We've all been guilty of "cutting to the chase." Or in my traditional OMPT days, cutting off the patient's long and complicated history so you can get right to passive care!
Showing posts with label patient interaction. Show all posts
Showing posts with label patient interaction. Show all posts
My favorite part of the initial evaluation is the history. That initial interaction, sets the stage for the subsequent visits. Many patients are nervous, especially if they received a lot of the standard gloom and doom from well meaning, but misinformed providers or loved ones.
Most of the patients walking through your door will respond rapidly even with "chronic pain." Only a small percentage are centrally sensitized or have an underlying disorder which slows down or prevents your current approach from working rapidly. Just because a patient had their function limited or pain for a certain time does not mean you won't be able to hit a home run in the first few visits. We've all had that patient with knee or back back for longer than they can remember yet, still feel 80% better after the first visit.
Some patients are convinced they're a mess, and they've been to so many other providers. For your own prescription and outlines of care, plus to alleviate their anxiety, here are 5 Ways to Tell If Your Patient is a Rapid Responder
1) Their Symptoms are Intermittent
- just went over this in a MMT video, here's the link
- the short of it is, intermittent Sx = times when the nervous system is not threatened, chances are they're a Rapid Responder
2) They have recovered from similar episodes with or without care
- is the patient's entire ecosystem healthy enough so they recovery from other or similar episodes?
- often they see clinician X, go for 20-30 visits, and they recovery - if it's been that long, was it really the clinician or just time? Tough to tell, but if they've recovered before, chances are, they can do it again
3) With previous flare-ups, "enter treatment here" really helped
- I almost tune out to what a patient received as treatment when it comes to previous providers, it may be the best evidenced based care in the world, or terrible
- I really care about two things
- what were they taught for HEP, and overall education of their condition and recovery
- did it help rapidly
- patients will often say, manipulation, IASTM, Needling, etc all helped but only lasted 2-3 days
- that's where I know it was a failure of the HEP, most likely in dosing
- if whatever magical treatment they received improved their symptoms/function for hours or even days, all they have to do is dose the appropriate home program high enough to Keep the Window of Improvement Open
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4) They have an open mind to your approach
- we're all in sales, if the patient doesn't buy in to your treatment and overall approach, good luck!
- being a Rapid Responder means their entire mental and physical ecosystem is open to suggestion and ready for changes
- When I think back as to all the patients I had difficulty with, many of them were non-compliant, or we flat out didn't get along for whatever reason
- pro-tip: if this is happening to you - refer to a trusted colleague or co-worker
- I've swallowed my pride, referred a patient to a co-worker and his pathoanatomical approach was just was she needed
5) Their Symptoms Are Still Significantly Better on Visit 2
- making huge changes on initial evaluation is always a thrill for both clinician and patient but that does neither of you any good if they are back at square 1 on follow up
- if they have all of the above points, AND you gave them the appropriate HEP to maintain improvements between visits, the majority of the changes should remain
- I used to tell patients I wanted "most" of the improvements in function, mobility, and pain to stay between visits
- now that I treat people once every 2-3 weeks, all that self treatment, I expect most of them to be better, not just where I left them at the end of visit one
- education and self treatment are the only things a patient can take home, no matter how much they want to take your "magic hands"
- emphasize the HEP, not the treatment
- when a passive/manual approach makes rapid changes, frame it that "this was applied so that you can now perform your home program and loading strategies pain free." It's up to you to keep it!
The last bonus tip is that honestly, unless you work specifically with a certain population that are non or always slow responders, chances are, the patient in front of you is a Rapid Responder.
If you've tried your best, and the patient is compliant, know your limits and refer out. I've had very grateful patients refer me a ton of their friends and family because I was the person who referred them to the clinician who finally was able to help them. Ask yourself, when was the last time I made a breakthrough 6 weeks into care?
Learn these strategies and how to simplify your assessment and treatment approach at a #manualtherapyparty or click below to do it online with the MMT Premium Community!
Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. Live cases, webinars, lectures, Q&A, hundreds of techniques and more! Check out Modern Manual Therapy!
Keeping it Eclectic...
