DELIVERY
3.1 The Initial Appointment
Now that you understand the basic ideas behind what we do as therapists, it’s time to deliver this to our Patients!
The art of delivering health care (or any other service for that matter) is not something that is taught formally.
HOW we deliver our services to our Patients is crucial in establishing trust and rapport. If we are unable to deliver our services in a way that the Patient sees value and appreciates, they will inevitably drop off and not receive the care that they need.
How can we help people if they don’t show up to our agreed appointments? We can’t!
The biggest thing to establish upfront is the Patient’s goals – what do they actually want?
Most will say they want to “get out of pain” and “find out what is going on”. Now that’s all true and very important, but what is the deeper reason why they have shown up now?
A great question to ask in order to probe deeper is “why is that important to you?”
It may take a few goes, and eventually you will be able to understand exactly why a Patient has presented to you today. Remember, injuries take time to develop and they would have pain for weeks/months before showing up to your door. But why have they finally come in now? What function/emotion/task can they no longer do because of their current symptoms?
(Hint: the true reason why a client presents to you is due to an emotional reason)
The initial appointment is where it all begins – and sometimes where it all ends. It is imperative that we create an outstanding first impression if we are to help our Patients through their entire treatment plan.
There are 4 key steps that must be followed:
The art of delivering health care (or any other service for that matter) is not something that is taught formally.
HOW we deliver our services to our Patients is crucial in establishing trust and rapport. If we are unable to deliver our services in a way that the Patient sees value and appreciates, they will inevitably drop off and not receive the care that they need.
How can we help people if they don’t show up to our agreed appointments? We can’t!
The biggest thing to establish upfront is the Patient’s goals – what do they actually want?
Most will say they want to “get out of pain” and “find out what is going on”. Now that’s all true and very important, but what is the deeper reason why they have shown up now?
A great question to ask in order to probe deeper is “why is that important to you?”
It may take a few goes, and eventually you will be able to understand exactly why a Patient has presented to you today. Remember, injuries take time to develop and they would have pain for weeks/months before showing up to your door. But why have they finally come in now? What function/emotion/task can they no longer do because of their current symptoms?
(Hint: the true reason why a client presents to you is due to an emotional reason)
The initial appointment is where it all begins – and sometimes where it all ends. It is imperative that we create an outstanding first impression if we are to help our Patients through their entire treatment plan.
There are 4 key steps that must be followed:
- Build trust and rapport
- Greet the Patient with a smile and firm handshake (if appropriate). Introduce yourself by your first name/nickname and warmly welcome them into the treatment room.
- “How can I help you today?”
- Listen to their subjective history
- Set expectations for today's procedure
- Commence your objective examination and establish your working diagnosis
- Attain positive treatment effect to meaningful movement
- Establish their most meaningful movement/s or ADL that they are having difficulty performing (for example, bending down to pick up groceries; reaching above shoulder height; prolonged sitting/standing)
- Break down their meaningful movement/ADL into its constituent parts
- Eg. Reaching above head height consists of:
- Break down their meaningful movement/ADL into its constituent parts
- Establish their most meaningful movement/s or ADL that they are having difficulty performing (for example, bending down to pick up groceries; reaching above shoulder height; prolonged sitting/standing)
- Test each individual component and determine its restrictions and limitations – is it myofascial/joint/neural?
- Provide appropriate treatment
- Re-test their meaningful movement/ADL
- If you provided the right treatment, this will improve.
- If not, continue to provide treatment to another structure.
- Early follow-up
- Conclude the session by summarising today’s progress and outlining the importance of next session
- “You did so well! Today we found out that your pain/symptom is coming from [DIAGNOSIS AND/OR CONTRIBUTING FACTORS] and we managed to get you some relief. At our next session (in 1-2 days) we will confirm your diagnosis and create a treatment plan so we can get you to [HEALTH GOAL] ASAP. How does that sound?”
- Book in their follow-up session (or kindly ask our reception team to)
- Thank them for their time and that you are looking forward to your next session with them
3.2 Follow-Up Appointment
In the follow-up appointment, it is crucial to deliver the client’s diagnosis and their treatment plan clearly and effectively. Bulk booking should logically follow.
In this appointment, there are 4 key steps:
In this appointment, there are 4 key steps:
- Continue to build trust and rapport
- Greet them warmly and tell them how good it is to see them again
- Review treatment response
- Establish their response to treatment.
