Caroline McCarthy is an academic GP and aspiring master’s runner. She has developed a recent interest in narrative based practice, inspired by attending a workshop “Conversations Inviting Change” led by Dr John Launer.
It’s been two days since I noticed (or perhaps more accurately, admitted) there was a problem and that I should take a break. The problem is a tender spot in my left medial thigh that showed up after a slightly too ambitious running week. It’s frustrating but not catastrophic. I might have to be a no show for my leg of the national road relays this weekend but it will in all likelihood settle soon and I will have other races this summer. In this short time, I’ve had to stop myself from over-analysis of the situation and its potential repercussions. I’ve had an arguably unhealthy number of ChatGPT conversations about the anatomy of the left medial thigh, and potential rehab and ‘prehab’ strategies I have no intention on following through on.
Needing a more personal touch than a large language model, I am thinking about going to the physio. I have a physio who knows me fairly well, and I’d like to think that, over the years, thanks to multiple consistent training blocks and a solid conditioning routine, I’ve ended up needing to see him less often. His diagnosis is usually weak hip abductors and his prescription banded side lying leg rises. Which I hate. And know I should probably do and so hate them all the more.
Needing a more personal touch than a large language model, I am thinking about going to the physio.
But being totally honest with myself I have realised the reason I want to go and see him is not to get an accurate diagnosis or rehab plan. I admit, it probably helps that with my own clinical knowledge and personal history with a similar injury I am pretty confident this is a mild left adductor strain (hopefully not tendinopathy). The real reason I want to see him is the space to tell my story. To describe what exactly brings it on, why I think it started, how I’m worried I will have to let the team down this weekend and disappointed about this blip in my training. Not to mention all the odd little ideas I have about things that may be related (like my tight left plantar fascia and calf or how I’ve noticed my left oblique is stronger than the right). What I really want from him is to listen with interest to my rather uninteresting story. Maybe some reassurance that yes, this is just a little blip, and yes, it’s frustrating and also an acknowledgment that I’ve made a lot of progress, that I’m strong, and that this doesn’t undo all the work I’ve put in. What I don’t want is a lecture about my weak glutes or the many benefits of side-lying leg raises. (Yes, I know I have a very strange and strong dislike of side-lying leg rises).
But this self-indulgent reflection on my potential physio appointment has led me to reflect on the patients I saw today. Was I curious? Was I attentive? Did I help them navigate their own story or was I quick to jump in with my ideas and fixes? Were these ideas helpful or even wanted? For example, the middle aged man with low energy and poor sleep.* I quickly noticed the raised MCV and slightly low white cell count on recent bloods and was correct in my suspicion that his weekly consumption of alcohol is too much. This may well be a contributing factor to his low energy and poor sleep but now I wonder whether this was a convenient answer for me to end a conversation that could have continued. Many GPs may consider that a reasonable and efficient approach. And maybe it was. But as he left the room, I had the quiet sense that I’d closed his story with my ending, not his.
He knows his alcohol consumption is too much. I know I need to do my side lying leg rises. My guess is he wanted a sympathetic ear from a GP who knows him well. As for my poor unsuspecting physio, he will be left dealing with a GP patient armed with performative, half-formed hypotheses and expectations of attentive listening, affirmation and just the right amount of charismatic reassurance, and not a single mention of side-lying leg rises.
*Note: This is a fictional patient based on my experiences as a GP and does not refer to a particular patient alive or deceased.
