Re-framing cognitive errors...

[drusso]

How aggressive are you at reframing patient's cognitive errors? I do my best, but sometimes I just give up. Here's three I've heard in the last 10 minutes:

1) "Medicine's work differently in me than other people. Things that put other people to sleep amp me up and vice versa."

Me: That's physiologically impossible.

2) "My PCP said that my nerves are wired differently from most folks. That's why I feel things differently."

Me: That can't be true.

3) "My back has been broken in three places since I fell off a tractor at age 12. They can't see it on x-rays, but my chiropractor can feel it."

Me: Your x-rays are normal.

Somedays, it's like this all day long...

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[emd123]

How aggressive are you at reframing patient's cognitive errors? I do my best, but sometimes I just give up. Here's three I've heard in the last 10 minutes:

1) "Medicine's work differently in me than other people. Things that put other people to sleep amp me up and vice versa."

Me: That's physiologically impossible.

2) "My PCP said that my nerves are wired differently from most folks. That's why I feel things differently."

Me: That can't be true.

3) "My back has been broken in three places since I fell off a tractor at age 12. They can't see it on x-rays, but my chiropractor can feel it."

Me: Your x-rays are normal.

Somedays, it's like this all day long...

I don't spend too much effort trying to reframe people's cognitive errors. I think it's usually counterproductive, since often people have wholeheartedly bought into such ideas because they trust the person who's convinced them they're true. When you try to undo that, often paradoxically they end up distrusting you as a result, even though you may be the one who's most right. Generally, I nod my head, and move past it, and work towards getting them to buy in to what I think they need to buy in to on that given day. I generally try to work towards trying to gain their trust as opposed to tearing down their trust in another. If I can get them to buy into my plan for them, that's worth more to me (and the patient) than it is to spend time undoing beliefs planted in them buy others, which requires effort, but for little or no gain.

Look at it this way: If you have identified that your patient has an entirely illogical belief, it's extremely unlikely they're going to listen to your logical explanation, and is likely time wasted.

Example:

1) "Medicine's work differently in me than other people. Things that put other people to sleep amp me up and vice versa."

Me: Wow, that's interesting. Since you react oppositely to medications, clearly roxicodone 30mg won't help your pain, in fact it will cause you pain. Let's look at some other, better options...

2) "My PCP said that my nerves are wired differently from most folks. That's why I feel things differently."

Me: Wow, your PCP must have known you really well. Considering that, let's try something that will work for your specific needs (insert whatever it was you were going to recommend to them anyways).

3) "My back has been broken in three places since I fell off a tractor at age 12. They can't see it on x-rays, but my chiropractor can feel it."

Me: Wow, falling off a tractor at age 12 must have been painful and I don't doubt you still have pain in those bones. The good news is that it's healed enough that the x-rays look really good today. Let's not forget that there are other things that don't show up on xrays, that may generate pain like this...

 

[ziggyziggy]

Reframing cognitive errors can be counter productive especially when done during initial few visits. It takes time to build that trust. Once you have that you can challenge those beliefs.
But, unfortunately we in interventional pain spends way less time on follow up visits to work on any of those issues.

 

[Orin]

Reframing cognitive errors can be counter productive especially when done during initial few visits. It takes time to build that trust.

One of my attendings used to remind me that you can be efficient with processes but not with people. Relationships take time, energy, and communication. You can't do it all in a single visit.

 

[drrosenrosen]

The only thing I usually try to correct are beliefs that I think are harmful to our relationship. For example, catastrophizing "my pain is terrible because my back is broken in five places and this doctor won't even help me" but with normal imaging. I reassure these people that their MRI looks great. I always try to frame things as unexpected good news, rather than argument. E.g. "well, the good news is that your MRI looks really good, so although you still have a lot of pain we need to deal with, you certainly don't need surgery and you aren't facing a danger of paralysis. So, thank God for that!" They often don't buy into it at first, but I keep hitting the same button over and over and try to get them on board with the message. Arguing with patients, on the other hand, is always counterproductive. If they try to argue with me, I just disengage and change the subject.