When working with a patient,
Tell yourself a story.
Tell your patients a story.
Create the story out of their plan of care.
Narrate to them what is going on, where they are in the story, etc.
Bring them along the journey.
Of what is seen (but not necessarily fully understood)
And what is not seen - which is your thought process - (which can’t be known until it is spoken aloud).
I learned this trick from a friend back in undergrad.
And then really ran with the idea years later teaching grad students on their clinical rotations. It was a great way to instruct a student (and patients) in real time.
From what the potential thought processes were heading into the visit,
To what I needed to learn (testing),
To what I needed to do (treatment based on the testing results),
And what we were going to do to keep the change (patient’s work between visits).
How that day’s objective fit in the overall presentation,
And progress of the plan of care.
Language is big here. A bit more ‘insider’ clinical language with a student/colleague. More translated and analogized language for patients.
Narration helps keep your eyes on the prize.
Keep the data in front of you.
Keep the thought process alive and progressing,
Guiding your clinical decisions.
Telling the story tightens up your game.
It is hard for your concentration to wane or
Become relatively lazy
Or ‘phone in’ a visit
When you are committed to telling a story.
'They' say -
You know something well when you can teach it.
Telling a story also
Invites patients into the work that is involved in their care.
Without narration, a patient may experience you ‘pushing on a sore part of a muscle,’ nowhere near where their actual pain is.
With narration, they may see the fascial restrictions found within the gluteus medius are propagating an externally rotated left lower extremity that is forcing valgus stress of the pes anserinus as the patient plows through the medial region of their knee in each stance phase of walking, worsened while running (and that doesn’t even mention the rotated left innominate feeding the restricted left glut medius that seemingly stems from the impaired relationship between the left internal oblique and left hemi-diaphragm.)
The story welcomes patients into the whole process of their treatment plan.
Everything you are doing for them -
All of the evaluation, testing/retesting, skilled interventions -
Or did for them - schooling, continuing education courses, certifications, mentorship, studying, researching, etc. -
All of which pours into your clinical thought process and skill level to work with them on making positive change.
The narration experience helps to better inform the process and results we are all in and heading towards.
Patients may not value your skillset, your efforts, your brain as much if they do not know/see much of what is going on.
Gift them the experience.
A writer told a story about how he was on his way to a speaking event
And stopped off at a coffee shop since he was quite early.
After reviewing his notes,
He left, only to find his keys were locked in his car.
Approaching being late for his event, and with growing anxiety,
He called a locksmith.
One happened to be around the corner.
The truck arrived.
The locksmith exited his truck with tool in hand,
And within seconds, the door was unlocked.
With a charge of $225.
A moment of jubilation.
And jubilation quickly thwarted.
In that moment, the writer felt ripped off.
He paid, and headed to his event.
It took some time for the him to figure out why he felt so slighted.
The writer surmised that he wanted there to be more of a struggle, more work involved to resolve the situation.
The situation was ‘big’
And he wanted the solution to feel equally ‘big.’
He did not feel slighted by the cost.
He wanted the amount of work involved
To match the size of the problem.
He wanted the experience of the solution
To match the experience of the problem.
Though the result was exactly what he wanted,
He wanted the process to be seen - experienced -
So that it would match his experience of the problem.
Telling a story
Keeps focus in your clinical decision making process and intervention.
It allows your patients to see and experience the efforts involved.
You work hard.
The story reminds you of that.
It helps your patient see and understand that.
And you both have the opportunity to see your value in that process throughout -
And not pin all of the value on an end result.
Waiting for the end result, delaying worth until your patient leaves the clinic pain free,
Devalues your daily experience;
Your daily investment.
It takes the worth out of your daily efforts and responsibilities.
Not finding the full value of your daily work,
Yet working so hard throughout your day -
Such a disparity loses sight of fulfillment, joy.
High value unnoticed is hard on the soul.
Telling the story
Illustrates the craft in each part of your day,
Highlighting the value you provide,
Allowing your soul to shine.
By Dr Adam Fujita PT, DPT CAFS
8 Years of clinical experience in the physical therapy environment.