You just had an initial evaluation. You crushed it, gave them home exercises, and even scheduled them out for the rest of the month! Unfortunately THE PATIENT NEVER COMES BACK to PT.
You start reflecting on where it could have gone wrong. It makes no sense because you did everything according to the book. The patient was a really good candidate for PT and you could have made them better
Hey, relax. It happens.
The best you can do is try to put yourself in the best position so you will have a better outcome next time. Majority of patients want to be in physical therapy. A majority of them know why they’re there and are highly motivated to get to work. Once in a while you will get the really skeptical patients. You know that they should be here, but they don’t think they should be here. They say things like:
“I’m only here because my doctor told me to come here”
“What is physical therapy going to do to fix my rotary cup?”
“The Green Bay Packers are my favorite football team***”
We all know how hard it is to change someone’s mind in an argument right? WELL, GUESS WHAT? You may not be aware of it but you are now in the middle of an argument.
The patient is saying “Physical Therapy is not going to help me. I just want to sit, get medications, or get a surgery to fix this”
On top of examination, forming a diagnosis, performing a manual intervention, prescribing a home exercise program, educating on your findings, educating on self-care and joint protection, documenting your findings, reporting your findings to the physician. YOUR JOB NOW IS TO PERSUADE THEM AND SELL THEM TO PHYSICAL THERAPY. Something you were never taught before in your life is now the most important aspect of your treatment.
In Aristotle’s Rhetoric, he goes over some modes of persuasion. I will go over three of them that will be beneficial to add to your toolbox and they are ETHOS, LOGOS, PATHOS.
ETHOS- establishing credibility through character or reputation
Your patient’s opinion of you starts before you even open your mouth. They want someone that will be knowledgeable and trustworthy. As a student you already have a slight uphill climb in credibility, and it is normal to be self-conscious about it. Try not to have any kinks in your ethos.
COMMON FAULTS: unprofessionalism, tardiness, lackadaisical body language, calling the patient by the wrong name, usage of slang, chewing gum, untucked shirt, mustard stain
CLINICAL PEARLS:
- Dress the part- There is a “lab coat effect” for patients in the waiting room they just generally develop trust when someone in a lab coat grabs them. In the past, I have never even noticed if it was a 3rd year med student or a fellowship trained MD that has grabbed me from the waiting room. If your facility has a dress code, adhere to it. Otherwise, it wouldn’t hurt to look snazzy for work. Look good feel good
- Introduction with your title – “Hi, I’m Dr. Sampang” or “Hi, I’m Fred and I will be your Doctor of Physical Therapy today”.
- Finding common ground with the patient – “I see that you’re wearing a CUBS shirt. How bout that game last night?”
- You have to break the wall first before you get through it – The first visit is a really critical period where buy-in should be had before you can be buddy-buddy with them. Personally this is where I utilize manual therapy. When I see their eyes light up after an alleviation of an asterisk sign, I know I got them on the hook and that they will listen to everything I have to say from here on out.
LOGOS- logic and reasoning
This branch is what DPT school prepares us for. The turning point in this whole “argument” is with the patient reasoning. This is where you start MAKING THE PATIENT THINK THAT THIS IS THEIR IDEA. You can try and coach them, use cheerful encouraging words, point out their progress, but all of that is for naught if they lack INTRINSIC MOTIVATION.
COMMON FAULTS: too much medical terminology, talking down to the patient, unprepared, informal language, poor non-verbal communication, lack of active listening, not making it salient for the patient
CLINICAL PEARLS: Perform this step-by-step as this has changed my game substantially
- Ask the patient what they know about their impairments – before you start spitting facts using a shotgun effect, have the patient tell you what they know about their symptoms. In this way, you can avoid cognitive overload for the patient
- Ask how they perceive their impairments – this will give you a better understanding on the severity of symptoms and how they view their disabilities. They may say 2/10 pain, but now they can’t golf, or garden. That is something that we will have to address.
- Address fallacies or faulty reasoning- patients states that if she bends over her disc will bulge…you should be licking your chops after a comment like this
- Educate accordingly- fill in the holes using language a 5th grader can understand. You can scale this, obviously, but that is just a general rule of thumb. If you don’t know the answer, it is not the end of the world. Say something like “I don’t know right now, but I will find out for you”
- Ask patient what he/she thinks they need to do to accomplish their goals- THIS IS MY FAVORITE BULLET POINT IN THIS BLOG. For patients there is something about saying something out loud that is both cathartic and self-realizing for them. You will ask “You have had PT three times in the past, with each time feeling good while you were in PT. How is this time going to be any different?” and they will respond with something like “Well this time I have to do the exercises at home more regularly”. BOOM! Your job just got a whole lot easier!
PATHOS- the appeal to emotion
This method is the most commonly used tactic by marketing and ad agencies. Think of that Jenny Craig commercial with the lady showing you before and after pictures and telling an emotional story about her struggles of being overweight. Think of T.V. at 1 a.m. and Sarah Mclachlan comes on the screen. Need I say more?
COMMON FAULTS: too many facts leading to cognitive overload, poor active listening, poor bedside manner
CLINICAL PEARLS:
- Stories will always have more impact than scientific jargon, and they will be more relatable
- Active listening – eye contact, light touch, follow-up questions, being emphatic. I know you know how to be an active listener. Never sacrifice writing up your documentation for a chance to make a connection
- Lastly, relate everything to your patient’s goals like improving their squat so they could play with their grandson. They will tell you how to treat them, you just have to LISTEN.
This blog on persusasion is not exclusive to PT and may be applied to your many roles like entrepreneur, coach, parent, etc. Even though the art of persuasion will appeal to human nature each patient should still be treated like an individual. When you’ve seen a person with ______ diagnosis, then you’ve only seen one person with ______ diagnosis. Theodore Roosevelt once said
“People won’t care how much you know, until you show how much you care.”
Sources:
1)Aristotle. On Rhetoric: A Theory of Civic Discourse. 2nd ed. Trans. George A. Kennedy. New York: Oxford UP, 2007.
2) Aristotle’s Rhetorical Situation website https://owl.english.purdue.edu/owl/resource/625/03/. Updated April 27, 2012. Accessed May 25, 2017.
***Go Bears!