Where Beliefs Come From and Safer Words to Use With Patients

Beliefs come from family, friends, culture, the internet and social media, but Ben Darlow's work shows that health care professionals have an enduring influence. Clinicians with biomedical beliefs are more likely to advise rest, time off work or less activity, and their words stay with patients long after a consultation. Oliver offers alternatives and their likely effects: sensitivity instead of damage, repairable changes instead of a tear, a spine that might benefit from strength and movement instead of instability, normal age-related changes instead of wear and tear, persistent instead of chronic, complex or multifactorial instead of non-specific, normal variation in spinal curves, and swelling instead of jam coming out of a doughnut. The take-home messages are to question implausible models, reflect on everyday professional language, let patients tell their own story, ask about beliefs rather than assume them, check understanding by asking patients to summarize key messages, validate the pain experience and build a safety narrative. He closes with Peter O'Sullivan's advice: even if we believe it, don't tell them.