Even getting a patient to realize this, and telling them, "If your symptoms are intermittent, chances are you fall into a category where you can get rapid return of function and improvement in pain," may be game changing. Using positive language and setting patient expectation for return of function, instead of making everything about what they can't/shouldn't do, focus on regaining function and a positive attitude toward recovery.
Educating on Constant Vs Intermittent Symptoms
Keeping it Eclectic...
Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. Live cases, webinars, lectures, Q&A, hundreds of techniques and more! Check out Modern Manual Therapy!
Keeping it Eclectic...
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Listen in to Dr E. sharing one of his early treatment stories (17 years ago!) of when a patient he treated did not respond to manual therapy...but got better with some unexpected fancy treatments.
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Untold Physio Stories is sponsored by the EDGE Mobility System, featuring the EDGE Mobility Tool for IASTM, EDGE Mobility Bands, webinars, ebooks, Pain Science Education products and more! Check it out at edgemobilitysystem.com . Be sure to also connect with Dr. Erson Religioso at Modern Manual Therapy and Jason Shane at Shane Physiotherapy.
Keeping it Eclectic...
“It’s going to be okay.”
When teaching weekend courses we often refer to this
statement as some of the most powerful words in medicine. The ability to deliver
reassurance to our patient that things are going to be okay can have a powerful
effect on their outcome. As with everything that can have a powerful effect,
that effect can be positive or negative depending on how we use it. It is well
understood from a neurobiological perspective that when a patient expects to
get better that many positive physiological, behavioral, and social responses
are involved in assisting in recovery. Belief and hope are powerful treatment
tools.
When delivering reassurance the health care provider needs to
determine that no significant injuries or illnesses are present. False or
inaccurate reassurance leads us to violation of the “First do no harm”
principle. We need to do our due diligence to rule in or out any potential
serious pathology that can be occurring within the patient in front of us. A
sound clinical examination is imperative to help us with this determination. The
evaluation of the clinical exam findings need to be synthesized with sound
clinical reasoning. While we need to be cautious to make sure there is no
sinister pathology, we also need to protect against the other end of the
pendulum that we are not creating a “mountain out of a mole hill” with some
findings that we can come across within our examination process. Everyone will
have deviants from normal; the bigger question we need to consider revolves
around is that deviation relevant to this condition or a true predictor of
future risk of injury or illness.
The literature on reassurance for our patients is very
interesting and would encourage a read of a few articles that this post is
synthesized from. Pincus,
et al., 2013; Coia and Morely, 1998; Linton,
et al., 2008; Sep,
et al., 2014
The use of medical reassurance is complex process of
psychological components of patient illness behavior and provider persuasion.
Sep showed in their study that it may be very important to deal first with the
patient’s emotions and illness behaviors before providing additional medical
information. As a provider, we need to understand the importance of timing and
having developed trust through empathy and compassion prior to instilling our
medical knowledge and utilizing our persuasion techniques to calm a person’s
fears and anxiety down.
Bottom line: Make sure you are mindful of your patient’s
emotions regarding their condition. Provide reassurance mostly in the fashion
of cognitive reassurance that may increase knowledge and enhance the patient’s
self-efficacy and control. Trust in the practitioner may be a key component on
how well reassurance is received and whether it increases or decreases fear/anxiety
in the patient. Be aware that reassurance is a very delicate process that as a
clinician you should not take lightly and pay mindful attention to how the
patient is understanding and coping with your reassurance. We should notice
improved compliance, better management of symptoms and coping with any relapse
of symptoms, acceptance of current condition all leading to improved health and
reduced impact of health problems on life if reassurance (and treatment) when
done properly.
Remember if a patient comes in because they #choosePT, good
clinical treatment does not always have to entail multiple visits. It is okay
to do a sound evaluation, find nothing sinister and send our patients on their
way with some reassurance that “it’s going to be okay” and basic guidance to
recover.
via Dr. Kory Zimney, DPT
Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. Live cases, webinars, lectures, Q&A, hundreds of techniques and more! Check out Modern Manual Therapy!
Keeping it Eclectic...
