This month we explore self-efficacy.  When employees / patients are confused by advice and treatment from the 'caring profession', confidence in their ability to cope with their health problem is diminished.   

This article was originally published as a blog post on Noijam.com on June 29, 2014. Republished with David's permission.  

I have been loitering lots in doctors’ surgeries in the last few weeks taking a loved one on the rounds for assessment and treatment post cancer diagnosis. Lots of stressy waiting but an awful lot of time to ponder. Last week in yet another waiting room, now sick of reading “Who” magazines, coughed upon copies of “National Geographic” and outdated sports mags, I pondered my own profession and others in the rehabilitation world of neuropathic and musculoskeletal pain and contrasted it with cancer treatment.

A quote from Anton Chekov, the Russian author and physician came to mind. He said “When a lot of remedies are suggested for a disease, that means it can’t be cured”. Quite a remarkable quote when you consider Chekov lived in the late 19th century.

Of course, many forms of cancers such as that of bowel, lymph, prostate and blood are now very treatable, especially if managed early. They are probably more treatable than some neuropathic pain states. I noted in the situation I was in, how treatment outcomes could be stated with great accuracy, side effects accurately described, and a management process could be mapped out with confidence. There was little argument between, and support from all professionals involved. The whole process, while not pleasant itself, probably engendered its own placebo add on. Surely I am not being too “out there” suggesting that the process allowed immune cells in the tumour and those representing the meaning of the tumour to release their surveillance potency, their need to protect and to be more accommodating. That is, a bit of a better balance.

Whiplash, which is really just “Sprained Neck at Speed with frequent Neural Irritation” (SNSNI) – is it really more difficult than a cancer to treat? Chekov looms – so many remedies offered by so many groups for the problem. Perhaps some of the problem starts when we whack the useless and danger enhancing metaphor “whiplash” onto it.

You are not often offered such an opportunity to reflect about your own professional world and contrast it with that of others. For instance, so many professions want to help SNSNI in so many different ways that there is almost a sectarian war in the rehab world, held only in place because all participants are currently reasonably well fed. But where does a reasonable truth start? Look around – the obstacles are everywhere – a lasting guru culture exists in physical therapy, promulgating an ugly self righteousness- “follow me first and then maybe the science”, there are still course participants who sometimes say “just give me the techniques, I don’t want the lectures” or the dangerously deluded who sometimes say “we know all that anyway”. Politics abounds between and within groups, researchers pack up and move on, such as the ex motor controllers now moving to other fields without saying a word (or apologising) and leaving the debris at the feet of first contact clinicians, Pilates practitioners and other groups. It goes on – the sales catalogues put out by therapy suppliers increasingly look like the “skymall” booklets on aeroplanes, there is an exponential growth of dry needling, unmatched by growth in research, making it cult-like in some circles. Even national bodies sell education without a defined overarching curriculum goal statement.

I guess this blog is all about asking people to reflect on where you want to be and where your moral compass lies; and to create a greater awareness of how the patient is the sandwich in the middle. In cancer there is no room for bull. Why should whiplash be any different?

David Butler initially trained as a physiotherapist.  He is an international freelance educator and a senior lecturer at the University of South Australia. His professional interests focus around the integration of neurobiology into clinical decision making, and public and professional education in pain.

He is the co-author of the well regarded book "Explain Pain" (2003).