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Eur J Pain. 2019 May 9. doi: 10.1002/ejp.1412. [Epub ahead of print]

Discharged and dismissed: A qualitative study with back pain patients discharged without treatment from orthopaedic consultations.

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Department of Psychology, Royal Holloway, University of London, Egham, Surrey, TW20 0EX.
Department of Orthopaedics Wexham Park Hospital, Slough, Berkshire, SL2 4HL.



Consultation-based reassurance for patients with low back pain (LBP) in primary care has been shown to be associated with patients' outcomes. Little is known about the role of reassurance in people with LBP consulting with orthopaedic spinal care teams. Reassurance may be important, especially in cases where surgery is not indicated and patients are discharged without treatment.


Semi-structured interviews were conducted with thirty patients with chronic disabling musculoskeletal LBP who had recently consulted with spinal orthopaedic care teams. Interviews were audio recorded, transcribed, coded, and analysed.


Most patients reported feeling dismissed and discouraged. Patients perceived that they needed specific behaviours from practitioners in order to feel sufficiently reassured to commit to self-management. These behaviours group into four domains: 'Knowing my whole story' (evidence that practitioners read the case notes; were familiar with the patients' previous health care history; carried out tests and a physical examination and gathered information about the patients' lifestyle), 'Seeing the right person' (showing empathy; listening; building rapport, demonstrating they are qualified and experienced), 'Nothing to worry about' (reducing generic reassuring statements but increasing validating statements recognising suffering), and 'Getting to grips with my problem' (providing explanations and a clear management plan). In the absence of these behaviours, patients rejected advice to self-manage, reported distress, anger, and intention to re-consult.


Effective communication with patients attending spinal orthopaedic care settings is important, especially when no active treatment is being offered. This article is protected by copyright. All rights reserved.


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