When evaluating and interacting with patients there will inevitably come the part where they ask “So, what’s wrong with me?” or “What’s my problem?” It is our job, no, our duty to educate the patient and inform and discuss with them their condition and prognosis to the best of our knowledge.
I have gained many insights during my clinical experiences, but have also found some wisdom from other professionals who must get across ideas in a positive manner. (note: not coercive manner.) To get results, the patient must be a part of treatment, they are in fact the third pillar, according to Sackett’s EBP, and their participation is key.
As I said, other professions must get across information so that they have better outcomes as well. So there is this jury consultant, Harry Plotkin, who writes about how to engage jury members during a trial. He writes Jury Tips of the Month. (please do not think that patients are on trial or need to be persuaded, but placebo and nocebo statements must be monitored and, as my dad always said: “Words have meaning.”)
Within the context of Physical Therapy and communicating with the patient about their condition, prognosis and adherence, etc – read these quotes from one of my favorite jury tips from 2009:
Jury verdicts should be decided on the evidence, but the evidence is less important to your jurors’ decision-making than their impressions of credibility, their ideas about common sense, their values, their sense of fairness, and the predispositions they bring with them into the courtroom…
As I’ve said before, jurors merely use the evidence to support what they already believe to be true and then use that evidence to convince other jurors in deliberations. You won’t win a jury trial without supporting evidence, but the evidence itself does not persuade your jurors…
…trials are about the details, but not as much as you might think, and not in the way that you might imagine. You won’t win a jury trial without wading into the details–educating your jurors about medical procedures, business practices, or crime scene forensics, for example–but the details themselves won’t persuade your jurors. Even worse, getting into those complicating details–the minutiae of trial–during your opening statement will derail the persuasive process, and you’ll have wasted your best (and perhaps only) opportunity to win over your jury…
Wow, does that sound like trying to jump into explaining pain to anyone?! How about explaining the limitations of the pathoanatomical model?! Trying to explain what their imaging results mean to their condition?! Trying to explain why switching up their treatment protocol at this time is best?!
As passionate PTs we want to get ideas across; grad-school, medical-professional, important-type ideas! But we can get caught up in the terminology, the minutia, the details, the facts that we loose sight of one big idea: we must convince the patient that we know what we are talking about and that this is the place and time that is best for them. They must ‘buy in’ or outcomes will suffer, again: the patient is a major part of the team.
Here is a PTBT post on the benefits of argument and getting ideas across – Argument. You’re doing it wrong.
Check out this quote,replace the word “juror” with “patient” – again from Harry Plotkin:
Think about the timing of your opening statement. You’ll deliver it during the “framing” phase of your jurors’ decision-making, the time in which they are open to persuasion, wondering what the case is about and looking for clues to help them decide which side is telling the truth and which side is being dishonest or unreasonable. In a nutshell, your jurors spend your entire opening statement comparing what you’re saying to what they already believe to be true, what they believe to be likely, what they believe makes sense, and what they believe to be fair…
This is unbelievably important to understand, in my opinion, when formulating the Therapeutic Alliance and becoming part of the patient’s healing team. Heck, we do the same thing when listening to the patient’s subjective report: we bounce their words off our own body of knowledge and see what makes sense and pass judgments on how future actions will play-out (treatments, etc). Just like them, we have information to get across, and it is important that the other party know and understand it well enough.
Mr. Plotkin also wrote about adding too many facts up front: ” This is like emptying the box of a jigsaw puzzle in front of someone and expecting them to see the picture.”
We must first become a trustworthy source within the sea of information that the patient has access to (the internet, other providers, friends, etc). Then we can progressively build their base of knowledge with much more ease.
If you have wondrous amounts of knowledge and ideas, but cannot portray them to the patient in a meaningful way… well, let the frustrations begin, for everyone involved. Think about how you want your patient to digest all those facts. Can you say it in a better way?
– Matt D