- Are they feeling better? Great!
- Were they sore after treatment? That’s okay – this is a normal response after treatment which should only last 1-2 days at most, but in today’s treatment we’ll go a little softer just in case.
- Are they feeling worse? Great! Confirm that it is actually their condition that is worse (not post-treatment soreness) and if it is, tell them that this gives us more information to work with. Did they perform any aggravating tasks? Did they listen to your recommendations? Is there anything else that may have caused this to happen? We are simply trying to figure out what has happened – it’s not a blame game.
- Establish their response to treatment.
- Provide diagnosis and deliver treatment plan
- Pre-fill the Treatment Action Plan template before your session
- During the start of the session, clearly explain the treatment plan and expected prognosis including:
- How long it will take for recovery (Timeframe)
- Frequency of sessions
- What type of treatment will be provided
- What equipment they may need
- Any additional factors affecting their recovery
- “From what you’re telling me, it sounds like you have [DIAGNOSIS] which is great because now we know what we’re dealing with! To get it fixed up and for you to reach your [HEALTH GOAL] it will take [TIMEFRAME] where you’ll need to come in [FREQUENCY]. During these sessions we will be doing [TYPE] and you’ll need to buy [EQUIPMENT] to get the best results (we sell them if they don’t have it). [ADDRESS ANY ADDITIONAL FACTORS]. Do you have any questions at all?”
- Bulk bookings
- Get agreement with your client for their Treatment Action Plan by ensuring both therapist and client sign at the bottom of the page
- Make a scan of their Treatment Action Plan and attach a copy to their Files on Cliniko. Give them the physical copy to take home and study.
- Book in all of their sessions in advance so you can guarantee their appointment times.
- “What we need to do now is to book all of your appointments in over the next two weeks. We do this in advance because I’m always busy and I want to make sure that these times are available for you. If you need to change any appointments, please call us with at least 24 hours’ notice to avoid a cancellation charge.”
- Conclude the session by summarising today’s progress and outlining the importance of next session
- “You did great today [FIRST NAME]. Today we managed to reduce your pain by half, and increase your arm motion by 30 degrees! We will continue to get your shoulder moving more at our next session on [DATE]”
3.21 Delivering a Clear Diagnosis
Being an outstanding therapist involves delivering a clear diagnosis to your client in a way that both parties can easily understand it. This can be challenging as it requires high levels of clinical competency and good communication skills.
The following structure should be used when delivering the client’s diagnosis in your follow up session:
The following structure should be used when delivering the client’s diagnosis in your follow up session:
- Pathological diagnosis – what is the actual pathology (if present)? This is determined by using your clinical experience and orthopaedic testing
- Biomechanical diagnosis – what are the biomechanical faults that are leading to overload of the affected region and causing a pathology/tissue lesion?
- Contributing factors – what are the lifestyle/medical factors that is leading to poor biomechanics or tissue overload
|
Pathological Diagnosis
Supraspinatus tear (Grade 1) Protracted/winging scapula with dyskinesia (poor upward rotation) |
Biomechanical Diagnosis
Thoracic kyphosis and ribcage stiffness Sedentary lifestyle with prolonged sitting at desk job |
Contributing Factors
Highly stressed leading to poor breathing patterns |
3.22 Delivering the Treatment Action Plan
Your client’s Treatment Action Plan is perhaps the single most-important document. It is the document that outlines exactly what you and your client will be doing over the 4-8 week period (or longer) that you’ll be working together.
It is imperative that you give adequate emphasis and importance to this Plan:
It is imperative that you give adequate emphasis and importance to this Plan:
- Fill out Name, Date, Therapist, Diagnosis, Specific Goal
- Tick Desired Outcomes and Expected Recovery Time
- Highlight Treatment Modalities required in the Treatment Action Plan
- Indicate any Equipment Required
- Indicate Number of Sessions required:
- [Relief Phase] XXX Sessions Per Week for XXX Weeks, then
- [Recovery Phase] XXX Sessions Per Week for XXX Weeks.
- Fill Reassessment Date
- Client to fill Name, Signature and Date.
- Therapist to Counter-Sign next to Client’s Signature to indicate joint commitment to the Treatment Action Plan.
