Lorrimer Moseley asked us today to share practice about inclusion of pain strategies and delivering the message in msk outpts. I'm just putting some thoughts together. My observation is people arrive in msk outpts often not knowing what we can offer with...

2/a variety of expectations some influenced by Gps, ahps,prior experience. There is sometimes a story outside of the room or opinion that influences the conversation ie the nhs is not fit for purpose, there's no money for scans. Diagnoses may be held onto which have adversely...

3/ influenced their outcome or sometimes helped them accept certain things. The challenge we discussed as a clinician with morals and ethics how far do you go to challenge these beliefs what strategies can you use. I'm no expert but some things that have helped my practice...

4/a conversation about the conversation what's on offer, what we can do, what's on the table. Education often starts for me just about whether there is even a conversation to be had. I try to plant seeds considering the long game for future conversations, try to identify ....

5/ discrepancies in their understanding with best practice or evidence informed practice. I try to use analogies to help explore concepts or to offer an alternative narrative. I avoid being personal about a previous health professional s diagnosis or explanation if historical..

+accurate acknowledge medical advances + the complexity, if reductionist try to help build this into a larger model so still has a part to play but zoom out to explore the bigger picture. I use humor as a vehicle sometimes to explore contradictions in thinking. I explore anatomy

6/ to help understand why things hurt. Thing I don't often do is ask for permission to get into conversations around more complex concepts. I do probe to explore prior knowledge and understanding. I do look to promote 2 way dialogue and invite information...

7/ to be challenged. I set scene for 2 way process today and with other clinicians I look to promote a more collaborative involvement in their own care. I explore options to get differing opinions or acknowledge sometimes we as health professionals have the right message but..

8/ don't click with a person or are clumsy in delivery. I acknowledge life and difficulty but also give my opinion as to adequate dosing. I write down lists of things tried and key words on a piece of paper between us so can revisit and recap with their own phrases and explore

9/ these or explore how when and what a particular treatment involved and whether it can be discounted or whether it was suboptimal in some way. I try to explore expectations they had for treatments and clarify what we would expect in line with diagnosis. I utilise opt in, ...

10/ sign posting and safety netting acknowledging the time may not be right but door always open. I highlight resources to echo my messages or reinforce them and also to allow people to go away and further their understanding and challenge me. I include more complex ideas even

11/ if simple resolving pathology i think if I have the rapport today I may influence future thoughts and beliefs if more serious issues, again this is only planting seeds. Mostly i try to be human and act with compassion but opening the door to change i see..

12/ my role as an msk physio as one of a coach facilitating a recovery through education, understanding and demystifying care. Anyway as a thread not sure if I addressed the qu in hand or just did a brain splurge anyone who has made it this far sorry!