Mistakes Patients Make That Make Our Lives Harder...and What To Do About It

    Our patients typically have the best-meaning intentions when starting therapy, but sometimes, patterns emerge that make harder the job of a therapist or other healthcare worker. Today we're breaking down the Top 3 Mistakes we tend to see in the outpatient physical therapy setting, widely applicable to a range of situations in healthcare, and what we can do to not only improve the trajectory of the episode of care but make it enjoyable for all!

• Mistake #1: Subpar goal setting at the Initial Evaluation - We all know as therapists, that "No more pain" is NOT a meaningful goal!  Many patients have been in pain for several years, which will take time to rectify, and we want to have a more concrete means of determining our progress day in and day out. 
  
  Solution: At that first meeting, take the time with your patient to establish a few SMART goals  - Specific, Measurable, Attainable, Realistic and Time-bound.  In my experience, this enhances patient motivation and facilitates more buy-in from the patient than using your last few minutes to demonstrate a simple stretch or two that they’ve probably seen before (especially just for the sake of squeezing something  "new" in). The sessions in which I have really gotten to know the patient and have worked together to establish concrete goals have been some of the best, with both myself and my patient highly confident that there is a solid plan in place to work towards the right outcomes with objective measurements along the way. 
  
  
• Mistake #2: Only doing exercises in session - We’ve all met the patients that do the work only when they’re standing in front of us clinicians. They don't remember any exercises when asked, and may not even remember any practical education provided in earlier sessions. This can be incredibly frustrating to handle as a therapist.
  
  Solution: Set these patients up for success on the first day by outlining expectations - you will show them the ropes, provide them the tools to continue getting stronger and decrease their symptoms at home, facilitating independence.  You are in a pact to work on this problem list together - if they’re not on board, they're letting down their end of the bargain and ultimately, they won’t see results. Between insurance and time constraints, you are not going to be able to see them forever. While it might feel harsh to bring this up on the first day, you can set expectations kindly and use your judgment as to which patients are going to need this emphasized more than others. Some patients are extremely transparent as to why previous therapies did not work for them - use those admissions as a chance to educate, build rapport, and change the trajectory of this episode of care before it even begins so that this experience with you might be different this time.
  
  
• Mistake #3: Impatience - Everyone wants the quickest fix, and patients often want to put a concrete timeline on their return to work, sport, or when they will be out of pain. While there are a few conditions that we do have some timelines or recovery estimates for, based on experience and research, every person is different and it can be incredibly challenging to guarantee a quick turnaround or an end date to symptoms. 
  
  Solution: I would argue that while the quickest fix might be popular, many more clients want the long-term solution. Selling rehab as that long term solution can get our clients through the ups and downs of a typical episode of care and improve buy-in throughout the natural ebbs and flows of rehab. Strength training alone takes 6-8 weeks to build a clinical change in strength, nerves take frequency and consistency of treatment to desensitize, and muscles and joints need weeks to make clinically significant, lasting improvements in range of motion. Reference the research on these physiologic time frames to build your case for requirement of time for therapy to work, reiterate that progress is routinely and objectively measured via re-evals, and be sure to present therapy as the long term breaking of habits and establishment of new movement patterns. Collecting testimonials from former patients, taking before and after videos or photos, and more can be invaluable to supporting patient buy-in and mitigating any impatience directed your way as a therapist. 

Got more tips for dealing with the most common mistakes we see? Leave them, along with any questions or suggesstions, below!