3.3 Subsequent Appointments
Each subsequent appointment is an opportunity to continue to build your rapport and continue to deliver outstanding results for your client. With each treatment session, the client should be moving closer and closer to their goals.
The structure of each subsequent appointment shares similarity to the follow-up appointment:
The structure of each subsequent appointment shares similarity to the follow-up appointment:
- Continue to build rapport and trust
- Greet them warmly and tell them how good it is to see them again
- Ask them about a recent experience/event/etc. that they were excited about at your last session.
- Greet them warmly and tell them how good it is to see them again
- Review treatment response
- Establish their response to treatment:
- Better? Same? Worse?
- What does this information tell you? Is it still consistent with your original working diagnosis?
- Better? Same? Worse?
- Establish their response to treatment:
- Provide appropriate and effective treatment
- Establish their most meaningful movement/s or ADL that they are having difficulty performing (for example, bending down to pick up groceries; reaching above shoulder height; prolonged sitting/standing)
- Break down their meaningful movement/ADL into its constituent parts
- Test each individual component and determine its restrictions and limitations – is it myofascial/joint/neural?
- Provide appropriate treatment
- Re-test their meaningful movement/ADL
- If you provided the right treatment, this will improve.
- If not, continue to provide treatment to another structure
- If you provided the right treatment, this will improve.
- Break down their meaningful movement/ADL into its constituent parts
- Establish their most meaningful movement/s or ADL that they are having difficulty performing (for example, bending down to pick up groceries; reaching above shoulder height; prolonged sitting/standing)
- Conclude the session by summarising today’s progress and outlining the importance of next session
- “Awesome job once again [FIRST NAME]! Today we got your pain down to only 3-4/10 and your arm is almost moving through full range! We will aim to get you pain-free and start on some shoulder stretches at our next session on [DATE]”
- “Awesome job once again [FIRST NAME]! Today we got your pain down to only 3-4/10 and your arm is almost moving through full range! We will aim to get you pain-free and start on some shoulder stretches at our next session on [DATE]”
3.4 High Performance Booking Strategy
Every good therapist needs to know how to assess, diagnose and successfully treat a client’s condition. They need to know the basics of anatomy and pathophysiology – that’s a given.
But not every good therapist is successful.
The two biggest differences between a good therapist and a successful therapist are:
The most effective way to book clients are in “Blocks” of time (in “Relief Phase” and “Recovery Phase”). There are 4 key stages of the therapist-client relationship as outlined below:
1. Initial Appointment to Follow Up Appointment:
2. Relief Phase:
3. Recovery Phase:
4. Performance/Maintenance Phase:
CONSOLIDATION:
But not every good therapist is successful.
The two biggest differences between a good therapist and a successful therapist are:
- Effective communication skills, and
- A high-performance booking strategy.
The most effective way to book clients are in “Blocks” of time (in “Relief Phase” and “Recovery Phase”). There are 4 key stages of the therapist-client relationship as outlined below:
1. Initial Appointment to Follow Up Appointment:
- Ensure you complete the Big 4 Steps during your Initial Assessment:
- Generate trust and rapport
- Outline procedures for today’s session:
- Comprehensive assessment to determine their pain/diagnosis
- An outline of their contributing factors and WHY their pain/symptom is present
- Provide treatment to get immediate relief today
- Necessity for early follow up
- Comprehensive assessment to determine their pain/diagnosis
- Provide clear diagnosis and good treatment effect
- Early follow-up appointment scheduled within the next 3 days
- Generate trust and rapport
2. Relief Phase:
- Duration – typically 2-3 weeks after your Initial Assessment (can be longer)
- Booking frequency – 2-3 sessions per week
- Reason – to settle down the injured site and relieve the client of pain and stiffness
- Focus – manual therapy to provide symptom relief (resolve pain and inflammation) and restore full range of motion
- Graduation criteria – only when their symptoms are stabilised (>90%) resolved are we permitted to enter Phase 2. If symptoms are not stabilised, continue to book 2-3 sessions per week until it does!
- If a client doesn’t complete this stage, then their pain/symptoms are likely to persist and continue to be an ongoing problem.
3. Recovery Phase:
- Duration – typically 2-3 weeks after graduating from Phase 1
- Booking frequency – 1-2 sessions per week
- Reason – to stabilise symptoms and ensure that the client’s problem doesn’t come back again
- Focus – basic manual therapy; focus on exercise strengthening and rehab to restore basic activation, motor control, strength and endurance in the affected area and surrounding regions.
