Back from holiday, feeling somewhat refreshed, I have been pondering the idea of values. One of my original purposes for setting up this blog was to convey the idea that healthy living, whether because of a health problem or not, is about living a life that allows for the expression of what is important in life. Values have often been ignored, it seems, in our health system – well, perhaps not ignored. Let me start that again – values are inherent in everything we do as humans IMHO. In our health care system some of the values that seem to be supported are
– health is the priority,
– individual choice (provided that we agree with medical treatment)
– the individual is as important (or more so) than the collective (family or community)
– discharge into the community as quickly as possible
– adherence to treatment is important
For physiotherapists, movement is good, mobility must be retained as a priority.
For occupational therapists, being able to do, being independent – these are priorities.
For doctors, finding out what is wrong and fixing it – that is the priority.
Yet when a person goes to a health care provider, more than one value is being expressed – perhaps it’s worry about independence (this pain means I’m going to end up in a wheelchair), perhaps it’s to appease a partner (my partner wants me to see you and it’s important to me that our relationship is good), perhaps it’s to satisfy curiosity (I don’t want treatment, I just want to confirm what is happening to me because it’s important that I am informed).
As health providers, I think we hold a lot of values that we assume our patients also hold. We may assume that our patients ‘should’ place their health as their highest priority. We may assume that being well is equivalent to completely abolishing pain (despite the treatment being time-consuming, uncomfortable and not always successful). We may assume that being independent and active is always the best option (even if, in this person’s culture, being cared for by others is their right, and normal). We may even assume that an evidence-based approach to health care is always the best way (even though the person really wants spiritual healing and believes that prayer will provide the cure).
Holding different values from each other can sometimes mean working at cross purposes. If the person I’m seeing really wants to have a perfectly tidy house because that is important to her, and I suggest she needs to take some time out for herself to reduce her anxiety because she is becoming overly fatigued, chances are we’re not going to make progress. This is often called ‘resistance’ because the person doesn’t follow or adhere to my recommendations.
Using a motivational interviewing approach, I can work with her to find out where she is on the stages of change cycle, and perhaps explore her ambivalence. With cognitive therapy I may help her clarify whether her beliefs that ‘everyone will think I’m lazy’ are accurate – or helpful. With ACT I may wonder with her about whether her actions and thoughts are working, what is she avoiding by staying busy.
What is my role as a health provider? Really, I’m there to do just a couple of things: listen carefully and respectfully to what this person says; with permission, provide information on options (being clear with her about my position); provide space and a forum for exploring those options; help the person clarify her own values and help her resolve any ambivalence; and help her develop a strategy to take action to achieve a life aligned with her values.
The technical skills and knowledge I bring come from my professional background and ongoing learning both as a health professional (I read widely about pain management in the literature, maintain my professional skills in communication, develop my knowledge of different therapeutic approaches) – but more importantly as a person. I have blind spots – I may never have checked out my own values, or the values of my profession, or that of my community, cultural heritage or family. I may not be aware of the importance I place on various actions. This is my challenge to myself, to notice when I feel my own resistance – what underlying ‘should’, ‘must’, ‘ought’ am I encountering? Where does it come from? Can I hold it, make space for it – and keep listening?
If you’ve enjoyed this post, and want to read more – you can subscribe using the RSS feed link above (just click on it and it will tell you the rest!), or you can simply bookmark this page and come back again another day. I post most week days, love comments – and this week I’ll be writing mainly about values and actions, the result of reading about ACT over the holidays!