A phrase I often use with patients is ‘nothing happens in isolation’. This concept is about priming and how the neuroimmune system is set at the time of an intervention as this will affect the outcome. The question to ask is ‘how is this system likely to respond to the treatment I am about to employ based on what I hear from the patient and what I can see?’
How will this system respond to the treatment I am about to give?
This is the same for any healthcare practitioner whether it be a physiotherapist about to mobilise a joint or ask a patient to perform a movement, a doctor prescribing a drug or administering an injection.
The key factors that are somewhat controllable are the environment in which the treatment is taking place and the approach of the practitioner. Both of these can be created to optimise the patient experience and hence the effect of the therapy. We must also consider prior experiences and expectations of the patient. Here are two scenarios to illustrate.
1. A patient arrives at the clinic and discovers that there is a delay. There is no explanation given when they are directed to their seat. Naturally the patient is a little anxious about the forthcoming injection. They sit in a waiting room that is plastered with posters and leaflets about various health matters. And there is a pile of old magazines. Dogeared. Twenty minutes later the patient is called to Room 5 by an electric sign. They tap on the door and a gruff response permits entrance. There is no eye contact, no smile and no invitation to sit down because the practitioner is looking at the computer.
How would this prime a neuroimmune system? What would an aroused and threatened system do? Will it be readily acceptant of a needle? May the musculoskeletal tighten in response?
2. A patient arrives at the clinic and is greeted warmly by the reception team. On taking a seat the patient notices the artwork on the wall. The healthcare professional emerges smiling from his room and invites the patient to enter, welcoming them to take a seat and be comfortable.
What might this do to a threatened neuroimmune system (threatened because the patient has been thinking about the injection and is slightly anxious)?
Whilst it is always easy in theory to create scenarios, it is quite feasible to employ an approach that considers the influential factors upon the patient experience. In essence they do not want to be there, they do not want to have to have treatment but they must for the sake of their health. The neuroimmune system is on alert because of the actual health issue and also because of the experience of visiting the professional. We can certainly impact upon this in a positive way by thinking about our interface with the patient, use techniques to reduce anxiety and construct an environment that is conducive to better outcomes. Nothing happens in isolation.