- Graduation criteria – full resolution of all symptoms after weaning down treatment frequency to 1 session/fortnight for 2 consecutive fortnights
- If a client doesn’t complete this stage, although they will currently be pain-free, the root cause of their symptoms hasn’t been properly addressed. Therefore their same symptoms are likely to recur and/or lead to compensations to another body region.
4. Performance/Maintenance Phase:
- Duration – ongoing
- Booking frequency – 1 session every 4-6 weeks
- Reason – ensure problem remains solved; control any niggles that may arise from pre-existing issue; treat and manage any new injuries and prevent them from developing into larger problem.
- Focus – manual therapy for symptom relief (if required); assess and treat new injuries if necessary; continue high-level exercise rehab and strengthening.
CONSOLIDATION:
- Explain the benefits and importance of the Relief Phase Treatment Plan to your client
- When can your client graduate from the Relief Phase Treatment Plan? What would you do if their symptoms persist longer than anticipated?
- Explain the benefits and importance of the Recovery Phase Treatment Plan to your client
- When can your client graduate from the Recovery Phase Treatment Plan?
- Explain the benefits and importance of the Performance/Maintenance Phase to your client
3.5 Client Follow Up Calls
Follow up calls are made at 3 key stages:
It is also to continue to build long-term relationships with your clients should they (or their friends and family) require your services in the future.
The procedure is outlined below:
These calls are crucial for building long-term relationships with your clients. They will feel special, cared-for and important – can you imagine how good you would feel if your advisor/teacher/doctor called you out of the blue just to check up on you??
- After the Initial Appointment and before the Follow Up Appointment*
- 1 month after a client has been discharged
- 3 months after a client has been discharged
It is also to continue to build long-term relationships with your clients should they (or their friends and family) require your services in the future.
The procedure is outlined below:
- Identify appropriate clients by using Cliniko Reports > Patients Without Upcoming Appointments > Last Appointment Date (over last 3 months).
- Call each client while standing:
- Lift your energy and be excited to speak with your previous client again:
- “Hey there [FIRST NAME]! It’s Lawrence from Activ Therapy, how are you going? I’m just calling to check up on you and make sure everything is 100% with your [CONDITION].”
- If you cannot reach your client, send an email with the basic template above.
- Lift your energy and be excited to speak with your previous client again:
- Listen to their response – are they back to 100% or is there more that you can do for your client?
- Do they still have any pain?
- Do they have any joint stiffness in relevant body regions?
- Can they perform all of their daily activities without any discomfort?
- Are they back to their peak performance for their sport or at the gym?
- Do they have ideal technique and motor control?
- If they are 100%:
- “I’m so glad to hear that [FIRST NAME]! Thank you for putting in the hard work and continuing with your program. If you or your family or friends need my help in the future, feel free to give me a call!”
- Send a brief email immediately after to thank them for their time and effort, and welcome them to contact you if in need. End procedure here and move on to your next client.
- If they are not 100%:
- Listen to their story – why do they feel they are not 100% yet? What is it that they still can’t do?
- Take a “Modified Subjective History” of their symptom quality, current presentation, aggravating and easing factors.
- “It sounds like you may have [CONDITION] but I can’t be sure without a proper assessment…”
- “I’ve had cases like this before and typically it responds very well to hands-on treatment”
- Take action:
- If you have performed the above correctly, the next logical step is for the client to ask you if you have any appointments available. In that case, make a booking at the earliest available time slot.
- If they do not request an appointment, gently ask them:
- “What should we do from here [FIRST NAME]?”
- This is a guiding question towards the logical conclusion of rebooking an appointment to get their problem fixed
These calls are crucial for building long-term relationships with your clients. They will feel special, cared-for and important – can you imagine how good you would feel if your advisor/teacher/doctor called you out of the blue just to check up on you??
3.6 Receiving Handovers
Activ Therapy is a multi-disciplinary and holistic practice. Treatment modalities between disciplines and practitioners are integrated to ensure we offer a complete solution to the issues preventing our clients from living a full and healthy life.
Our goal is to address the many environmental and physical factors that place stresses on the body during sport, work and daily life. To achieve this, we aim to achieve a comfortable and professional experience for all Patients within our care.
