A few months ago I published a piece that was titled What I Learned My First Year In PT School and was overwhelmed by the amount of traction and support it got – it got over 1000 shares on Facebook, it was published by the APTA, it gave me the opportunity to make an appearance on one of my favorite physical therapy podcasts (PT Pintcast) and heck, it even got translated into a few different languages!
So thank you from the bottom of my heart to all of you who took the time to read, like, comment, share and even reach out! It means the world to me.
Since that post seemed to resonate with so many people all over the world, I figured I’d write a similar piece on what I’ve learned over the course of my first clinical rotation.
To give some background information, my first clinical rotation took place over a six-week period in an outpatient orthopedic clinic in my home state of NJ (best state there is). Although my clinical took place in an outpatient setting, I had to opportunity to see a fairly wide variety of patient populations (neuro, cardio, ortho, peds, etc.) and feel that the lessons I’ve learned can be applied to all physical therapy (and healthcare) settings.
I learned a lot these past six weeks, but once again, perhaps the most important lessons I’ve learned transcend physical therapy and can be applied to the broader category of life. Without further adieu, here are five things I learned during my first clinical rotation.
1. Social Awareness Is A Must
Before going out on my first clinical I wrote about how “it always depends,” and when it comes to physical therapy, perhaps the most important thing to realize is that everybody is different.
No two people are exactly alike and for that reason, no two people can be treated exactly the same.
Throughout my first clinical I encountered hundreds of patients and I came to realize how truly unique each patient is. Obviously, every patient is physically unique, but what I found to be just as relevant, if not more relevant, is the fact that each and every patient is cognitively unique.
This cognitive uniqueness means that each patient has a preferred style of communication with which they feel most comfortable and they can learn most effectively. Communication is the cornerstone of effective rehabilitation and as a result, social awareness is critical when it comes to discerning how each patient communicates and learns best.
To me, social awareness is the ability to pick up on subtle social and environmental cues and use these cues to modify your own behavior and interactions in order to achieve the desired results.
In physical therapy and in life, every individual has a preferred style of communication where they feel safe, where they feel understood, where they learn the best and respond positively.
As physical therapists, this means that it is extremely important to be able to pick up on both verbal (words, tones, inflections, etc.) and non-verbal (body language, postures, gestures, etc.) cues in order to identify the style of communication that will best suit each individual patient and maximize the positive potential of each interaction. Once the patient’s preferred style of communication is identified, the physical therapist needs to adjust his/her own communication (both verbal and non-verbal) to best match the preferences of the patient and as result, maximize the patient’s comfort, trust and ability to understand. This increased comfort, trust and understanding eventually results in patients buying in to the treatment and becoming more active participants in their own rehabilitation.
In short, social awareness allows for more positive and productive therapist-patient interactions which ultimately result in better care and better outcomes.
2. Confidence Is King
The last thing a patient wants to see is his/her therapist turning red in the face, fumbling over words, and paralyzed by an apparent lack of confidence in their knowledge… and trust me, this is the last thing a student physical therapist wants to feel (I speak from experience).
Patients come to physical therapy with some sort of pain, injury, problem, etc., and as a result, they are vulnerable and in search of answers. While not always true, many patients come to therapy with an inherent trust that their therapist has the schooling, training and practical knowledge to help make them better. Part of what makes effective therapy effective is patient buy in. If patients don’t trust in their therapist and believe in the treatment plan, they won’t buy in and as a result, their rehabilitation is set up for failure.
Throughout the course of my first clinical rotation I’ve learned that confidence (whether forged or genuine) goes an extremely long way in earning patient trust and putting patients at ease.
Have you ever heard how dogs can smell fear? Or how sharks can smell a single drop of blood in from miles away? Well patients are essentially shark-dog hybrids who can smell fear, insecurity and lack of confidence from all the way across the clinic.
Therefore, I’ve found it essential to exude a quiet confidence at all times in the clinic. This quiet confidence takes the form of speaking with conviction, carrying yourself well, walking with a purpose and believing in yourself and your abilities.
Any therapist, no matter how skilled or experienced, will have moments where they don’t know the answer. As a student physical therapist, I’ve faced this scenario more times than I can count just within the past few weeks. What is important to realize is that confidence does not mean faking an answer or faking knowledge. In these situations of uncertainty, true and genuine confidence manifests in a therapist’s ability to clearly state what they do know to be true, to acknowledge their uncertainty and to reassure the patient that they have the resources and ability to find the answer and solve the problem.
Throughout this first clinical I’ve encountered many patients who have asked me when they are going to get better. For student physical therapists (and even DPTs) it’s not always easy to give a straight forward answer, because as we know “it always depends.” Rather than faking knowledge, a truly confident response may look something like this:
“To be completely honest, I have never treated this type of injury/condition before and I am not completely sure as to how long it will take for _______ to get better. BUT I can tell you that we are going to work together as a team to figure things out, we are going to work hard, and we are going to make progress towards your goals.”
