Have you tried asking your patient “WHO are you”?
Don’t! Most people would just give you a strange stare back and say something like; “I just told you. I’m David Thompson. Now can we get started?”
So, the magical transformation I’m about to share with you is not in the question per se, it’s a shift in the attitude towards the patient, or PERSON in front of you. It took me minutes to get the idea, but years to start mastering the craft.
How should we approach patients?
In my opinion, worst case scenario is that we never try to connect with the patient on any level, just go on with our agenda “interrogating” the patient, squeezing out any detail that will ultimately fit into our preconceived idea of what is wrong, and then forcing our treatment on them without even asking about their opinion, expectations or previous experiences.
STOP! Don’t do it! Just… don’t!
I believe the most common procedure out there is this one: we start the conversation with an open-ended question like “So, tell me why you are here”, or “How can I help you?”. This can be a good opener, but ultimately, too often we end up plowing through our list of questions searching for WHAT is wrong with them. Questions like:
- How did it happen?
- Where does it hurt?
- How long has it been hurting?
- How much does it hurt on a scale from 0-10?
Don’t get me wrong, these are all valid and fundamental questions to start understanding the “shape” and “size” of the problem, and they should be included in most cases. This is following a predetermined formula, it’s clever detective work.
This leads you to understanding the “WHATis wrong”, but do you have any idea of what that MEANS to the person in front of you? HOW that effects their life? WHO the affected person is?
Is that even important?
Person centered care
So, what was my big discovery through these last few years? It was delivering Person Centered Care!
– Focusing more on UNDERSTANDING THE PERSON in front of me has given me far stronger tools to deal with most peoples’ problems! –
Why? Because ultimately, we are working in the behavior change industry, whether we want to, or realize it. And, giving people a list of treatments or exercise programs SOLELY based on WHAT is wrong with them will probably turn out to be quite ineffective in the end.
The most common musculoskeletal pains are most likely a product of a string of choices/behaviors made over time, not just something we can fix or correct within a few minutes. And, most behaviors won’t change with generic plans that neglects the needs of the individual.
We need to get better at digging deeper, at understanding WHO we are dealing with. And, how do we do that?
How I do it
It has a lot to do with asking the right questions, or give cues, driven by the idea of “I want to get to UNDERSTAND YOU better”. These are some examples:
- “Tell me your story”
- “How did that experience make you feel?”
- “How has this problem affected your life?”
- “Are there things you can’t do that you want to get back to?”
- “What would you do tomorrow if your pain was gone?”
The idea is to give the patient space to show themselves to you, and when I start to get an idea of who they are, their fears, expectations, goals and wishes, I start tailoring information and a plan based:
- More on WHO they ARE
- Less on what DIAGNOSIS they HAVE
Of course, a treatment and movement plan should always take the diagnosis into consideration, but for most type of average person painful complaints you don’t have to be overly specific. It’s more important to get the person moving regularly towards an individual goal, than finding the exercise that loads the exact area, that will often feel detached and boring, and in the end: NOT BEING DONE!
So, let’s say you have done four times of manual therapy and explaining pain, while giving them a rubber band and a sheet of 4 exercises per day. After six weeks they feel a bit better and remember to do their exercises from time to time.
Instead, the solution that might work much better in the long term might be just telling them that “based on my assessment there is no risk with movement” and getting them back bowling again, or dog walking. And more often than not you can use bowling or dog walking as part of the rehab plan. You think it might be easier to find motivation for that?
It’s about finding that key that opens up the possibility for both physical and PERSONAL progress, plus a bit of that natural motivation. Your role will be guiding towards that personal goal, acting as the helper/coach. You don’t always have to strive to be the superhero.
– Getting over those personal stumbling blocks, tackling those individual fears, targeting those individual goals, I believe is the recipe for high quality musculoskeletal health care! –
But remember!
YOU changing the attitude towards the patient does not mean that the PATIENT will change their attitude towards you. Most patients are stuck on the “WHAT is wrong with me” and if you fail to deliver that service to them, many will be disappointed and cancel their next appointment.
You should always deliver a proper clinical assessment and give the patient a good explanation for their complaint! Never forget the basics!