A key part in delivering this is to ensure that when a Patient’s care moves from one practitioner to another, it is done intentionally and with the Patient fully understanding the benefits.
The most important aspect of handing over and receiving Patients is that it is a two-way interaction:
Handing Over:
“I will be organising an appointment with you with [RECEIVING THERAPIST], he is a gun and very good with [PATIENT’S CONDITION]. We always try and get more than one person involved to get the very best clinical outcome for you.
[RECEIVING THERAPIST] is our [PATIENT’S CONDITION] guy. He will have a look at you from a different perspective and introduce some new treatment concepts to really boost your recovery.”
Receiving the Handover:
“Hi [PATIENT’s NAME], I’m [THERAPIST’S NAME] and I’m really looking forward to helping you to get better.
I’ve spoken with [HANDING OVER THERAPIST] and we have had a meeting about you. What I will do is assess you and see what is going on to help you get an excellent result. Is that OK?”
“Now [handing-over practitioner] explained to me that you have [Patient’s condition] and have been doing [progress to date]. Today I want to take a look at [focus for the session]”
Action: Therapist assesses the Patient.
“Actually I’ve found an anomaly. Let’s get started and assess it further. I’m going to need to add an extra technique to your treatment plan”.
Action: Perform palpation/treatment as required.
Our goal is to address the many environmental and physical factors that place stresses on the body during sport, work and daily life. To achieve this, we aim to achieve a comfortable and professional experience for all Patients within our care.
A key part in delivering this is to ensure that when a Patient’s care moves from one practitioner to another, it is done intentionally and with the Patient fully understanding the benefits.
The most important aspect of handing over and receiving Patients is that it is a two-way interaction:
- The Handing Therapist over needs to provide information to the Patient and the receiving therapist, AND
- The Receiving Therapist must also accept the referral the right way so that the Patient feels comfortable and the treatment plan continues seamlessly.
Handing Over:
- Introduce the concept of a multidisciplinary team early in the treatment plan. Preferably at the follow up (2nd) session.
- Introduce the receiving practitioner to the Patient personally if possible.
- Ensure a detailed handover is provided so that the receiving practitioner understands the case.
“I will be organising an appointment with you with [RECEIVING THERAPIST], he is a gun and very good with [PATIENT’S CONDITION]. We always try and get more than one person involved to get the very best clinical outcome for you.
[RECEIVING THERAPIST] is our [PATIENT’S CONDITION] guy. He will have a look at you from a different perspective and introduce some new treatment concepts to really boost your recovery.”
Receiving the Handover:
- Be enthusiastic and friendly
- Shake their hand and be different. Make them feel special and important, and not like just another person.
- Read the handover provided and ensure you understand the Patient’s situation.
- Make a follow up phone call the next day.
- Assess something new. It is important to provide a new investigation and perspective to demonstrate value in the handover.
- Provide something different. As with performing a different assessment, providing a new treatment will allow you to demonstrate value in the handover and avoid unnecessary overlap between practitioners.
“Hi [PATIENT’s NAME], I’m [THERAPIST’S NAME] and I’m really looking forward to helping you to get better.
I’ve spoken with [HANDING OVER THERAPIST] and we have had a meeting about you. What I will do is assess you and see what is going on to help you get an excellent result. Is that OK?”
“Now [handing-over practitioner] explained to me that you have [Patient’s condition] and have been doing [progress to date]. Today I want to take a look at [focus for the session]”
Action: Therapist assesses the Patient.
“Actually I’ve found an anomaly. Let’s get started and assess it further. I’m going to need to add an extra technique to your treatment plan”.
Action: Perform palpation/treatment as required.
3.7 Effective Communication 101
Having excellent communication is essential when working with your clients so that you can extract the correct and relevant information about their condition.
It is an art to find out useful information, communicate your professional findings to them, and at the same time discard information that has little relevance to their condition.
“Effective communication is the bridge between confusion and clarity”
Here are some basics of communication that will help you understand your client at a much deeper level:
Ask Good Questions
Know exactly what you really want the answers to – what is the true purpose behind your questioning?
It should be so that you can figure out the best way to help them. Make sure you are asking questions only if they are relevant.
To do that we need to know:
By avoiding “Yes/No” questions, you will be able to gain a lot more information much more quickly from your client regarding their condition, motivations and goals.
