Pain and Suffering in the ED – the talk and the inside story

The Talk

The Audio

The Inside Story

It was in July 2013 when I first received an email from Chris Nickson at SMACC headquarters asking if I was going to SMACC Gold and would I like to be considered as a speaker. My initial reaction was “Of course. I’ll be there”, but instead of an immediate reply in the affirmative I thought I’d better just think through the practicalities: another trip to Australia, a 24 hour plane flight and the financial implications therein, but more than that trying to come up with a talk that was somehow comparable to those I’d seen just a few months previously in Sydney. I canvassed opinions at home and at work and the general consensus was that I would be a fool to turn down such an incredible opportunity. And it was then that an incredible journey began….

smacc-gold-logo-2I’d been given the title “Pain and Suffering in the ED”, but this was a thinly veiled reference to the actual talk content: “Chronic Pain in the ED”. When I first started thinking about what I was going to say (not long after confirming to Chris) I suddenly became rather fearful – what on earth had I taken on? In amongst all of the glamour and excitement of SMACC how on earth could I make this topic remotely match up to the others? Nightmares began – people getting up to leave as soon as started talking trying to find something more fun and interesting was a regular vision.

My car journeys to work became dominated by trying to find some sort of angle that I could approach it all from. I’d try listening to music or a podcast, but I always seemed to drift back to the same frightening thought: it was a long way to travel to speak to a handful of sleeping delegates.

I’m sure these are fears that go through the heads of even the most experienced speakers at SMACC. They have raised the bar – it is no longer acceptable to just turn up and deliver something “acceptable” and we all know it. I told myself over and over that they wouldn’t have asked me if they didn’t think I was up to it and I knuckled down to writing the bloody thing.

With my personal experience, my Mum has had chronic pain since a car crash in the late seventies,  I’d always had an interest in the topic. In truth it mystified me, but I had sympathy with those coming to the ED with visceral memories of doing the same for my Mum when I was younger. I remember pleading late one evening  with the doctor in our local A&E who seemed to just not be listening or helping take my Mum’s pain away. These memories became more and more prominent as I tried to work out what I was going to say and suddenly the whole thing became very personal. In amongst the worry, a rather thrilling thought emerged. Perhaps if I did my talk well I could make it just a bit better for this group of patients?

I thought I knew quite a bit about the subject, but as I read more I realised I’d barely scratched the surface. Determined to know as much as I could I sought out journal articles and asked colleagues for advice and as I did so the structure for the talk gradually formed.

Apart from clinical knowledge I was also keen to learn about how the best speakers actually do it and I turned to Victoria Brazil’s talks from the first SMACC conference for guidance. I also read (and reread) advice from the conference organisers, and  watched other well known speakers, both medical and non medical, on the SMACC and TED websites.

In the months before travelling the talk was just about there in my head. I had my take home messages and a structure of sorts. My drive to work is about 20 minutes and the content seemed to get me from the house to the car park and so, as I boarded the plane, things were pretty much in place.

It was as we took off that the self doubt really started and I reached into the overhead compartment and took out my laptop. Something wasn’t quite right and so, in a moment of decisiveness, I rewrote the whole thing. I kept large sections, but it was only now that I added my Mum’s story. I’d been reluctant to put it in, but realised that without it my talk was, well, just another talk. And SMACC needed, and deserved, better. I knew that my Mum had said she was happy for me to talk about her, although I’d dismissed it out of hand when she suggested it, so I didn’t need to worry about breaking her confidence and I found a way to include a little bit of her, and our, family’s story.

I didn’t fly straight to Australia, but was lucky enough to spend a week with UK friends and colleagues Nat May and Nick Jenkins in Fiji teaching some of their doctors. This distraction couldn’t have been more welcome, but not only that my travel companions were patient and kind advisors when I asked for reassurance that my talk was ok. They even listened to it on more than one occasion without complaint.

smacc programme
The first morning’s programme at SMACCGold

My speaking slot was in the first concurrent session on the first morning just after the opening plenary. I sat in the hall, there in body, but was barely there in mind, as luminaries Brazil, Brohi, Levitan and Weingart did their incredible thing, my imposter syndrome worsened. By now the nerves were almost overwhealming. Not only did I have these four giants ahead of me, my session had three other very well known speakers, all doing talks with exciting titles, whilst the three concurrents all seemed to have more than enough to lure away the distracted delegate.

