I’ve been thinking more than ever about what I do on a daily basis and a large part of that is
treating helping patients. I have to be careful with the language that I use because convention in the physical therapy profession can sometimes feel outdated, impersonal and even sterile. One thing that I’ve been adamant about since graduating school in 2019 is that I’m not above the people that I’m serving (yes, serving) and that I’m not “fixing” anything but instead guiding people with a spirit of compassion toward their own goals. I felt that while school touched on the human side of healthcare, there wasn’t enough emphasis on it or immersion with it. I’m not sure if I got this wording from something that I’ve seen in the past, but this blog is a simple reminder that our “soft skills” have very hard consequences.
In our profession, it can be easy to focus on what is “wrong” with the person sitting in front of us. We’re trained to look for deficits, problems and impairments and there is value in that. However, discussing these things at length can bring with them negative language that can instill fear in the people who hear them. I’m not arguing that we should ignore the “negatives,” but what I am saying that we should make an effort to spend more time emphasizing the “positives.” I believe that we should focus on strengths just as much (if not more) than we point out “weaknesses.” We are the stories that we tell ourselves and as healthcare professionals, we are in a perfect position to help people re-write their stories in a way that benefits them. Our words hold immense power to the people that we tell them to and we (as PTs) are in the perfect position to reassure our patients, encourage them and empower them. Through our dialogue, we can help shift their perspective, build their confidence and foster resilience. Those things are all associated with more positive outcomes, and that shouldn’t be a surprise. It is imperative that we choose our words carefully.
Sticks and stones can break your bones but words can do some damage too.
The best compliment that I ever received as a physical therapist was when an 80 year old woman told me that my encouragement made her feel “confident for the first time in decades.”
First, we have to meet people where they are. We all see the world through a different lens. Everybody has a different perspective and no two people are in the same place. Because of this, different people need different things. To maximize effectiveness, communication need to be tailored to the individual sitting in front of us. In order to do that, we need some level of social awareness. We need to be able to understand where people are coming from so that we can meet them where they are, not where we expect them or want them to be. Once we understand where they are, our job is to take people where they want to be. Whether you think so or not, [outpatient] physical therapy is a customer service profession. It’s our job to help take people where they want to be, not where we think that they should be. If a patient wants to be able to do something, it’s ultimately our job to help them get there, not to tell them that they can’t [exceptions exist].
Everybody in this world is coming from a different place and our job is to meet people where they are so we can take them where they want to be.
One of the best outcomes that I ever played a role in came from a patient who missed their first three appointments (evaluations). I gave them the benefit of the doubt for the fourth time and it turned out that they were battling a deep depression which improved over our time working together (exercise played a large role in that).
If we want to be an effective physical therapists, we need to build a relationship with our patients that is set on a foundation of genuine interest, compassionate caring and empathetic love. In the most basic terms, we need to get to know our patients and actually care about them so that they feel comfortable and compelled to invest their time, energy and effort into letting us help them. To be blunt, if you can’t connect with your patients, then the rest doesn’t matter. With few exceptions, people who seek healthcare are vulnerable on some level and it is a privilege to be able to help people who are in that position. One way to strengthen therapeutic relationships is to be open and vulnerable as healthcare practitioners ourselves [in an appropriate manner]. The bottom line is this; each person is a new story that we’ve never heard and our job is to be interested, understand that story so that we can have a positive influence on it.
Creating genuine human connection drives positive patient experiences (and outcomes). What’s important to the patient should be important to us, and we can’t know that until we know them.
This isn’t a specific anecdote but it’s a helpful suggestion. I start off every single evaluation with this line “tell me something about you not related to what brings you in for physical therapy.” Without fail, I learn something cool about the person in front of me and the response almost always leads back to what brings them in (they tell me how their injury/pain/diagnosis/etc is stopping them from being them).
Before being a good healthcare professional, our job is to be a good human being. If we can care about the people sitting in front of us and choose to do what is best for them, the rest will fall into place. Sometimes all that someone needs is to know that someone cares about them. You never know what someone else is going through below the surface and that is why part of our obligation as PTs is to be there for people. The truth is that even the most “evidence-based” treatments in the world, won’t reach their full potential if the patient doesn’t feel valued and cared for on a human level.
Compassion can’t be measured but it makes a real difference.
I had a patient who started off the initial evaluation by telling me that they had been to “six PT’s in the past two months” and that this was “the last attempt.” We ended up hitting it off and a few weeks in, I asked why he chose to stay with me and he said “you were the only person who seemed like they actually cared about me and not just my leg.”
Whether you know it or not, every single person in this world is battling something that you can’t see. Whether it’s a patient or just somebody passing on the street, be the reason that someone smiles today, because a smile can make someone’s day and even save someone’s life. In the PT profession, we are surrounded by people could use a smile. We all have the incredible opportunity and privilege to interact with people who are in pain, who are suffering and who are vulnerable. If you can’t do anything else for a patient in a given treatment session, make them smile. The masks mess this one up a bit, but you get the point (give good energy).
Smiles are free to give and great to get.
I once had a patient who wrote me a thank you card because coming to physical therapy was “the most smiling” that she does and “most fun” that she has throughout each week.
Patients will often tell you exactly what is wrong, if you let them. What they choose to talk about is what is important to them. it feels awkward at first, but there is a lot that can be learned in the silence. Don’t be afraid of it. Listening is an art and it is worth making a masterpiece. People aren’t used to healthcare professionals giving them time to talk. However, sometimes it just takes another few seconds of silence for someone to build up the courage to say something that is really important to them (and to you). There is a lot that lies beneath the surface and if we want to get deeper, you have to not only listen to patients, we have to make them feel heard. You have to give them space, make them feel valued, give them time and make them feel comfortable.
There is something therapeutic about listening.
I once spent an entire initial evaluation listening to my patient talk about her cat that had just passed away. She was in tears and all I could do was be there for her and listen to what she was telling me. I got nothing (no measurements, no objective data, no intake paperwork) done on that first visit but it meant everything. She didi need someone to measure her range of motion, she needed someone to listen (and care). We ended up building great rapport and this patient had a very successful outcome.
These skills are bigger than us.
These words are about how to connect with people, how to encourage people and how to care for people. These so called “soft skills” are anything from soft. I would argue that these “soft skills” are more important than any other skills. I would even go as far as to say that any other PT skill is useless without the foundation of stellar “soft skills.”
I want to end this blog with a reminder that there are no neutral interactions. Every single time that we cross paths with a patient (or another person for that matter), no matter how small or how brief, we have the potential to lift someone up or bring someone down. Being more aware of how we impact others is something we can all be better at [myself included]. It’s time that we take that to heart, put effort into honing those “soft skills” and do better as humans first.
Go change someone’s world.
Thank you for taking the time to read – I appreciate you!
Joe Rinaldi, PT, DPT
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