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Old 11-07-2011, 02:01 PM   #1
proud
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Default Help with presentation title

I've been invited as a speaker to a regional Nurse Practitioner's conference where there will be 150+ attendee's. Given that Nurse practioner's in canada have primary access and referral authority, I felt this would be a good opportunity to promoate Physiotherapy as the subject matter experts when it comes to painful conditions.

I have one hour to present.

The conference organizer approached me two months ago and suggested I present on "clinical pearls...things not to miss" in a musckuloskeletal examination.

I'm okay with that( standard clinical tests for identifying meniscal tears, rotator cuff tears, differentiating cervical radiculopathy from shoulder problems etc).

I am sure that is what is expected of me and I think I've got to "give" what is "expected" to a degree. So a good portion will be the standard fair....

But I'm going to throw in there concepts such as fear aviodance beliefs, how primary care providers( such as NP's) play a huge role in how the patient will frame the current painful condition going forward. I'm thinking of suggesting key phrases to avoid in an initial consult( degenerative disc disease, pinched nerves, bulging discs etc etc).

I imagine at least 1/4 to 1/2 will encompass this.....as to me....it's more important.

I've been asked to submit my presentation title:

Any suggestions for a title?

Last edited by proud; 11-07-2011 at 02:11 PM.
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Old 11-07-2011, 02:50 PM   #2
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Default

Quote:
I'm thinking of suggesting key phrases to avoid in an initial consult( degenerative disc disease, pinched nerves, bulging discs etc etc).
:th umbs_up
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Old 11-07-2011, 03:27 PM   #3
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Default ideas?

Clinical pearls ............and the shells around them ........

'sometimes its much more important to know what kind of person has a disease than the disease a person has' Osler quote..

sort of explain the nugget in the middle like you have done but how the nervous system and the communication network surrounding the 'pearl' may be the real issue ........ you could do a visual image of this.
Don't know if this metaphor would work or not . You could do some basic info on 'nerve' pain or look at the ref's that David Butler used on his 'spirituality and nerve root' re catastrophisation and pain for example?


You could put a few bullet points down as to why knowledge in this area could perhaps make 'complex' presentations more understandable and possibly prevent chronicity?

ian
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Old 11-07-2011, 03:48 PM   #4
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What a great idea, proud.

I don't have a title to suggest, but if I think of one, I'll add it. The Osler quote supplied by ian is pretty good I think.
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Old 11-07-2011, 04:07 PM   #5
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Going along the lines of what ian suggested..."Clinical Pearl. Things not to miss and things not to add."

I like the idea of helping them understand the fear and lack of understanding that words with our "diagnosis" can bring that we all too often use in medicine..."blown or ruptured disc", "torn muscle". Adriaan Louw recently challenged people that get his ISPI newsletter to cut off the dreaded red bulge that comes on all of our spine models at L4-L5. Reducing fear and not adding to it goes a long way to recovery.
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Old 11-07-2011, 04:38 PM   #6
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Default Some ideas

Is Your Examination Iatrogenic?

The Iatrogenic Clinician and The Power of Words

Examination Fail: Avoiding Iatrogenesis

Communicating Exam Findings: What Were You Thinking?

The Examination and What the Patient Hears

Communicating Exam Findings and The Power of Words
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Old 11-07-2011, 04:59 PM   #7
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Default nocebo messages.........

Jon --great suggestions esp this one and here are some obvious links in support


Communicating Exam Findings and The Power of Words
http://www.cortona.ethz.ch/services/...ers/fbenedetti

http://www.ncbi.nlm.nih.gov/pubmed/17379417
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Old 11-07-2011, 05:47 PM   #8
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Jon, I like those...
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Old 11-07-2011, 06:16 PM   #9
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I submitted the full length Benedetti article "When words are paiful" in SoS. See here

Good stuff...
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Old 11-07-2011, 07:02 PM   #10
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Wow, thanks everyone for your excellent input.

Jon...I specifically like your direction: iatrogenic examination.

Keeping in mind that I am going to be spending at least half of this presentation providing the typical examination nuggets....

How could a title that utilizes the potential iatrogenic aspect of examination also reflect that they are going to get "what they also paid for"( so to speak...given I'm not gettin' paid)....

Last edited by proud; 11-07-2011 at 07:05 PM.
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Old 11-07-2011, 08:12 PM   #11
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"Clinical Pearls: separating real pearls from cultured ones"

Sorry proud, have brain cramp right now - can't do better than that.
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Old 11-07-2011, 08:12 PM   #12
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I speak to and teach primary care folks often and the NPs are always an attentive audience who want to learn.
I make a lot of connections with them by pointing out the poor psychometrics on all the musculoskeletal special tests so that they feel better about not using them and memorizing their names - also so they stop according people who use them frequently (they know who they are) elevated respect.
Love Jon's suggestion and you could tie it with this advice too.
My pick is "Examination Fail..."
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Old 11-07-2011, 09:53 PM   #13
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Iatrogenesis is often not well recognised and practitioners believe they are being 'honest' with the patients.
Something along the lines of: How useful is a diagnosis in trhe presence of pain?

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