Impact of Language

[Katie Long]

Hey guys, I don’t know if anyone else has read this recent publication from JOSPT on the impact of language in MSK rehab, but I think it is a really good read. I often find myself struggling with where the line is when educating patients. Specifically regarding how much information is too much or scary vs. what they need to know about their condition. I love the chart they provide on alternative language for commonly used “scary” language. I think my take away from this publication is that I really want to be better about asking my patients at the end of the evaluation what they now understand about their condition that they did not prior to coming in. I always ask if they have any questions, but I think they are often overwhelmed and don’t even know what to ask.

What are some metaphors/strategies that you all use during initial evaluations to convey diagnoses?
What are some strategies you use to assess patient understanding of their condition?

Thanks for any insight! I just thought it was a good read and wanted to share!

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[Sarah Bosserman]

Great read, Katie. Thanks for sharing!
I think this type of language and patient education can make or break an evaluation. Many patients come with some type of misconception or are already catastrophizing – whether it was due to something their MD, the internet, or friends have told them. Finding the right balance of information is difficult, being able to parallel with the patient is a skill that I continue to work on. I have used tools like the JOSPT perspectives for patients to help reinforce education and I always try to leave room for questions at the end of each session.

[Tyler France]

Hey Katie,

I love the chart in that article. I have seen it floating all over PT social media in the past week, which I think is awesome. I will definitely be sharing that table with my future students. One of the big takeaways that I have gotten from residency is the importance of challenging patient beliefs from the start and using your exam to de-threaten. For example, if I have a patient who comes in with a script for hip OA and spends the whole subjective talking about how their hip is degenerated, I may use their negative scour test or something from their functional screen to emphasize that their hip is functioning better than they give it credit for. I have also tried to adopt a habit of Eric’s in my patient care. At the beginning of first follow-up visits, I often ask “What did you learn from me at the evaluation?” That way, I am able to assess a patient’s understanding of what we discussed and I am able to address any shortcomings early on in the rehab process.

[Justin Pretlow]

Thanks for posting this, Katie. It’s a very good, short read.
I think this helped me rethink the implication of the “wear and tear” phrase. I often use “wear and tear” when I cannot come up with a better description for a degenerative joint issue. I say “wear and tear” thinking that it sounds very non-threatening by comparison to other lingo patients have heard. While this might be true, I haven’t really thought about the way that might make patients think the problem needs a technical fix. I will definitely keep this in mind. Thanks for passing it along.

[Justin Pretlow]

Ditto previous comments on the helpfulness of the chart suggesting alternative language.
Another point I liked -“When we are physically and emotionally low, we not only hurt more easily, we also seek information that supports our vulnerabilities.” This point is helpful in considering how patients may interpret and hear part of what we are saying, or grab on to the negative connotation of a seemingly neutral word or phrase, making it all the more important to consistently work on improving our communication style.

[Kyle Feldman]

Great article.
With communication becoming so big in the PT world sometimes we have to even listen to our new verbiage and see if it could be improved on. I love how wear and tear now needs to be re-worded. It will be a constant review process. But like clinical reasoning, as long as you are constantly reflecting and reviewing what you do, things will continue to improve for you and your patients.

Having a student this summer helped me realize that what I was saying still had negative connotation.

Reflect in action and reflect on action. Never stop learning. Great article!

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