This is just a short piece, a reflective piece, about a value that makes up the very core of what I believe in and what I strive to achieve as a Physiotherapist - empowering my patients with the knowledge and the skills they need to make them independent. This year has been hectic, trying to understand and adapt to working in America and personally accomodating to a new workload after studying for nearly two years. I'd be lying if I said I wasn't tired or that I didn't get lost in the daily grind. But not today! Today I am going to take a moment to reflect and to celebrate :)
These past few weeks have reminded me of a very special part of treating patients - discharging them. For months now I have worked intensely to help the small patient population I have contact with. After investing so much time in their development and progress, it is a magical moment when they come to me and say "I am not 100% better, but, I know what the problem is, I know how to make it better, what I need now is time to follow through on my goals and I can take it from here."
What a pleasure it is to hear that. I know that no one will ever be 100% when it comes to discharge and I am fine with that. Firstly, I don't set "being 100% pain free" as a goal and secondly, I think we all suffer from pain at some point in time. What I feel is more important is for patients to functional normally and in the most ideal way for their lives.
STEP 1 - LET ME HELP STEER YOU IN THE RIGHT DIRECTION
It all starts at the beginning. Where life is altered by pain or injury and when patient's seek out care because they don't function in their normal way anymore. It can be tough sometimes to get the ball rolling, to retrain movement patterns and daily habits, to get pain levels under control, and to motivate patients to begin to drive their own recovery. The first step is showing patients what the problem is, setting milestones that help them identify with their own recovery process, and then guiding them through rehab until they reach step 2.
STEP 2 - START TO TAKE THE WHEELS
Once pain is no longer driving their willingness to come to therapy, who is?
Sure ain't me. As I've said once before - I will sit beside you on this journey to recovery, but I will not drive you there. So step 2 is all about recognising what other barriers need to be overcome or goals need to be achieved before the patient can be functionally unrestricted.
STEP 3 - NOW IT'S YOUR TURN TO DRIVE
Once you are functioning well - do you know how to stay that way?
At this point in time I hope that my patients are developing a sound knowledge about how their bodies present/move/behave when they are both feeling good and feeling bad. Developing this self awareness is a key step towards understanding their bodies better and identifying where their rehab needs to go for them to be 100%.
STEP 4 - I AM NO LONGER A PASSENGER
If you're staying good and doing what you love - do you still need my help?
It is definitely sad to say goodbye sometimes but we have to set them free. This past week has been sprinkled with discharge assessments. Patients who come in smiling because they only have good news to report. They are playing the sports they love, they can use exercises to manage any niggles that may come up, they are no longer thinking about their injury or their body part, and they see the end goal in sight. And this is when I ask - do you still need my help to get to the end? And with a smile, they reply, I can take it from here.
So to my patients who shared these moments with me - thank you. Thank you for the months you invested in your own life. Thank you for driving the rehab in the direction you chose. Thank you for the endless open conversations trouble shooting problems and setting personal goals. Thank you for stepping up and being the lead part in your own story. Without this attitude, this approach would not be possible.
And to my readers. Don't take for granted the immense impact we can have on someone's life as physiotherapists. Not for one second to I think I can help everyone and that everyone will get there, I am not that naive. But I am experienced enough to take a moment to celebrate the wins, because they make it all so worth while.
The journey is always the reward.
Sian Smale is an Australian-trained Musculoskeletal Physiotherapist. Sian completed her Bachelor of Physiotherapy through La Trobe University in 2009 and in 2013 was awarded a Masters in Musculoskeletal Physiotherapy through Melbourne University. Since graduating from her Masters program, Sian has been working in a Private Practice setting and writing a Physiotherapy Blog "Rayner & Smale". Prior to moving to San Francisco, Sian worked at Physical Spinal and Physiotherapy Clinic and has a strong background in manual therapy and management of spinal spine, headaches and sports injuries. Since moving to the Bay area, Sian has become a Physiotherapist for the Olympic Winter Institute of Australia, traveling with their Para Alpine teams. Sian currently works full time at TherapydiaSF as a physical therapist and clinical pilates instructor.
twitter @siansmale
instagram @siansmale_SF
Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. Live cases, webinars, lectures, Q&A, hundreds of techniques and more! Check out Modern Manual Therapy!
Keeping it Eclectic...
