Is the connection lacking in the patient - therapist relationship? Lets Find out!
Now lets first of all make it clear about what a connection is before understanding whether its important or not and if it needs improving. Connection is the bond or relationship that’s made between two human beings. It is this connection that I feel is vital in the client- clinician relationship and certainly in my opinion a lack of emphasis has been placed on its development.
1. Service providers vs Care Providers The big difference between us as future or current physical therapists is to understand that were are not simply service providers, we are care providers! Now that might be a little bit difficult to internalize since most of what we’ve learnt and will continue to learn is a set of diagnostic skills, evaluations, tests, techniques, treatment etc the list goes on and on , a set of defined services as part of the rehabiltation process. Due to this People skills are often overshadowed or overlooked. Now don’t get me wrong clinical skills are important for handling with physical impairments and shouldn’t be forgotten but its only one side of the coin. it’s never only the pain that is troubling them but a lot of other things too.
Let me put the situation into perspective. Whenever you go to a store, buy something online, even go to a hair dresser you know what you’re paying for, you know what you’re receiving and your expectations are usually met because you’ll spend higher and get higher you spend lower you’ll get lower. Never really much disappointment. Keep in mind that there’s very little meaning to the human interaction in most of these transactions apart from a fake smile from the person behind the till as you hand them the money. Now if we learn to remember as future therapists to understand that people walking in the door aren’t just mindless consumers and an economic opportunity to be capitalized on. But instead if you see them as real people with real problems, the whole relationship changes but why? Because pain isn’t like a product you buy online, it’s not something that comes and goes is bought and sold, it comes with a whole host of other issues primarily psychological or emotional. People feel desperate, left out and frustrated. ( APA 2016 ) If pain was the problem they wouldn’t be coming to you. They could pop an aspirin instead. Pain prevents them from doing the things they love, going on a walk, playing sport and simple things like picking up their kids or as simple as walking up the stairs and that impacts them mentally. Because of this it’s all about our connection with the patient and how we facilitate that connection.
Connecting with the client is of primary concern, Its about Ensuring our human interaction with them is as personal, strong and thorough as possible, an interaction that will create and maintain a strong sense of trust between both the client and the clinician is one that should be strived for. ( Hojat 2007 ) This can be achieved in a number of different ways. A few of them include looking them in the eye, a firm handshake, avoiding excessive note taking while they speak, listening and repeating, empathizing with them, ensuring they come out of the door with more confidence than they left, ensuring them it’s going to get better and if you can’t do anything more you’ll help them find someone else who can, a touch on the shoulder, even the amount of time spent talking to them will influence this. These are just a few examples of what would make a quality connection with a patient and psychology proves many of those basic premises.( Ward 2012 ) By no means does this interaction need to go as far as hugging them or even feeling sorry for them, this might be counterproductive and evoke unnecessary sympathy. It’s as simple as putting ourselves in the patients shoes to try understand what the biggest thing they need at the moment and prioritize that whether it being heard, understood, empathized with and cared for. Remembering some of those key principles of can help them with the emotional aspects of their pain and research has linked these psycho social interventions to increase satisfaction in physical therapy ( Hush 2011 ). They don’t want to hear about the latest new gadget or technique you have in the clinic that can rid them of their ailments Remember if they have been in pain long enough they’ve heard it all before. Patients are people just like you me and everyone else on this world, not test subjects or dummies. This approach isn’t unheard of and healthcare used to be as much as an art as it was a science but progressed to a more mechanical approach rather than a person orientated approach in the 19th century which has had negative consequences. ( Khouzam 2002 )
Language and why its so important: imagine travelling to a distant far away obscure foreign country not knowing a word of the people’s language national language. Then imagine yourself straight off the plane bursting to go to the toilet and there’s no way of asking where the toilets are and the only way of finding out is by miming it. While that would be a great story to watch let’s think for a second whether that has got anything to do with how the clinician and the client interact.
Yes it does, Communication or a lack therof is one very important part of the patient process. Good quality Interaction is an essential part of the overall process and key to maintaining an understanding between both patient and clinician. We need to be very careful as to the words we use and how we get across our meaning and what impact they all might have. One thing that I’ve experienced dozens upon dozens of time and I am sure a lot of you can agree is that therapists can talk a lot of mumbo jumbo, especially about complex explanations of pain, anatomy and pathology. This is a complete foreign language to most patients so don’t expect any light bulbs to go off over their heads anytime soon. The last thing they can remember about anatomy is the dummy skeleton hanging up in the dusty corner of the biology lab. First of all, most if not all patients won’t likely remember half of the stuff you say or show them and second of all is this going to help with their pain? Clinicians in my experience are quick to jump to conclusions about syndromes, impingements, itises, disc problems etc. Assuming pathology in many cases has actually shown to slow down recovery especially with back pain (Webster et al 2013). The information a patient receives is the information a patient believes. Advising patients against activities they can and cannot do solely on the information you think is correct on the base of fear could end up becoming so engrained and limiting that it ends up becoming an impeding reality. This idea of fear avoidance has even prolonged recovery times in some injuries.( Julie 2002 ) I would be dubious to think that complicating things further are going to help them in any way. In any case if a thorough explanation is needed and necessary how about a touchable model? or a coloured video? Or a diagram or video to take home? An information pamphlet that they could read over not just a bunch of ramble. Remember we’re likely to forget half the stuff were told if it’s purely by ear and all of it by the next day.
Here are two different examples of communication I use below. Both vary greatly and have a think about why one over the other could potentially lead to a more positive and effective outcome.
Case 1: Clinician( looking at patient standing up ). “ ooohhh ok hmmmm hmm I see now I see now your posture is all wrong , youre putting a lot of pressure back here when you lean back like that and that’s whats causing you pain, people should just not look like that, were doing so much bad sitting these days its really bad for us and muscles get tight where theyre not supposed to, were not designed for that”
Case 2: Clinician ( looking at patient ) “ ohhhhh ok that seems generally alright, but let’s see what positive effect we can have by freeing up some of the muscles back here, maybe change how you stand a little bit and see how that will help you with your pain, in my experience it usually does so Would you be willing to try that and like to me to go through some changes with you?
Hope you enjoyed some thoughts on the patient/ therapist relationship and plan on doing a few more of these in the future as there are other things I would like to discuss.
1.Jennifer Ward, “Creating a Partnership: Building Rapport with Your
Patients,” NurseTogether, 2 April 2012.
2.M Hojat “Empathy in patient care: antecedents, development, measurement, and outcomes”
3.Julia M. Hush, Kirsten Cameron, Martin Mackey (2011) Patient Satisfaction With Musculoskeletal Physical Therapy Care: A Systematic Review Journal of American Physical Therapy
4.Khouzam HR (2002) “ Customer service vs Patient Care “Conn Med. 2002 Mar;66(3):161 -
5.Barbara S. Webster, Ann Z. Bauer, YoonSun Choi, Manuel Cifuentes, Glenn S. Pransky,(2013) “Iatrogenic Consequences of Early Magnetic Resonance Imaging in Acute, Work-Related, Disabling Low Back Pain” Journal of Spine
6. Fritz, Julie M, George , Steven Z ( 2002 ) “ identifying Psychosocial variables in patients with acute work related back pain : The importance of Fear avoiding Beliefs” Journal of Physical Therapy; Oct 2002; 82, 1
Caolan here. Im a curious man to say the least and as an enthusiastic enrolling physiotherapy student. I have felt the need to share my thoughts and conclusions on the topic that is pain. Its something that will effect us all. Above all its very mysterious, misunderstood and complicated one and Im here to figure out more.