Conversations with colleagues often produce unexpected results. One of these recently was, for me, the realisation that you can’t help everyone.

We graduate from college, ready to take on the world and  slowly the experience knocks the corners off us, we grow into our own style of practice and learn what works for us.

However, one of the hardest things to face up to is that not everyone will get better. There are, of course, the red flag patients who should be referred to medical care and those who need other forms of intervention. But in theory, the rest should be amenable to treatment, at least to some extent.

So to understand that you can’t do it all is a big leap. There will be some where  your personality clashes with theirs, those who come with high expectactions, hoping for a magic click that frees them of the chronic pain that they have had for the past 20 years, people who blame you when they don’t improve, in spite of not following your advice, patients where the problem is as much psychological as physical and many others.

The skill is in recognising this, accepting it and moving on in the most appropriate direction, whatever that may be.

For me, once I came to this conclusion, the pressure lifted and, as long as I felt I could stand by my clinical decisions, my practice improved.