To be or become a successful health practitioner - experience and a level of education are obviously a must. For those in the physical and manual therapies, a skilled set of hands and empathy are also important. However like with most aspects of life, outcomes are what matter. You need to get people better, and if you do, your patient will tell others. Word of mouth recommendation in healthcare trumps everything else by a country mile.
In theory it should be easy; you accurately diagnose the condition and devise a treatment plan using current gold standard evidence, and your patient gets better. If only it was that easy. Sometimes best practice is not the most appealing option to a patient.
I reflected on this notion during an industry breakfast I attended on the current state of play of the management of tendinopathy. As most people who read this blog will know, load management and strength training by far are the most effective and evidence based strategies for the management of lower limb tendinopathies. However this approach takes patience and perseverance by both the patient and the therapist.
Getting people to comply with this treatment regime is hard, and you need to convince your patient not just once, but multiple times along the way. Patients these days are much more (I didn’t use the word “better”) informed. If you start typing “treatment for tendon..” Google will give people “treatment for tendinitis” as the first option, and here’s a screen grab of the first half page of results.
If you want to get angry (or laugh), have a read of the number 1 result from the Arthritis Foundation. The others aren’t much better. When someone comes to see you, and have clicked the first 4 or 5 links their expectation is that they will get better with ice packs, a splint, analgesics and anti-inflammatories - oh and some physical therapy down the bottom (hot/cold, ultrasound, laser and water therapy). It sounds like a quick fix.
Will sports people with a degenerative patellar tendinopathy get back on the field with OTC medicines, ice packs, splints and ultrasound and laser? No. A recent graduate can tell me that. And I’d expect most sports medical practitioners will appropriately advise their patient that medium-long term load management and a strength program is what will give them the best chance.
However, you’ve got a patient sitting across from you who probably couldn’t care less about the evidence or science, but is only focused on getting back onto the field as quick as possible. Drugs and ice, or an injection sound much more appealing, after all it was on the American Arthritis Foundation website.
It’s at this point that the successful (and busy) health practitioners do something different. They switch to an emotional approach to gain confidence and respect from their patient, and in turn convince them to take what may seem like the more difficult, but most effective option. So how’s this done?
Trust is earned, and developed over time. Get to know your patient as a person rather than a condition. Ask them about their sport, their job, their family, their ambitions and fears. Pick up on things you share in common and give back some information about you. Be authentic but professional. When your patient feels that they know a little more about you and you about them, a sense of trust, belief, compliance and ultimately commitment will develop.
Be an active listener
Your patient will tell you what they want if you listen. Ask open questions like “what’s your main reason for coming in today” and get them to tell you what’s important to them. Listen closely to their answers and repeat it back so they know they’ve been heard and you understand. I always say something like “just so I’m clear on things, the most important thing to you is that you want to be ready to play basketball for the state selection trials in 6 months. Is that right?”.
Be a teacher
It’s important to keep communicating with your patient, get their feedback, and keep constantly educating along the way. Trust and respect will continue to develop if you continue to keep actively involved in their progress rather than them feeling they’ve been put into a treatment sales-funnel.
Good teachers and practitioners also motivate. Encourage your patient, tell them that they are doing well and things are improving (with objective measures of course), but give them a kick up the butt if they’re not doing their homework. Celebrate milestones achieved, as health professionals have a tendency to highlight problems only. Flip it the other way and keep things positive and upbeat.
The cliché is treat the person, rather than the pathology. I agree. Tap into what motivates your patient and their reason for seeing you and individualize your approach to each and every one. The busy and successful health practitioners always do.
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