Tailor your questions to find only information that is relevant to their condition and how you can best help them
The easiest and most efficient way to do this is to ask open-ended questions:
The more you talk, the less you listen. And the less you listen, the less information you get. Your aim is to understand where they are coming from and the exact nature of their condition.
After you ask your open-ended question, actively listen to their responses and what that means for your diagnosis. What they say will then guide your questioning so that you can dive deeper and seek a clearer understanding of exactly what’s happening with their condition.
For example, if they describe their pain as “shooting” and “radiating”, you should be thinking “nerve pain”. But where is it coming from? Is it a spinal nerve or a peripheral nerve? When does it flare up?
So what you might ask to gain the right information is:
Avoid the urge to interrupt their responses unless they are veering off track and giving you irrelevant information. In that case, learn to use re-directing questions to keep them on track such as “That’s very interesting – how does that relate to your condition?”
Your role is to guide them so that they can tell you the right answers.
Clarify Mutual Understanding
Communication is a two-way street: it is an interaction between two (or more) individuals, not a one-way lecture.
That’s why it is crucial to check their understanding frequently and ensure both parties are on the same page.
Some ways to help with this are “Check-in Questions”:
If you want to get absolute satisfaction and compliance with your clients, here’s the secret – you need to make them feel like they “came up with the idea/solution” all by themselves, even though it was you who guided them towards it.
Remember: “When you say something, it means one thing… But when the client says something, it means everything.”
Create Buy-In to Grab Attention
“What’s in it for me? (WIIFM)”
That’s the question that is always running through people’s minds when they are making decisions.
If you can’t clearly communicate the benefits of your expertise for them, then they are much less likely to pay attention to what you have to say.
To be a master communicator, you need to be able to capture and hold your client’s attention so that they can receive your message. The quickest way to do this is to create buy-in from them by delivering perceived value – of course, this is different for each person, however your clients will fit into three broad categories:
Low Motivation/Short-term results:
When clients come in and see you, they just want to get out of pain and make sure the problem goes away, right?
Wrong.
Don’t assume you know what they want. Instead, clarify.
Ask them open questions like:
Meet Them at Their Level
Effective communication has 3 components:
You need to communicate based on their level of understanding:
You may have heard of Dr Albert Mehrabian’s 7-38-55 Rule which says that our personal communication is made up of:
What will give you a better understanding of what your clients are really saying can be interpreted by paying attention to their body language:
It is an art to find out useful information, communicate your professional findings to them, and at the same time discard information that has little relevance to their condition.
“Effective communication is the bridge between confusion and clarity”
Here are some basics of communication that will help you understand your client at a much deeper level:
Ask Good Questions
Know exactly what you really want the answers to – what is the true purpose behind your questioning?
It should be so that you can figure out the best way to help them. Make sure you are asking questions only if they are relevant.
To do that we need to know:
- Exactly what is the client’s main pain/discomfort/symptom including its quality, behaviour and aggravating/easing factors so that you can provide the most effective treatment to gain results.
- What are your client’s goals and why are they so important to them? This is so we can provide the most appropriate treatment plan for them as well as keeping them motivated and accountable to their health goal.
By avoiding “Yes/No” questions, you will be able to gain a lot more information much more quickly from your client regarding their condition, motivations and goals.
Tailor your questions to find only information that is relevant to their condition and how you can best help them
The easiest and most efficient way to do this is to ask open-ended questions:
- Exactly how can I help you today?
- Why do you think it's occurring? Are there any patterns to it getting better or worse?
- What have you done to help? Is it working?
- What is it stopping you from doing in your everyday life? How does it get in the way?
- What is the ideal outcome for you? Are you looking for pain relief only, or are you looking for a long term solution to fix your pain for good? Why is it important to you?
The more you talk, the less you listen. And the less you listen, the less information you get. Your aim is to understand where they are coming from and the exact nature of their condition.
After you ask your open-ended question, actively listen to their responses and what that means for your diagnosis. What they say will then guide your questioning so that you can dive deeper and seek a clearer understanding of exactly what’s happening with their condition.
For example, if they describe their pain as “shooting” and “radiating”, you should be thinking “nerve pain”. But where is it coming from? Is it a spinal nerve or a peripheral nerve? When does it flare up?
So what you might ask to gain the right information is:
- “Okay it sounds like nerve pain… can you trace the exact area that it’s radiating to?”
- “What movements or activities make it better or worse?”
