This article was featured in our November 2014 eNewsletter and is republished with permission (C) 2014 International Association for the Study of Pain. All rights reserved. IASP Insight magazine, August 2014.
Amal Helou, a nurse practitioner at the Pain Management Centre at Royal Prince Alfred Hospital in Sydney and a past president of the Australian Pain Society, shares what she has learned in her 33 years in pain management.
What motivates you in your clinical practice?
Nurse practitioners are sought after for their ability to engage with patients from all backgrounds and educational levels. One patient described it as “the ability to make clear what is so complex and muddy.” I think she was referring to the use of person-friendly language, rather than clinicians showing off what they know.
Having a “whole person” approach in man- aging chronic disease ensures patients can collaborate with the entire health-care team. This ability to communicate with practitioners in different disciplines also allows the patient to remain central and engaged. Turf wars become a thing of the past when our focus is the health and well-being of the patient.
Asking our patients what is their primary concern helps us focus on the proper path to take and can save a lot of time as we wander through the many aspects of history taking. It is essential to learn what is in the heart of the patient, their fears, and how to motivate them.
In fact, when you listen carefully, patients volunteer how to reach them. And when we can effectively communicate that we understand those concerns, we earn the right to be heard. Sometimes in our isolated specialties we can get caught up in using abbreviations and jargon that does not impress or reach the person.
What limitations or obstacles have you faced?
I enjoy working in a multidisciplinary team setting. Hearing other members’ perspectives and receiving their support has prevented burnout. Most team members want to find a way to engage patients and be effective. The problem occurs when we are not open to negative critiques and see these as personal affronts, rather than as opportunities to improve and make appropriate changes.
Another clinician’s insight into a patient’s perspective and his or her ability to reach a particular patient should not be seen as a competition. Unfortunately, I do not think that humility, which I define as having a sane estimation of your gifts and abilities, is prized in the medical field. In some circles, what is prized is an accumulation of up-to-date scientific jargon. Most patients learn best from stories and “simple English” explanations of the scientific evidence behind them. We do not need to cover every new concept; we need to find a balance between too much and too little.
What have been your best success stories?
In one of the programs at our centre, I teach patients about the role of medications in managing pain. It also covers the limitations and the best experimental evidence we have behind what we prescribe. At the end of that talk, over half of the patients voluntarily make an appointment to see me because they want to understand, reduce their opioid consumption, and make changes. I consider that a success.
I find it is important to listen to all the bits that may not seem relevant at first. Patients come back to me and say, “I told the doctor, but he or she was not interested.” Or even worse, that the doctor did not ask about….
What would you tell someone who is beginning a career in pain management?
Read lots and listen carefully. Human-to-human interaction, I call it “human therapy,” is essential in our field. Read escapist novels with happy endings to balance out the sad stories of some of our patients’ lives. Get involved in an absorbing hobby. I paint and watch Star Trek and English murder mysteries.
Listen to patients, and find out how well they went with the homework they were given when seeing them at follow-up. Offer them a hot or cold drink and have one with them. It helps break down barriers when you have to be firm with them. And smile—it does not reduce the impact of your professional dialogue.