I remember this interaction very clearly. I had just finished an evaluation and was walking the patient to the front desk. I felt good about the whole interaction. As we approached the front desk the patient asked, “How often should I schedule?” which caught me off guard.
Oh yeah… I probably should have addressed that as we wrapped up the evaluation. Whoops.
“Um, why don’t we start with two times per week? Does that work for you? Then we can go up or down in frequency from there as needed.”
“Sounds good, I’ll set something up,” the patient replied.
Okay, not a bad plan. But my tone clearly reflected a note of uncertainty.
Later that day one of my seniors who overheard the interaction approached me. He said something that resonated with me. “You’re the professional. People come to you for help and value your opinion. Speak with confidence.”
It’s likely that the patient didn’t give that interaction or my tone of uncertainty a second thought. However, the more I reflected on that piece of advice and the interaction from earlier, I realized how important it was. I began to recognize other interactions where I could speak more intentionally. Communicating planned interventions for the day, sets and reps, resistance for a given exercise, and expected outcomes among others. The directness, poise, confidence, and intent with which you speak to patients can have a major effect on quality of care and the patient’s appraisal of value.
Recently there has been a movement to provide higher-quality, higher-value care due to growing costs associated with musculoskeletal care. In addition to using evidence-based, patient-centered care, effective communication plays a large part in creating higher-value. It’s been researched and well-documented (albeit poorly understood and implemented) that clinician-patient communication during interactions can affect patient outcomes in the short- and long-term.1
I think this is likely a common occurrence with many new clinicians and students because of the nature of physical therapy. There is a lot of uncertainty associated with diagnosis, prognosis, and health-related conditions otherwise; not to mention the most commonly uttered phrase in physical therapy school, “It depends.” At its core, it is difficult to provide straightforward answers to complicated questions.
Speaking confidently, however, can have a direct impact on a patient’s perceived value of that interaction, not to mention the possible short- and long-term outcomes related to their condition. One of the biggest payoffs that results from high quality communication is increased rapport between patients and clinicians. Increased rapport results in increased value for service, decreased cancel/no-show rates, increased patient retention, completion of plan of care, and increased “compliance.” Each of these results is associated with higher productivity, greater fulfillment, and increased patient outcomes. There are benefits from the clinician’s point of view, as well, since ultimately this lessens the chance of experiencing burnout and apathy.
It’s also important here to address what speaking with confidence is NOT. Speaking with confidence does not mean you need to have all of the answers or give the allusion of knowing it all. As previously mentioned, there is a lot of uncertainty associated with physical therapy. Patients will ask you questions to which you do not have the answers. That is okay! In these moments it is critical that you as the clinician take a moment to reflect on what you do know, acknowledge what you don’t, and speak intentionally to address the patient’s concerns. Easier said than done. Let’s break this down.
Take a moment to reflect. A brief pause to collect your thoughts can be helpful here. While it may feel lengthy to you, it won’t be. Patients will understand and appreciate that you’re choosing your words wisely and it will make the interaction feel more organic. This is critical to building rapport.
Reflect on what you know. Address what you know about the situation and what actionable steps can be taken at this time to help the patient’s situation. These can be commonly referred to as the “low-hanging fruits” (i.e., relevant interventions or home-exercises, activity modification, and other self-management strategies that increase patient self-efficacy).
Acknowledge what you don’t know. It is absolutely okay to make this explicit. For example, a patient asks you a direct question on a topic you are unsure about. You may respond “I don’t have that information available at this time, but I’m going to do some research on it and get back to you next session.” In these instances it is important to probe for understanding and to establish checkpoints/exit points to make the patient comfortable with the plan (i.e., objective measures and possible referral options if the patient does not progress as expected).
Speak intentionally. Be conservative in how you use your words. Speak on the patient’s level and don’t hide behind jargon and verbose answers. Patients will see through this, and it can seem disingenuous. This hurts rapport.
Speaking confidently is a skill that takes time to develop. As you learn to employ this skill effectively, however, you will notice positive impacts in your practice and patient outcomes. In the meantime, work to develop a solid understanding of common diagnoses, interventions, tissue healing timelines, and prognostic factors to expand what you may speak confidently on. Additionally, practice speaking confidently and delivering information in “low-risk” situations including exercise cuing, sets/reps, plan for the day, etc.
Citations:
[1] Street, R. L., Makoul, G., Arora, N. K., & Epstein, R. M. (2009). How does communication heal? Pathways linking clinician–patient communication to health outcomes. Patient Education and Counseling, 74(3), 295-301. doi:10.1016/j.pec.2008.11.015
