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5 Things Your Patient Isn’t Saying… But You Should Know

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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.

3 Steps to Improving Your Listening Now

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Preaching the virtues of listening is a double-edged sword.  It is one of the most important skills on can possess and translatable across language and culture.  At the same time, listening is a virtual unicorn in our fast-paced, multi-tasking society.  Let’s get practical with 3 steps to improving your listening now.

  1. Quiet Your Environment

This should be pretty straight forward, but I can’t tell you how often I’ve personally observed important customer conversations happening in the middle of a busy office.  Of course, these conversations happened with the best of intentions – organic and spontaneous in nature, the customer asks a question and the clinician responds in the moment leaving the conversation at the surface level without digging deeper.  Confession: I’ve been the clinician in this scenario

Exercise: As a matter of practice, take the time to routinely (weekly or every other week) to check in with your customers in a quiet space free from other noise and interruption.

  1. Quiet Your Mind

Controlling environmental noise is one thing, quieting the noise in your own mind is an entirely different beast.  The sheer number of demands in a day – other customers, documentation, needs of staff/colleagues, needs of your home – is often overwhelming and always growing.  While society has extolled the virtues of multi-tasking, our relationships, including clinical & customer relationships have deteriorated.  I’m not claiming causation, but the correlation cannot be denied.

Exercise: Practice your listening skills.  #1) Aim for 2-3 minutes of complete silence listening to every breath you take.  #2) In the coffee shop (or any public space), close your eyes and try to identify by sound, how many different conversations are happening around you.  You’re working to parse sound & channels.

  1. Make Your Goal: “That’s Right.”

You are excited to help and serve your customer.  That is a good thing.  In that excitement, though, we often subconsciously try to anticipate customer questions and answer them.  We do this at the expense of asking questions and seeking clarity.

Exercise: When your customer is done relaying their story, start with the words, “Let me make sure I’m hearing you correctly.”  Briefly summarize what you heard.  Wait.  You’re waiting for the customer to independently say, “That’s right.”  Be careful not to add the leading question, “Is that right?” to the end of your summary.  This creates the potential for agreement rather than affirmation.  The tiny psychological step that takes place with your customer independently assesses and confirms your summary turns into a giant leap of empowerment ending with that customer being heard, possibly for the first time in a healthcare setting.

Practice these three simple exercises and be sure to let me know how it goes for you.  Keep in touch through the comments below, our facebook page (www.facebook.com/thevoiceofthepatient) or through Twitter (@DReedPT or @ZachRStearns).

Preach It, Teach It – Summer of MOVE

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It wasn’t much more than 12 years ago that I was on the path of being THE patient, instead of the Voice of the Patient. I’ll tell you what I mean:

Headed into the final year of grad-school, studying to be a PHYSICAL therapist (you might appreciate the irony), I weighed in at 260 lbs. To be clear, there was minimal muscle and my “athleticism” consisted mainly of watching others play sports. I was uncomfortable, winded from climbing a single flight of stairs, and knew something needed to change. There were also a number of other personal factors changing rapidly in my life at the time, which I won’t discuss in this forum, needing an outlet.

My resolution was to do something (an actual activity) that would make me sweat for 30 minutes every day (#sweat30). Having put the effort in to sweat, I didn’t want to torpedo it with poor eating, so I ate vegetables and other foods that were real (not processed, could be found somewhere in nature). Things were different within a very short period of time. It seemed that the more energy I expended, the better (read: less tired, more focused) I felt. Somewhere in there, I also discovered that I enjoy running, albeit slowly, so I set a goal to run a 10k.

Pounds were shed, especially at first, and I eventually made it to 180 lbs. A much more athletic 185 than the 260 of the start. 75 lbs! Essentially, I stopped carrying a 7th-grader on my back every day, all day. Goals were met and new ones were set. First it was the 10k, then a ½ marathon, and eventually a full marathon (disclaimer: I have never felt closer to death than when crossing that finish line). Now, I’m just working to lift heavier things & running shorter distances.  The biggest, and most important change was that happening between my ears.  I began to believe that I could be healthy and could hit the targets I was setting.  It was very powerful & something that, once earned, can’t be taken away.

Please don’t read this blog entry and hear, “look at me,” or “look at what I accomplished.” First, nothing is accomplished in a vacuum. My faith and my family are solid and constant. Second, it’s not over yet. At 211 to start the summer & still holding that the cheeseburger is at the same time the most beautiful food invention ever & the most diabolical. Lots of stuff tried to get in the way of my Sweat30 plan – and is often successful. Mike Eisenhart’s brain-child, #SummerOfMOVE, has been super helpful getting this train back on track.

What I do want you to hear is that I have walked a mile in your shoes – and it may have counted toward my Sweat30 on more than one occasion at the beginning. It’s not easy. To make the change & commit to it, the old adage is true: The pain of staying the same must outweigh the pain of change. Also, there is support when it gets tough & it seems no one else is making the same changes you are.

Your Motivation

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Why do you do what you do? Why are you making the choices that you’re making? Why are you reading this right now? Why am I choosing to spend my time writing a blog post?

The answers are evasive at best and unique to the individual. Getting a little messy never scared me away, though.
The field of economics addresses motivation to action in terms of utility. Utility, here, is defined as the measurement as “useful-ness” that a consumer obtains from any good. Whether that useful-ness is realized in terms of money, education or learning, or just a good feeling, we do what we do because we recognize utility in that action at that time.

So the questions bend a bit here. Where do you see utility? Is it in giving or receiving? I believe that there’s a way, with a little effort, that business can be sustained in genuine service to others.

We’re here to support you in your service to your communities.

Personal

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Care is personal.  Always.

As a provider, you are reaching into another human’s life, touching something, changing something.  When you’re done, they will never be the same.  Changed for better or for worse.

You have the privilege of serving your fellow man.  A person who serves a purpose, has inherent value in personhood, and plays a role in your community.

To serve is its own reward.

Honor these things and treat them with the reverence they deserve.

Get Better Results Now.

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Tweet This

 

Give a hoot.  Actually assign value to what the person in front of you is saying.

If I were to stop here and you were to implement this alone, I can guarantee that your results – in nearly any area of your life – would immediately change for the better.  For validation purposes, here’s what happens next:

1.      You get a strange look as if you were from another planet. 

This is especially true when changing your approach with people who know you well.  “This isn’t how he normally behaves.  What’s wrong with him?  Is he dying?”

2.      Your customer’s guarded position melts and you gain better depth of information. 

If you don’t know the person in front of you well (i.e. it’s a stranger), you may actually skip #1 and start right here.  When a person knows that you actually care about what they’re saying, that they’re not just a number or a widget on the assembly line,  they will open up.  They will give you the depth of information you need to actually help their specific problem(s).  But we’re not focused on solving their problem just yet.  We’re still listening here.  Valuing what the person in front of us is saying is the ONLY thing happening at this point.

3.      Your strategy to solve the problem with which you’re presented is tailored to the individual setting you up for success. 

This one is pretty straight forward.  Better information in yields better results.  When your customer feels valued, there is understanding that you are invested in them on a person-to-person level.  Some may call what’s happening “gaining buy-in.”  We like to call it: Establishing Therapeutic Alliance.  It is the foundation for enormous results.   

4.      Your customer says something like, “I’ve never had an experience like that before,” or “This is so much better than the last _______ I went to.”

This is the point where you tell them, “Thanks, I learned it all from The Voice of the Patient.”

Enjoy.