Where ever in the world you are practicing please consult your regulatory boards restrictions/allowances of what you are permitted to discuss with your patients. Some allow therapists to provide nutritional advice, some do not. Some allow therapists to diagnose and some do not. I take no responsibility for you not doing your due diligence in educating yourself as to what you are permitted to talk about with your patients.
Over my almost 20yrs of being in practice, I get asked a lot from students and colleagues about how to advise their patients without “crossing the line” so to speak. The Therapeutic Relationship that exists between a patient and their Massage/Manual Therapist is a unique one. It differs from the relationship with an MD, DC, Physio and so on. Because of this unique relationship, patients confide in us more so, and in doing so tend to seek advice or help with issues that are usually outside our scope of practice, but are possibly influencing their recuperation to some extent. It’s challenging for us to stay clinical.
Many of my colleagues and students care a lot about their patients (professionally) and as their regulations and educational standards that have not prepared them for situations such as this, they are unsure about how to give advice to someone in a way that helps them, yet doesn’t cross any legal/professional lines.
So what’s the conversation look like?
1. Be Present:
Life these days are very busy for all of us. There are always outside influences that have the ability to make it into your treatment room and become large distractions. If you allow distractions to become a primary focus in your sessions, you wont hear a word or any of the clues your patients are telling you concerning their complaints.
Stop checking your email, shut off your cell phone, get off Facebook, shut down Twitter, stop searching for more LinkedIn connections, texting will still be there when you are done your day. The world will go on if you are not online somewhere, somehow for a little while.
I find one of the biggest gifts I can give someone coming to me either for advice or treatment is my complete undivided attention and presence!
Really be present and connect with them!
Presence is everything to a patient.
2. Acknowledge and appreciate their emotional reality:
We are not educated in being clinical councilors/psychologists, and for the most part many times this is far from being within our scope of practice, but often we are asked for our advice or for help.
When a patient is really upset about their condition, injury, accident, work, husband, wife, kids, crappy day… don’t tell them how to feel. Listen quietly and acknowledge how they are feeling. Don’t discount it. Don’t try to transform their emotions.
You need to listen to your patient so that you are able to help them. When you do this patients will value you more.
Many times patients have been through the referral circuit. They’ve been told different things from different practitioners, and are continually not getting better or are not healing effectively from their injury/ condition. They can feel uncertain, unsure, lack confidence, may be feeling confused and possibly emotionally not as stabile as normal. They usually feel lost and are not sure what to do.
Listen in a way that allows you to help them.
3. Best thing you can provide to your patients is “Perspective”:
Most times when patients ask for help or assistance in figuring out something that’s troubling them, they really don’t want “The Answer!” What they really want is “perspective.” They want to know more about what their choices and options are to choose from. This is where you can use your experience from what you’ve gone through in your life, what others (patients, family members, friends) have gone through, share a story about someone else who has possibly been in a similar situation that may help them feel less alone and more connected. Help them synthesize the information and allow them an opportunity to discover the answer in their own way. Ask questions to elicit their own perspective rather than arbitrarily giving yours.
I like to simplify things for patients:
If this – Then that – What to watch for
Help them to feel more secure so that they can regain the ability to be able to handle the situation or problem. Ensure that they leave knowing that they are capable of figuring it out.
4. Also refer out to your TEAM!
Don’t have a TEAM, have a look at my video “ 6 Ways To Improve Your Practice”
A practitioner should always know when they are the “right” person and the “wrong” person for the treatment of the patient. Sometimes recognizing when it’s time to refer out to another therapist is the best course of treatment for the patient. Knowing when to include others along side you in treating the patient is an important skill to acquire. This skill requires you to let go of your ego or your belief that “you are the only solution” to the problem.
We have many patients that are being over treated by seeing too many therapists too often. Removing yourself from this cycle, from an over treated patient can be a difficult but necessary decision. In my experience, as soon as I’ve done this, the patients themselves start to take back control/ management of their health. They start removing the unhelpful treatments in their life. More often than not, I am asked back into the equation of what fits and works for that patient.
5. Defining Resolution:
Resolution! This term needs to be defined to the patient. Most patients associate “resolution” with being 100% cured or returned to their pre-injury state of health. This extraordinary expectation may never be achieved. Having a patient believe that this is a possibility, only places unneeded stress on the practitioner and discouragement from the patient when they continually do not achieve that state of healing.
Lets say your level of pain/discomfort in your life is rated at 9/10 with 10 being the most painful/discomfort you have felt with your injury, and your quality of life is 1/10 with 1 being the worse it has ever been. Throughout your treatments you have had diminished pain/discomfort to a 2/10 and quality of life has improved to 8/10. Could that be defined as “Resolution” to the injury? This is the level of acceptance that all patients need to be made aware of before and throughout the treatment process.
The practitioner should primarily be focused on improving the patients’ quality of life, through whatever means they can use as dictated by the condition on that day, by that patients’ body.
6. Stay Human:
Today there is a very science strong movement through the Manual Therapy profession. This is needed for it’s various improvements and advancements that are necessary for a profession to grow. Unfortunately, what is lost is the art form of the technique. Although a therapist should be considering what treatment techniques are scientifically sound for the pathology at hand, this should stay in their mind and not come out in their hands. Empathy, concern, love, caring, acceptance, positive intent, nonjudgmental, humanism; these are some of the characteristics that the patient should be able to infer from a treatment. The Language of Touch is an art and a skill that we all continually develop over our careers.
Conclusion
As always, I hope that I have been able to serve you in some way with this information, be it a completely new perspective into your patients, be it some new thoughts about how to approach a treatment or provide you with a review and acknowledgement that what you are doing, as far as I’m concerned, is having an amazingly positive impact in improving the quality of life for your patients.