Confidence is built through preparation and experience. While student physical therapists are by definition, lacking the experience aspect of confidence, we can all put more effort into preparing (studying, learning, practicing, etc.) and being ready for challenging situations as best we can.
Additionally, when it comes to confidence, we can all address our body language – deliberately carrying ourselves with confidence – as the way with which we carry ourselves has tremendous implications not only for how others view us but also how we view ourselves. Body language literally influences our physiology and changes how we feel, how we act and ultimately who we are.
Body language is beyond the scope of this post (I could write a book), but if you’re interested on learning more about how body language influences us, I highly recommend listening to this Ted Talk by Amy Cuddy.
Before moving on, I should be clear that confidence and arrogance are not the same thing. The line between confidence and arrogance is a fine one that needs to be navigated carefully. The easiest way, in my opinion, to avoid coming off as arrogant is to practice humility – be honest about what you do and don’t know. Be genuinely confident in your actual abilities and knowledge while also being honest and empathetic in all of your interactions and you can’t go wrong.
3. Being a Good Listener is Being a Good Therapist
As I’ve touched on in previous posts, earning patient trust and building solid rapport is essential to providing the highest quality of care. Without a therapist-patient relationship built on the foundation of trust, rehabilitation is bound to suffer.
Over the past few weeks I quickly learned that one of the easiest and most effective way to earn patient trust is to simply be a good listener.
- Listen to what your patients say, both verbally and non-verbally. Hear them at their core.
- Like Jarod Hall (drjarodhalldpt) puts it – “the biggest communication problem is we do not listen to understand. We listen to reply” … listen to understand.
- Listen with your ears and your eyes… non-verbal cues (body language, expressions, tone, etc.) often give much more information than the words themselves.
- Genuinely care for your patients. Be empathetic and let your actions follow in the patients’ best interests.
In short, talk less and listen more. Make a conscious effort to be present and truly hear what your patients are telling you. While it’s not always easy, especially in high volume clinics, give each patient your full attention as best as you can. Pain and suffering are incredibly complex – it is the result of an intimate interaction between physiology, psychology and social factors (and much more).
Injury and disability leave patients hurt and vulnerable.
Out of all healthcare providers, physical therapists often spend the most time with patients in this time of vulnerability and suffering. Therefore, it is our job to listen to patients and make them feel heard. We need to be there for our patients – sometimes this can be more therapeutic than any physical intervention we can give.
4. Trust Is The Foundation Of Successful Treatment
As I’ve mentioned above, trust sets the foundation for effective and successful treatment. When patients trust their therapists, their treatment is more likely to succeed – it is actually that simple. Without going on forever (I could also write a book about trust) I’ll briefly mention some of the avenues that I’ve been able to use to build patient rapport over these past few weeks.
- Pick up on patient preferences early on (social awareness) and use these preferences to guide your communication style so that is best suits the patient.
- Be confident in your abilities and carry yourself with positive body language. Believe in yourself.
- Be honest with patients and show them that you genuinely care about them. Do this by actually caring about them.
- Strongly consider patient preferences when creating a treatment plan. In the end, each patient is a paying customer and their needs/wants should be strongly considered.
- Respect your patients (duh)… I wish this didn’t need to be said, but unfortunately it does.
These were just a few of the ways that I’ve found effective for building rapport with patients. Keep in mind that every patient is different and you will not be able to earn trust using the same tactics for each patient (this is where social awareness comes back into play).
5. Patient Education Seals The Deal
If I’ve heard it once I’ve heard it a thousand times – patient education is extremely important, and after my first clinical rotation, I can attest that these words are true.
While the obvious goal of physical therapy is to improve someone’s physical impairment/condition, the ultimate goal of physical therapy is to transition a patient from a dependent state into an informed, confident and capable manager of their own body. The only way that we can empower and inform patients is through clear, concise and honest patient education.
Physical therapy is a teaching profession. Through education we have the ability to empower, inform and change a patient’s understanding, motivation and outlook on their body (and their story) in a positive and transformative way, leading to better and longer lasting outcomes.
This first clinical rotation was full of learning experiences, many of which humbled me in ways I couldn’t have predicted (shout out to Dr. Zak Gabor (@zakgabor.dpt) who accurately told me I’d be eating some “humble pie”). I’m incredibly grateful for the mistakes I’ve made, the lessons I’ve learned, the patients I’ve treated and the people who’ve helped me make the most of this first clinical rotation.
It was nice to be out in the clinic full time, but now it’s back to the classroom for a few months before clinical rotation number two. I’d like to end this blog post with a quote that pertains not only to physical therapy but to all human interaction.
Listen. Smile. Be honest. Be kind.
Thank you so much for reading.
Joe Rinaldi, PT, DPT
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