STEP 1: SHUT UP AND LISTEN
If we don’t listen… google search will!
Could you imagine a time where a patient could just type in their symptoms into an app that in turn gives them a diagnosis and an entire exercise program to follow without ever having seen a healthcare practitioner? In a time where our use of technology grows professionally and socially, we have to stay committed to what drives our efforts of research and desire for clinical expertise. That is being engaged and listening to our patients.
The first date is great… but the second date may be more important.
Structurally, we typically only set aside one point in time where we truly listen to our patients. We enter our evaluation, fully grounded in this concept of motivational interviewing in which we are empowering our patients, tactfully guiding them towards an internal locus of control over their situation. Before you know it, we’ve reached our 10th visit and it’s time for a progress note. We’ve updated a few exercises here and there, but we haven’t revisited their original reason for coming to therapy in the first place. Where did we go wrong? We fell victim to becoming too comfortable with the relationship and unfortunately taking their time for granted.
The world of speed dating
In the midst of our day to day caseloads, it may seem cumbersome to have a patient that won’t stop rambling. It’s their fault, they should know you have notes to write, another patient that is also requiring your attention and a few text messages you need to respond to from an hour ago. It’s like speed dating with two people simultaneously and you’re trying to listen to them both tell you their life story. You may take pride in finishing the day with your notes done, feeling efficient and like you’ve mastered the art of multi-tasking, but at what expense.
Use cruise control with caution.
It’s so much easier to take your foot off the pedal knowing all you need to do is control the steering wheel. You write up a great eval note from the first visit but fail to refer back to it. You go on auto pilot because you have already decided what is needed to get this person better based on their initial presentation. After a few visits with you, they’re doing much better, only having 1/10 pain and being consistent with their exercises. Their only problem now is being able to pick up their newborn grandchild. This was their initial problem described to you at the first visit, but we became sidetracked and only focused on the numeric pain rating scale as an outcome. We haven’t asked how their grandchild is doing or determined if they have obtained their goal of holding them in their arms. It may be minute in the grand scheme of medical diagnoses but remembering something this simple can go a long way.
With preparation comes less effort.
Give yourself time to chart review. Take notes. Go into each session as if it’s the last time you may get a chance to make a life better. There are a good number of people who will only seek our help when they are desperate, let’s surpass their level of vulnerability with preparedness. Being present, listening to them each visit and allowing their concerns to direct our care will ultimately prove most effective. Taking the time to hear them out can be useful if we are asking the right questions at not just the evaluation, but also during follow up visits. Appreciate their learning style and try your best to tailor to it. Understand your wealth of knowledge may only be useful to those that find value in it as it relates to their circumstances.
We might have different rooms, but we are all under the same roof
The debate of who to trust in our profession is like watching two parents disagree on how their kids should be raised. The good news is that both sides will almost always act in their child’s best interest. In the PT world, we’ve found ourselves in a place where we are stuck eating soup with a fork knowing there is so much yumminess still left in the bowl. At some point, we hope to scoop up this content with a spoon, leaving no good information behind.
I’ve been blessed enough to have had in depth exposure to great minds on both sides of the fence when it comes to comparing physical therapists in the academic and clinical settings. I can honestly say I admire the landscaping on both sides.
The Renowned Professor
The first group of intellects is what we are exposed to in school. This group includes those with PhDs, years of participation in groundbreaking research and even published books. Early in our careers, we spend countless hours consuming their content to grasp a proper introduction into the world of PT before truly getting our feet wet. This group may have had years of clinical experience as well, but usually will have been removed from consistent clinical practice to pursue even more accolades. They are the backbone of our profession; we’ll never make it through this stage of adolescence without them.
The Rockstar Clinician
The second group consists of clinicians who are out in the world carrying the profession in a different sense as they deal with the day-to-day load of patient care. Those at the forefront of this group may or may not have kept up with all of the latest research or even the most up to date textbooks, however, they are idolized by their colleagues and usually sought after for advice on complex patients even by some of the most experienced clinicians. Their approach to PT is probably different than what is taught in DPT programs, but they are getting their patients better consistently.
The Alligators of the Swamp
This last group is a very special one. They have shown the ability to not only run on the land of academia, but also swim in the marshes of patient care with the Rockstar. They value what both groups bring to the table and have found a way to master this art in a manner that an advanced practitioner can appreciate. These are individuals who have pioneered and disseminated their philosophies to the PT community as a whole. If you’re ever wondering what’s being left behind from the fork in the bowl of soup, here is where you will find it.
If you’re striving to be an alligator, you have to first respect how the Renowned Professor and Rockstar clinician are giving you landscape to explore on both sides of the fence. It’s impossible for either group to be right 100% of the time, but the level of intelligence in each provides plenty of fertilizer for you to excel. Stay grounded in why you chose this journey of becoming a master clinician and embrace the pearls you receive from each group knowing you’re leveling up with each patient contact.
Your Favorite PT Fellow
Meet Chris, the creator and sole author of the Your Favorite PT blog