Critical Thinking

Have you ever prejudged your patients?

Last weekend a friend and I went out to dinner to a cozy (means really small) restaurant in the West Village. There are so many restaurants to choose from in NYC and most of them have great food. So it is the service that really counts. Which is why I found it very unusual that one of the restaurant’s hosts was really rude and at some points just down right nasty, not only to us but to other patrons in the restaurant as well. On our way out I mentioned this to one of the other hosts at the restaurant and she said he was usually so nice and in such good spirits, but tonight he came into work with terrible low back pain. Of course, I felt so bad because I thought he was just a snob, not someone who was in pain. This got me thinking about how people in pain can sometimes be misunderstood. Believe me I know from experience.  As someone who suffered from chronic neck pain for many years I am sure I was that person who was not so happy or maybe had a short fuse or not a lot of patience. But I was also nervous, scared, and truly thought nothing was going to help me be pain free. That experience helped to shape my professional life as a PT in so many ways.  That experience, along with learning from some amazing therapists over the years, has led me to change my thinking and approach to new patients. Below are some of the principles I now follow when meeting and interviewing my patients for the first time:

  • Recognize that your patients may be scared, nervous, unhappy, depressed, etc, especially those with chronic conditions.
  • More often than not, your patients are coming to you with a painful condition and might not be themselves (just like the host at the restaurant) and you need to give them respect, understanding and time.
  • Do not pass judgment on your patients.
  • Be fully present and listen to your patients in order to deliver the best possible care. Getting their story is paramount!
  • Empathy, empathy and more empathy! Dr. Larry Benz wrote a great post on empathy last year on the EIM blog.  I find this really helps to “find a way in” with your patient.
  • Put your ego aside and make your patient a priority. Remember it is not about you!
  • If you are running from one patient to the next (as so many of us do) take about 1-2 minutes between patients to concentrate on your breath in order to be fully present for that patient and not thinking about what happened with the previous patient. This is a great habit to start!

I have found that following these principles during the first session have led to more meaningful connections with patients.  Your patients need to trust you with not only their body but with their story as well.  If that meaningful connection is not established in the first few visits it may make your job that much harder!

Now, I would love to hear what types of things you do to prepare yourself for your patients and ensure you are at your very best.  Please leave a comment below and perhaps we can all learn from each other!


– Karen @karenlitzyNYC


3 replies »

  1. I certainly echo your advice of taking a step back and trying to understand how pain affects attitude and behaviour. What I find particularly challenging is the patient who has had very negative experiences with health care professionals in the past and presumes that their consultation with you will be equally unproductive. Behaviour such as eye rolling, sighing, lack of eye contact and a general defensive demeanour are often coupled with expressions of ‘ another doctor telling me it’s all in my head’, ‘ so Ill just have to live with it then’. Sometimes even with the best strategies employed, these patients can be difficult to engage.

  2. I totally agree with you they can be difficult. For those patients that have been to several people trying to find someone to “fix” them or take away their pain I will use a lot of metaphors to try to explain pain to them, rather than get too technical at first. Also, I use my own story sometimes (I had chronic neck pain for years and now I feel good..really no ore pain) to try to get them to “drop their guard” so to speak. I also really try to get those patients to take more responsibility and ownership over their body. It may take a few sessions of chipping away at them but in the end I have had pretty good success with even the toughest patient.

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