I’ve come across three interesting and intersecting publications, all pointing out to one degree or another the importance of word choice in the context of healthcare. Sometimes I get in a zone where I’m focused on the task at hand, and my use of words is either non-existent or poorly chosen, so I have found these helpful.
The first publication is from a recent con-ed I went to, put on by ISPI entitled The Low Back is Having Brain Surgery, presented by Adriaan Louw. I remember a little bit about pain in PT school, but I don’t remember anything like this. It is amazing how pictures and word choice (both pre and post-op) can impact a patient’s recovery. I’ve been more aware of my words about pain and recovery regardless of their diagnosis (and is it time to stop the “Pain and Torture” joke? It does not help either the patient or our profession). I hope I can attend several other courses as well as get a copy of Explain Pain.
The second is an article entitled The Talking Cure for Healthcare that came out in the WSJ a week after I went to the course. It isn’t about PT specifically, but communication in a medical context. Poor communication “can hurt the quality of care, drive up costs and increase the risk of lawsuits. And under new Medicare rules, providers won’t get as much money if they rack up poor patient-satisfaction scores or too many preventable readmissions…Doctors are trained to ask permission to enter a room, introduce themselves and put patients at ease. And then they should be clear about how long an exam or procedure will take, when results will be back, what they are doing and why, what patients should expect and what the plan for the future is. Before leaving, they are expected to thank the patient and family and let them know it has been enjoyable to work with them.” Wow! I think I have good patient rapport and I explain what I am doing and why, but this article was a great reminder of how I could do things differently and what to be aware of when I am more focused on the task than the person. It is about them and their recovery.
The third is a research study that I had seen mentioned on Twitter but hadn’t had an opportunity to read it until the last week or so – Cognitive Treatment of Illness Perceptions in Patients With Chronic Low Back Pain: A Randomized Controlled Trial (April issue of PTJ). This post is not meant to examine the report in detail (although it appears to have “statistically significant and clinically relevant improvements in patient-relevant physical activities at 18 weeks.”). They wanted to see if addressing the patient’s perception about their symptoms would improve their activity limitations. The intervention had four phases – examining the illness perception, challenging the maladaptive perceptions, developing alternative perceptions, and testing/ confirming the new perceptions. What I found interesting is that rather than finding an anatomical cause of the pain and then doing manual therapy, exercise, or a modality, they spent time listening to the patient and dialoging about the problem, examining the person’s beliefs about the pain, and helping them to a new belief and testing it out, and that made a difference.
Now out of school for four years, I’m almost out of the “new professional” classification, and I have grown a lot (thanks in large part to the residency). In PT school we are taught how to take a good history – how long have you had the problem, what makes it better or worse, etc so that we are good clinicians upon graduation. For me, part of becoming a better clinician is seeing how our word choice can impact a patient both in recovery as well as their satisfaction with rehab as a whole. I’ve always had good rapport with my patients (well, most of them), but these publications about the importance of words have helped me further my “soft” clinical skills.