How can we achieve better outcomes?
- For the health of our patients
- By lowering costs for third parties like employers and insurers
- And, most importantly, for ourselves. That is, improved satisfaction and, hopefully, greater career longevity.
What factors hold us back? Do we need to improve on the skills we have? Or, are we missing certain traits entirely?
The answer lies somewhere in-between.
Physiotherapists have specific skills as experts of the human body. We know about things like muscles and tendons. Bones and ligaments. Movement and exercise.
Though, the body is more then we can see and touch. We’re taught about the biopsychosocial model. And we make sure to screen for yellow flags (and blue, red, orange and black ones too). But do we go far enough? Do we address our findings? Or, are we the right people to handle them?
The attributes of a physiotherapist differ depending on their field. One working in a hospital will excel with certain expertise. While a successful private practice clinician would possess different qualities.
Oftentimes, these skills develop on-the-fly. We absorb them from the job, the environment and our colleagues.
But there are fundamental traits that we’d all benefit from having or enhancing – regardless of our territory.
A holistic approach
The word ‘holistic’ is tossed around nowadays like a potato. It has lost its impact. As have its equivalents: integrated, comprehensive and whole.
Everyone, apparently, understands the need to look at the full person. Not just the hamstring. Or patella tendon. Or common extensor origin. We know physical structures form only part of a complicated puzzle.
But do we have enough of an understanding? Maybe the problem lies in our appreciation of the significance of our findings.
We often skip over factors that aren’t physical. What’s your social life like? Good. And general health? Not bad. What about work? A little stressful.
We need to get out the shovel and dig. Or, do we stick to the surface because of time constraints? Or, expectations? Or, fear? We’re physiotherapists after all. Not psychologists or dieticians or social workers.
And what happens when we do uncover something pertinent? Our patient says she is stressed. She reports that she’s sleeping poorly. And, quite frankly, she looks frazzled and worn down like an old toothbrush.
So, what do we do?
We write it in our notes. We point out that it might be having an impact on her pain – offhandedly. But rarely do we play up its importance.
“Your problem won’t get better unless you address your stress.”
We must take more time with our assessment to understand the whole person. Let’s contemplate:
- The potential barriers to recovery
- The non-physical influences
- Are we the best person to help?
Motivational interviewing skills would help too. Psychologists use this approach to put the client at the centre of their story. And it helps clients realise that they’re actions are critical for creating change. Not a drug. Or a scan. Or a manual therapy technique.
Then, there is knowing our professional boundaries. When we identify a roadblock that we can’t properly address, it’s time to refer on. Perhaps the client needs help from another professional before returning to our care. That’s why we should build a network of other people in health. And other areas too. Such as finance and law, for example.
Next, we must address our soft skills.
New graduates are drilled with the need to build rapport to estabish a conducive client-therapist relationship. Rapport, rapport, rapport!
But we need the right blend of other soft skills too. Like the ability to empathise, to be seen as a professional and to detach.
Establishing rapport means our clients like us. They like coming to see us. When we create a pleasant interaction it removes the stress from a potentially stressful clinical environment (i.e. Whitecoat Syndrome).
But there is such thing as too much rapport. There is a fine line that we don’t consider and often blindly trample over.
Our goal, after all, isn’t to make a new friend out of our patient. This changes the relationship entirely. We don’t see our friends as professionals in their specific sphere. We see Tom who likes cold brew coffees. Not Tom the physiotherapist. Therefore, we don’t take Tom seriously when he suggests a strategy to get our knee better.
That’s why we need to establish that we’re an expert.
This doesn’t mean we use big words (even when we really want to say tendinopathy). But, instead, by striking a balance between friendliness, using our expertise and maintaining a social distance with our patients.
Let’s stop chatting about how their labradoodle’s foray into puppy training. This is an inefficient use of everyone’s time. Instead, let’s establish just enough rapport. Then, we must focus on teasing out relevant information and skillfully managing this person back to full health.
We must understand our clients. What motivates them?
If we can see through their eyes, we can grasp how they’re perceiving us. We better understand the problem they’re dealing with.
With this insight, we can use the approach that fits. From the wording we choose, to our level of sterness as well as developing the appropriate management plan (how many exercises are realistic?).
The last, and most poorly executed attribute, is the ability to dissociate from our clients. This is another reason why we shouldn’t be making friends with those we treat.
It shouldn’t hurt when Glenn cancels his appointment. And we shouldn’t feel crushed when Roberta’s elbow doesn’t get better (though, we should probably ask ourselves, why?).
Detaching might seem cold and cruel. But it’s best for both parties. For one, remaining isolated maintains our clinical clarity. And two, it preserves our sanity.
And this second point is critical. It benefits our mental health, our job satisfaction and our career longevity. We can deliver a greater level of care for our clients over time.
One final skill we need to augment is asking for help. Like, daily – even when we think we’re right.
What’s the harm in more feedback?
Our ego impairs this ability. What if our diagnosis is wrong? Will our colleagues think we’re stupid? Could it jeopardise our job?
By constantly asking for others’ opinions (how would you manage Patient X?), we become better clinicians faster.
We start to think laterally. We consider symptoms – and the person at large – from different angles. Not only does it benefit the specific case we’re dealing with. But future ones too as we recall what a colleague once told us.
Also, the discussed case becomes less of a burden. We share the responsibility.
There’s no need for wholesale changes when it comes to our skills. A boost is what we need. Let’s fill in these gaps:
- Increased breadth of assessment – We need to get better at finding and acting on non-physical influences
- Refer – Within the profession, to other health professionals as well as people outside of the health realm (*plus, build a network of trustworthy individuals to confidently refer to)
- The right balance of soft skills – Rapport building, professionalism, empathy and the ability to detach
- Ask for help – Often
What do you think? Do you agree that these are skills and attributes that could do with an upgrade? Comment below.