Platitudes at Your Peril

Please note: This blogpost expresses humorous exchange of language between the nakedphysioette and myself as means of coping when she has a flare up. It is not meant to be taken literally. It is intended that people whom read this blog may relate either through their own choice of verbal, facial or bodily expression.

Platitudes are common phrases used in our clinical practice. They are an attempt to express empathy, encourage motivation or behaviour change, reduce threat or worry with an overall intention of providing a form of support to those living with long term pain.

What is a platitude?

The Oxford dictionary definition of a platitude is:

 

‘A remark or statement, especially one with a moral content, that has been used too often to be interesting or thoughtful.’

 

In the context of this blog, the platitudes I intend to highlight are the ones that we as clinicians might commonly use to explain say, the importance of movement in terms of tissue health, attempt to reduce patients’ fear associated with their pain, and suggest that when something hurts it doesn’t always mean the patient’s tissues are involved.

Despite the often-helpful intent there is a reason they can be referred to as platitudes per the definition above, and interpreted by patients as insensitive despite the well-meaning delivery. It is advisable to note that this may result in the clinician being on the receiving end of an emotional response (anger, frustration), a physical expressive gesture from the face or hands accompanied with a healthy portion of profanity . A mindful caveat.

Communication can be tricky particularly when you are faced with something as complex as a person living with pain that has any number of psychosocial issues contributing to their pain experience. At times like this it’s more helpful to show empathy. A simple, “That must really suck, I can imagine how hard that must be for you” and by adopting appropriate communication strategies can also support the highly anxious and stressed patient. In motivational interviewing, there are 3 styles (Asking, Informing and Listening) with subsets within each style (directing, guiding and following) (Rollnick, Miller & Butler, 2008).

So, I have put a small selection of such platitudes together (with a preceding message from a patient and a more appropriate response) that could be viewed as unhelpful when other methods of support such as motivational interviewing, active listening skills or empathy would be considered more appropriate. I LIKE TO THINK THAT CLINICIANS WOULDN”T JUST USE THE PLATITUDE IN ISOLATION.

I guess this blog serves a dual purpose: 1) Clinicians need to be prepared to receive a potential “Get fucked” (as per the nakedphysioette and naked physio exchange) response from a patient when using these kinds of phrases and 2) People living with pain, (although perhaps an inappropriate response) “Get fucked” maybe something that you might say to yourself with a look of distaste when these platitudes are used on you at an inappropriate time.

Pain explanation from the person living with pain:

“My knees feel and sound like they have broken glass in them and I can’t get down my stairs.”

Inappropriate platitude from clinician:

“You have to keep moving, Motion is lotion.”

Communication strategy: 

“I can see how difficult that must be for you, would you be happy to discuss what the noise and feeling is in your knees?”

Pain explanation from the person living with pain:

“My back is so sore I avoid leaving the house because it’s too painful to put my socks and shoes on.”

Inappropriate platitude from clinician:

“You’re sore but you’re safe.”

Communication strategy:

“It must have been really hard for you to get here today, what have you tried so far for your back?”

Pain explanation from the person living with pain:

“It feels like a thousand tiny knives plunging into my skin.”

Inappropriate platitude from clinician:

“We know that hurt is not equal to harm.”

Communication strategy:

“I can see that you are in pain right now, what have you noticed makes it worse?” “Have you noticed if anything reduces it?”

Pain explanation from the person living with pain:

“I get that my pain is associated with the nervous system being sensitive, but I am unable to move my (…affected body part) due to excruciating pain.”

Inappropriate platitude from clinician:

“It’s important to keep moving to calm the nervous system – move it or lose it.”

Communication Strategy:

“It’s getting hard for you to bear I can see that, tell me about what this pain is like and how it’s affecting you?”

Pain explanation from the person living with pain:

“The last time I had an intense flare up after doing the exercises, I really think I have done too much too soon.”

Inappropriate platitude from clinician:

“It might feel like your stumbling but your still moving forward.”

Communication strategy:

“You would have preferred to have been introduced to the exercises in a more graduated way?” “Are you happy to discuss which ones you feel comfortable to do?” We can then perhaps adapt your program to suit you better.”

I want to stress that this is not to say that these platitudes are completely inappropriate, it’s just important to consider the timing for when they MIGHT be appropriate. Remember to consider the context of the situation and the status of the individual at that time. Everyone is an individual so consider that ‘one size won’t fit all’ and the importance of critical thinking and reasoning in communication and language skills during your consultations.

Thanks all for having a read

 

TNP

 

Reference:

Rollnick, S., Miller, W.R. & Butler, C.C. (2008) Motivational Interviewing in Healthcare: Helping Patients Change Behaviour. The Guildford Press. New York.