations are all around us. If we have to wait for something we tend look for quicker alternatives. As a rule most of us are not happy if we are kept waiting.
How long is this going to hurt for?
How long will it take to heal?
When I can run / play football / leap over badgers again?
These questions, even the odd badger leaping one, are very important to patients. They want them answered clearly, accurately, and most importantly honestly. This its perfectly understandable, being in pain is an unpleasant experience and so having an idea of when its going to end is perfectly normal and reasonable.
However, it can be extremely hard for healthcare professionals to answer these type of questions as there are many, many variables that effect an individuals recovery, so most clinicians tend give estimations, but in my experience many do poorly here usually grossly under estimating the time it will take to recover so causing more problems than they solve.
For example, I hear the time frame of 6 weeks used by doctors, surgeons, nurses and therapists the most, but often this time frame is given without any thought or consideration. In fact I think that some clinicians think every thing takes 6 weeks to recover! A sprained ankle, six weeks… a broken wrist, six weeks… triple coronary artery bypass… six weeks.
More harmful than helpful?
Other common phrases I hear used when patients ask how long will it take are ambiguous terms like “you will be back at it in a few days” or “you’ll be up and about in no time”
Although usually given to reassure and encourage, I find they actually do the exact opposite when the reality doesn’t meet the expectation. One of the most frustrating and infuriating tasks I have to do daily is try to manage a patients unrealistic expectation given to them by someone else (surgeons, I looking at you the most) and try to explain to them why its going to take a damn site longer than a few weeks to fully recover from this rotator cuff repair.
This often causes patients confusion, frustration and sometimes anger, with them not sure who to believe or trust.
But its not just healthcare professionals to blame here, I also often find myself having to correct a patients mis-understanding of how long it will take due to other sources, such as the internet, the press, or even friends and family. Sometimes they listen and accept what I say, sometimes they don’t, occasionally my professional advice just can’t stand up against “Dave down the pub said…”
So poor information and understanding of recovery times can cause patients unnecessary distress, angst and frustration. It can also waste a lot of time, energy and resources with them seeking further unnecessary investigations, interventions or second opinions thinking something is wrong as its not recovering as quick as they expected.
I know this first hand as I often get patients sent to me for second opinions on shoulder issues. When I start to take a history it soon becomes obvious that they are doing just fine, but its just some poor understanding or awareness by the patient or their therapist of how long things take to heal and recover.
How can we prevent this?
This is a tricky question to answer, but a good place to start is to be aware of normal biological healing processes and time frames. Knowing what is happening from the first few minutes, hours, days, weeks and months after an injury is essential. Here are a few good resources here and here.
Next, healthcare professionals need to be aware of the different classifications of bone, ligament, tendon, muscle and nerve injury. This helps to estimate the expected time frames based on the structure, type, and severity of an injury.
Next, having knowledge on current research on ‘return to play’ time frames after an injury I think helps give and understanding of how long it will take a patient return to higher level activities. This is a massive topic to cover, and beyond this blog as there are hundreds if not thousands of different types of injuries and different guidelines for different sports/activities, but there is some more info here here here and here
Lets not forget experience
The more a clinician manages a particular type of injury, the better they get at knowing the time it takes to recover, classic pattern recognition.
However, even with experience and all this knowledge on healing rates there are still many other variables that can, and do effect recovery times, both physical and psychological. Having an understanding of as many of these as possible, such as the effect other health conditions have on healing rates, and how psychological factors such as stress, anxiety, fear and mal-adaptive beliefs can affect recovery is also essential. Finally recognizing the effects of age and previous activity level will have on neuro muscular conditioning is also paramount.
Honest communication
So, we can see that giving accurate and reliable time frames, to patients is easier said than done, and therefore it can be very tempting at times to guess.
Don’t. Managing patients expectations is a vital and critical aspect of your care, and answering these important questions honestly and to the best of your knowledge is essential to maintain trust, and this may at times mean saying “I don’t know”
There is nothing wrong in saying “I don’t know” I say it daily. I do understand that this can be challenging for some healthcare professionals to admit their ignorance. I also understand that it could also be risky as well, with some patients misunderstanding this honesty with lack of knowledge or experience.
However, I think when explained why you don’t know due to all the things mentioned above is far more helpful for a patients recovery. It also shows honesty and humility and can help develop trust between you and your patient. There is nothing worse than a Billy Bullshitter, and it can be extremely hard to regain a patients trust and respect when you have given them some duff and incorrect information.
So it can be a complex and tricky minefield to give accurate recovery time frames. We all need to be as well informed as we can on this subject, and consider that in this day and age of improving speed and efficiency in our day to day lives, the time it takes our bodies to heal is often not as fast as we or our patients expect.
So think twice before giving that patient a time on how long it will be… think more than twice before referring them on if you or the patient think things aren’t progressing as quick as they would like, and remember to not be afraid to say “I don’t know”
Often all you and your patients need to do is hold your nerve give it some more time.
Finally, I will leave you with some wise words from @TheGrumpyPhysio below, who although can be a little close to the risque side from time to time, I think his (or her’s) heart is in the right place!
As always thanks for reading
Cheers
Adam
