Table 3.

Highlights key areas with common “dos and don’ts”: practical tips for medical practitioners to identify psychosocial red flags

Practical tip	Dos	Don’ts
Develop rapport	Listen and validate physical symptoms Gently acknowledge the emotional impact of living with pain and the broader quality of life issues that could benefit equally from attention	Advise the patient that persistent pains can be caused by psychological problems or trauma
Signpost	Consider referring the patient on to clinical health psychology services or ask the GP to refer on to local service provisions	Try to manage the patient’s psychological issues independently if they need expert opinion e.g. “exercise for a better mood”, “think about all the positive things” Discharge them with no biopsychosocial plan or reference in your clinical correspondence to primary care that you have observed mood-related difficulties in the context of physical symptoms
Consider relevant systemic factors and build up a picture of holistic wellbeing	Enquire about treatment adherence in other comorbid health conditions Consider the age of the patient and the specific difficulties pain may have on life stage e.g. career/education/starting a family
Observe and make note of any discrepancies between physical disability/pain and distress	Ask patients to rate on a visual analogue scale (0–10) the level of pain distress/intensity and disability they experience—make note if pain intensity is high but distress is low and consider onward referral to psychological services
Communication style and language	Use accurate and clear language. Reduce the risk of misunderstandings by ensuring that the patient understands accurately what you have advised Ask the patient at the end if they need any aspects to be clarified or anything has caused undue concern	Avoid vivid and distressing analogies of structural problems Avoid unhelpful and potentially inaccurate predictions of physical prognosis