1. “There’s more to my pain than the sharp sensation in my shoulder”
To get a clear picture of an individual’s pain, we must understand both the nociceptive stimulation as well as the psychological stressors that can influence and magnify pain perception. These things are not always volunteered so the clinician who is truly listening is asking these questions and driving deeper, especially when these factors appear to be influencing pain.
Listen to Zach Stearns talk more about Psychologically Informed Care here.
2. “I’m not really doing my home program like we talked about”
This is something you probably already know if you’ve been practicing longer than a week. My question is why do you continue to assign a home program or any kind of independent follow up to your clinic time? I would urge you to look closely at the follow up work you’re giving your patients:
· Is it too complex? à Is there something very simple and convenient someone can do for short periods throughout the day that will influence their outcome?
o Look at complexity of the whole program & complexity of instruction
o Life is already complex. Simple is an artform.
3. The minimum viable product
Goals are important and it’s imperative clinicians be on the same wavelength with patients when it comes to the target at which they’re mutually aiming. However, we need to know what the area around the bullseye looks like as well. By this I mean, is satisfaction limited to hitting the bullseye? What kind of margin is there between hitting the bullseye and missing the target completely.
Please don’t misunderstand thinking that I’m insinuating that mediocrity is ever acceptable. It’s not. Sometimes, no matter the clinical skill, people don’t recover as quickly or completely. In those circumstances, we absolutely need to understand where we (you/I and the patient) stand.
4. “That’s all.”
A simple exercise to use in conversation where there’s something at stake and a problem list is being generated is to ask the question, “What else?” until the respondent says, “That’s all.” To address the main problem with which someone presents may address 80% of their concern. However, to address it all, try this exercise to understand all of the issues on the table, eliminate blind spots, & be awesome.
5. All the pelvic stuff
Bowel & bladder function may be a little gross. Talking about sexual dysfunction with someone outside of your peer group may be a little uncomfortable. You’re a licensed medical professional. Get over it. Ask the questions. Ask them privately. Make it okay to answer.
It’s even okay if you don’t know how to address these issues specifically. It’s a great time to get a mentor, refer to a specialized colleague, or plan some CE. Your patient will appreciate you for your professionalism and honesty. They may even refer friends.