Iain (not) looking calm and relaxed on stage.
Waiting to speak trying to control sudden urge to run away.

I felt physically sick and it was only thanks to fellow concurrent speaker, St Emlyn’s colleague and friend Simon Carley that I finally settled down as the audience gathered after the break. I told him how worried I was that I would mess it up, that I’d miss things out and it would be a disappointment. “Don’t worry if you forget something”, he said “None of them know what the talk is you hope to give, only the talk you do give. And that talk is going to be awesome”.

After I stood up to speak the next 20 minutes flew by in a bit of a blur. I know it wasn’t perfect but it seemed to go ok. People laughed at the jokes and not many left before the end as far as I could tell. I gave it my all, so that as I came to the final few slides I was emotional exhausted. I had a distant memory of someone once saying that “so long as the beginning and ending are good, it doesn’t matter what goes in the middle”, but as the last slide came up I could feel myself cracking a little, having to hold back tears. It had been a long journey to get there, not just the plane flight, or the months preparing, but the years of trying to help someone with chronic pain and trying to understand it myself. Determined not to cry (we were in Australia for heaven’s sake) I got to the end as best I could and headed to my chair. As I passed him Simon smiled and mouthed something that I think was complimentary and I sat down elated. It was done. It had gone ok. And now for me, SMACC Gold could really start…..

smacc picture

Iain Beardsell (@docib) With grateful thanks to Roger, Oli, Chris and all the SMACC team

Cite this article as: Iain Beardsell, "Pain and Suffering in the ED – the talk and the inside story," in St.Emlyn's, June 10, 2014,

16 thoughts on “Pain and Suffering in the ED – the talk and the inside story”

  1. Thanks for sharing your story Iain. I found your presentation at SMACC heartening and inspirational. It was one of my favourites. It has a significant impact on my interactions with patients with chronic pain. Thanks for changing my perspective. Looking forward to your presentation in Chicago… pressure 🙂

  2. I want to thank you as well Iain, it was the highlight of SMACC gold for me, easily the best. As an emergency registrar is so hard to manage and treat this patients mainly for the fear of the unknown and the fear of not been able to do much. Thank you so much for bringing inspiration and motivation on this hard topic, and also sharing your story.

  3. Iain, I missed your talk at SMACC – off in some other concurrent session listening to the nerdy tech talks. The twitter enthusiasm for your talk was overwhelming so I was very glad to finally be able to see it for myself and it didn’t disappoint. Well done.

  4. Iain Beardsell

    Thank you so much for your very kind comments. When I wrote the talk I had no idea what reaction it would get and the whole thing has been rather overwhelming. And there’s a lot more to come from SMACC, not least incredible presentations by fellow StE’s stalwarts Simon, Rick and Nat. A truly remarkable conference. See you in Chicago!

  5. Great talk Ian. I too was in another session when twitter went crazy during your talk. I marked it on the program to watch and was not disappointed. Thanks for sharing your story and wisdom arising from it.

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  9. Hi great talk… could you share and FOAMed the managment plan for patients with pain in the ED.. that would help alot

    1. Hi,

      Thanks so much for watching and I’m glad you found it useful. We don’t use a set management plan for all, but tailor it to what each patient needs. The key is that it is unambiguous and simple and has been shared with the patient prior to its use. Ideally it should be no more than one page of A4 and immediately available when the patient books in.

      Hope that helps.



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  11. Hats off to you for such an incredible talk on this difficult topic. It would definitely change my approach to patients with chronic pain

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Thanks so much for following. Viva la #FOAMed

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