Thursday Thoughts: Are You Assertive Enough? | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Thursday Thoughts: Are You Assertive Enough?

One of the biggest things I took away from MDT training, and thus remains integral to The Eclectic Approach, is patient compliance. And no, I don't see a negative connotation to the word "compliance" and switching it to "adherance" or whatever, sheesh....

Patients who want a "Quick Fix" often do not work well with me. I tell them that the quick fix literally is just that, a transient improvement that often will not improve itself, especially if it has been months with no change. Here are some points I try to get across

  • The Quick Fix you are looking for maybe lasts 2-4 hours for ROM, strength, 24 hours for pain if you're lucky
  • at least part of the quick fix must be maintained by YOU between visits
  • if you walk out better, and you don't stay better, assuming I chose the correct homework, that's YOUR fault
  • the dosage is dependent on how often you are negating your own reset
  • the things I tell you to do are just as important as the things I tell you to avoid
"I didn't do my homework as much as you told me..."
Two possible responses
  1. that's ok as long as you maintained some improvement
    • then you reassess movement, function, etc
  2. if you're not feeling better (or moving etc..), then you have to try harder
    • now don't automatically go flipping out (like I used to before I owned my own business)
    • try to find a way to motivate them
    • if they're type "A" - use those type A tendencies and put them toward your HEP
    • if they're athletes - take the dedication to your training and apply it to your HEP
    • this will help you lift your grandchildren, etc...
    • everyone has a motivation - find it and use it

My Jedi mind tricks are what separate my outcomes from other clinicians. If someone in my former practice had a non-compliant patient that always felt better upon leaving, but was consistently not better upon returning, they would have me sit down with them methodologically breaking down any argument they had not to be compliant. Sometimes this would take 30-45 minutes, or repeated sessions. Realistically, if you can find their motivation and politely, but firmly convince them to do their homework. They will see rapid changes. 

When I hear "You can't teach proper posture," I think, you're not showing cause and effect. When I hear, "I can't get my patients to do their HEP," I think, maybe your patients do not understand why they are doing it, or you just are not pushing them enough. If you really cared about getting your patient's better, you would not let your patients slack on their responsibilities. Most clinicians who are not getting the results they want need to work on patient compliance, unless treating someone every 3-4 hours is realistic.

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Keeping it Eclectic...

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