Rehabilitation for common musculoskeletal conditions has become increasingly complex recently, causing clinicians to become easily overwhelmed. The enormous number of live courses, certifications and rehab tools can be confusing when seeking out a professional development plan. Should you learn to manipulate or educate? Get certified in scraping the tissue, sucking the tissue or stick needles in it? Take an ACL course to learn knee strategy exercises or hip strengthening exercises? Or how about learn an entirely different way to evaluate movement?
Although each of these methods of evaluating and treating have added to our knowledge and skill levels over our careers, they can also be dangerous to an eager young clinician (or eager experienced clinician!). In this chaotic world of continuing education, we may easily forget about the most important element, the patient. Keep it simple and master the foundations of an orthopedic examination and provide sound evidence-based interventions. Thiscan have drastic effects on the patient experience. If you recently passed your NPTE and ready to start your career, a young professional feeling lost in the clinic, or an experienced clinician stuck in a rut, 3 simple strategies can make a HUGE difference in your patient’s experience starting RIGHT NOW.
Early in my career, I too often overestimated the effect of my manipulation, soft tissue techniques and exercises and underestimated the interaction between two people. I worked as the “musculoskeletal expert” as taught from graduate school and clinical rotations and figured the patient should do what I say because I had found the cause of their pain with my “skilled objective examination”. I have come to find over the first 12 years of my career that connecting with people seeking care is the first and simplest step to improve the patient experience.
If you do not connect with you patient, nothing else matters. A study by Fuentes showed the importance of a nurturing environment. All patients received electrical stimulation, the only difference was whether the therapist stayed present or left the room. The therapist who stayed in the room and provided a “nurturing environment”. The result was higher pain relief in the group of patients who received extra attention from their provider!
Starting the session with a smile is great start. A phenomenon called smile mimicry and emotional contagion can be utilized to the clinician’s advantage. Humans have the tendency to mimic those around them so set the stage with a smile and a warm greeting. Studies by Dimberg (1998, 2000) found that participants who viewed happy stimuli displayed increased activity in their zygomaticus major (the muscle that pulls the lip corners up to produce a smile). If you’re not a person who finds smiling easy (you may need to reflect on some things if that’s the case), just consider smiling a scientific method to enhance your outcomes.
Using other simple conversational starters like “where are you from?” can lead to deeper conversation and finding other ways to connect with your patient. Try to envision the last interaction you had with a health care provider. Did you feel a warm, welcoming human being was offering you help or was it an overworked, unfriendly and distracted individual? From which would you rather receive care? Which provider do you think receives better outcomes?
Test – Treat – Retest
How are we determining if our interventions are working? Outcome measures pushed in the rehab world over the past decade are meant to objectify functional gains over the course of our plan of care. But how do we determine if our interventions play a role in this recovery? Are we overestimating the effect of our interventions and minimizing the role of psychologic and sociologic factors? Or maybe the person improves simply with time? As many factors can contribute to a patient’s recovery, we should consider assessing our effectiveness within each session as well.
A simple method to prove your treatment’s effectiveness is test-treat-retest. For example, you have a person with neck pain with limited rotation to the right and a positive upper cervical rotation test (TEST). You know several manual techniques for neck pain and have seen studies that show manual therapy to be effective for short-term pain relief. Rather than select a technique at random or apply multiple techniques consecutively, you decide that due to the limited rotation you will select a treatment that may affect the C1-C2 level (TREAT). Immediately following the technique, you recheck the rotation and the upper cervical rotation test (RETEST). Symptoms and motion have improved! Now you have proven to the patient (and yourself) what you are doing is helpful and you can supplement with an active intervention. If it didn’t change, now you can systematically apply one intervention at a time to determine its worth with each of your patient. A simple concept, but rarely do we take the time to demonstrate the worth of our treatment!
Tell Them What They Want to Know
What do patients really want to know? Although each patient is unique, Louis Gifford believes everyone seeking our guidance wants the answer to four basic questions:
- What’s wrong with me?
- What can you do for me?
- What can I do for myself?
- How long will it take?
That’s it. Having a framework to follow at every initial visit will immediately increase the likelihood of patient buy-in. If you answer these four questions clearly and with confidence, you will win the trust in the majority of patients. Use your foundational knowledge and evidence to guide the answers to these questions and tweak as you gain experience. If you aren’t sure, just say so!
Are you getting better or staying average?
A coworker jokes with me everyday by saying “Are you getting better or staying average.” But in reality it can be hard to get better as a clinician when faced with a busy schedule and mountains of paperwork accumulating daily. In the face of time constraints, simple strategies that take no weekend courses to learn and can be refined with repetition can make you a better clinician. Build alliance, test-treat-retest and tell patients what they want to know and you will already be on your way to maximizing each and every person’s experience. And you didn’t have to give up a weekend skimp on your student loan payment to do it.
We realize continuing education can be time-consuming, expensive and inconvenient. It doesn’t have to be. Our mission is to provide simple, evidence-based information accessible all in one place. After experiencing many courses and certifications over the last decade, we feel the rehab professions are being drawn away from great in place of new. Skilled application of foundational examination and intervention combined with emotional intelligence can go a long way. We value great over new, simple over complex (whenever possible).
We believe a growth mindset seeking continuous improvement makes for an exciting and challenging career. If you are seeking to maximize your potential as a clinician, follow us on Facebook and Instagram @movementologists.
If you enjoyed this post, share with friends and coworkers you feel could benefit from these strategies!