Margit Kooijman

General discussion | 125 be aware of: the importance of timely referrals; the pitfall of wanting to do something thereby forgetting that giving advice is just as good an intervention; the lack of uniformity in diagnostic labelling even with the help of add-on techniques like MSU; the switch from diagnosis to prognosis based treatment including specific as well as generic prognostic factors; and finally the influence they themselves have on outcome. All things considered, one would easily forget that every clinician’s role is also to listen as a human being to the human being in front of him right there and then. Pain demands attention; a patient wants to be heard. They need a skilled observer who helps them identify what is their main problem and formulate what it is they want and someone to ask that same question time and time again. Only this way, the patient is the manager of his own healing process. Which matches the concept of health as the ability of people to adapt and take control, in the face of physical, emotional and social challenges of life. In a way, it parallels the macro process of management of patients with shoulder pain starting with the question: ‘where are we now?’ and continues to evaluate itself as a guide towards where we want to go. A more individualized approach with focus on the patients’ whole and unique experience including that of pain suits the seemingly natural capricious course of shoulder complaints. While this approach almost inevitably seems to lead to a higher demand on the already pressurized time patient and clinician have together nowadays, in the long run it is more likely to save time and costly interventions than continuing on the same track. And last but not least, lead to health and vitality.