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In response to Eric’s post – I really like how this article paints a picture of how our words can affect our patient’s perception of their condition. I initially read the article when it was first posted and, since then, have been more mindful of my words with certain patients. I noticed that my tendency when greeting a patient in the waiting room was to say “Hey ___, how is your ___ feeling today?”. By doing this I might have made them over-analyze their symptoms and maybe put it in their head that they should be thinking about their body part all day. Since reading the article, I have been making an attempt to be more vague in my initial greeting, but still get a subjective report that I want. The major change I’ve made is just starting with “Hey __ how have you been since our last visit?”. This minor change might make a small difference in their mindset at that moment and for the rest of the session.
A specific example of this that I have is an older gentleman with LBP who I have been seeing for a couple weeks. I introduced myself on Monday with “How’s your back feeling today?” and his response was “Well now that you mention it, it’s kind of aching. I hadn’t thought about it much today”. That session, the patient had a little more pain with functional activities that weren’t painful during previous sessions. Today, I saw him again and avoided discussing pain at all, unless he prompted it. He was able to go through the whole session with no pain. Now granted, this is an N of 1 and I might have been hyper-analyzing it, but I think this gave me more insight on how even my wording during “hello’s” can make a positive or negative effect on the patient’s session.In response to Dhinu’s post – I hate to say it, but I think that I fail to take advantage of the professional dress factor that could influence the placebo effect. My clinic is very laid back in a sense, with certain PTs wearing sweats and a t-shirt to work everyday, while others wear polos, and others wear button downs. I try to put myself right in the middle, with a loosely (sometimes un-) tucked polo and pants. In my mind, this wouldn’t affect how professional I would view someone, but that’s coming from my point of view. Some might find this completely unprofessional and might feel that I am not competent as a PT. I might try to change this up this week and see if I notice any changes. It’s never easy to admit that your dress is not up to par..but that was the first factor to stand out to me.
In response to AJ’s post – I think that the biggest factor of patient interaction that I can see I am going to have a hard time with is the amount of time that we have with patients. At my clinic, we are given a full hour to evaluate a patient, which is plenty of time to discuss POC and improve the shared decision making process with new patients. However, PTs can occasionally be triple booked in an hour slot for followups. Granted, they are scheduled every 15 minutes throughout an hour (not all at once). This gives us only a short period of time to talk with them and incorporate active listening because we have other patients in the building that we need to work with. I can 100% understand how this affects their perception of care and potentially their outcomes. Luckily, I am treating mostly on the hour right now, but once my schedule gets more rigorous, I will need to develop more refined interpersonal skills in order to ensure that my patient interactions are optimal in the time that I can give each patient. I’m curious if the more experienced members in the chat have any advice on how to best do this?
Erik – I really like how you put the last part of your comment. “What a person defines as being helpful is innately original to that person”. This is a great way to define how the way that we word our questions/descriptions/assessment is vitally important to how a certain patient will respond. Each person that we work with is completely unique and our words will impact them based on how they interpret them. This can be applied to the concept of increasing the placebo effect to improve patient outcomes. The way that we articulate our descriptions can curve a patient’s expectation from positive to negative or negative to positive (or anything in between).
During the last year or so at SU, I was a part of a research project that looked into the effects of various factors (dress, verbiage, gender matching/mismatching) on the subject’s subjective and objective outcomes. We found that there wasn’t a large difference in the outcomes objectively, however there was a difference in the subject’s perception of their objective improvement. The patient’s that were matched to specific criteria expected to get better and some had perceptions that they actually did improve, despite the numbers not showing that they did.
For reference our findings supported that two controllable factors improved patient’s expectation of a positive result: 1) giving the subject a detailed explanation of the intervention and 2) dressing professionally. As you can imagine, these two factors could potentially lead a patient to believe that we are more competent as a healthcare provider and potentially be more effective in our interventions – an example of utilizing the placebo effect to our advantage.
This goes to show that our words, how we dress, and our overall interactions with our patient’s can affect their expectation of our treatments. Whether we choose to be as detailed or dress as professionally as the methods in our study described, it is clear that our brief interactions with patients had an impact on their perception of treatment. This potentially could enhance the effects of placebo on their outcomes long term.
I think this was a great article to read and analyze, especially at this point in the program. I can appreciate the comparison of conscious and subconscious processing during clinical reasoning application. I’ve had a discussion with old classmates about this concept, believe it or not. I agree that clinical reasoning (and its application to patient care) is developed over a lifetime. However, I have always been of the mindset that it’s more beneficial to be proactive in your learning process and consciously be working towards improving these clinical reasoning skills. I believe that the SCRIPT tool does just that – with the added benefit of being able to discuss our thoughts with our mentors. I strive to develop these skills as the year progresses. As Erik said above, I believe the SCRIPT tool will improve our ability to see the whole patient in front of us – not the diagnosis or its “typical presentation”.
I plan on taking the opportunity to become vulnerable and share my thoughts with my mentor in the hopes to develop clinical reasoning skills that will benefit every patient that I will work with throughout my career. I believe that the SCRIPT tool is a great way to develop and discuss these skills in particular.