Avoid the urge to interrupt their responses unless they are veering off track and giving you irrelevant information. In that case, learn to use re-directing questions to keep them on track such as “That’s very interesting – how does that relate to your condition?”
Your role is to guide them so that they can tell you the right answers.
Clarify Mutual Understanding
Communication is a two-way street: it is an interaction between two (or more) individuals, not a one-way lecture.
That’s why it is crucial to check their understanding frequently and ensure both parties are on the same page.
Some ways to help with this are “Check-in Questions”:
- “Does that make sense to you?”
- “What do you think about that?”
- “What I’m hearing is … Is that correct?”
If you want to get absolute satisfaction and compliance with your clients, here’s the secret – you need to make them feel like they “came up with the idea/solution” all by themselves, even though it was you who guided them towards it.
Remember: “When you say something, it means one thing… But when the client says something, it means everything.”
Create Buy-In to Grab Attention
“What’s in it for me? (WIIFM)”
That’s the question that is always running through people’s minds when they are making decisions.
If you can’t clearly communicate the benefits of your expertise for them, then they are much less likely to pay attention to what you have to say.
To be a master communicator, you need to be able to capture and hold your client’s attention so that they can receive your message. The quickest way to do this is to create buy-in from them by delivering perceived value – of course, this is different for each person, however your clients will fit into three broad categories:
Low Motivation/Short-term results:
- Typically want symptom/pain relief only and not looking for longer term outcomes
- Usually very demanding and claims to want to improve their health, yet their actions speak the opposite.
- Required approach:
- More hands-on treatment for symptomatic relief
- Less education
- 1-2 exercises for symptom relief
- Wants a long delay in between treatment sessions; primarily motivated to avoid pain/symptoms and disinterested in prevention.
- Wants symptomatic relief and ideally long-term outcomes, but doesn’t understand what is possible.
- Usually very reasonable
- Required approach
- More education
- Hands-on treatment for symptomatic relief
- 1-2 exercises for long-term results and self-management
- Happy to adhere to a professional’s treatment plan if they see the right results
- Is tired of just symptomatic relief and wants long-term results and fix the problem; will not complain about pain/symptoms and willing to do whatever it takes to get results.
- Very enthusiastic and self-motivated
- Required approach:
- Education as requested
- Hands-on treatment to address the root cause
- 2-3 exercises to fix the problem
- Wants more frequent sessions so they can get results faster
When clients come in and see you, they just want to get out of pain and make sure the problem goes away, right?
Wrong.
Don’t assume you know what they want. Instead, clarify.
Ask them open questions like:
- “So tell me, what is the biggest reason why you’re here? Why is it important to you?”
- “What would you like to achieve by working together?”
- “Describe what your “best life” looks like”
Meet Them at Their Level
Effective communication has 3 components:
- Message Sent
- Message Received
- Message Acted Upon
You need to communicate based on their level of understanding:
- Low
- Speak in very basic language and use colloquial and vague terms to communicate ideas and concepts
- For example: “Your shoulder isn’t moving well and is being pinched which is why you have pain”
- Average
- Avoid the use of jargon and use layman’s terms and/or metaphors
- For example: “You have shoulder impingement stemming from shoulder-blade stiffness, and that’s causing your pinching pain”
- High
- Use jargon and technical terms as appropriate
- For example: “Your shoulder impingement stems from scapular dyskinesia, which is also why you have sub-acromial bursitis and pain in the front of your shoulder”
You may have heard of Dr Albert Mehrabian’s 7-38-55 Rule which says that our personal communication is made up of:
- 7% spoken words
- 38% tonality
- 55% body language
What will give you a better understanding of what your clients are really saying can be interpreted by paying attention to their body language:
- Proximity
- Generally speaking, a smaller distance between you and your client indicates heightened rapport.
- An attempt by your client to close distance can indicate that they are comfortable and trust your judgement
- However, an attempt to increase distance indicates that they are uncomfortable or uncertain. In this case you should:
- Maintain boundaries
- Ask them relevant questions to find out more about their condition/situation (“Can you tell me more about your shoulder? What makes it better? What makes it worse?”)
- Inform them of any procedures and why they are beneficial (“Today we need to do some tests to figure out exactly what is happening with your shoulder and how I can help you best”)
- Ask for consent to proceed (“Is that okay with you? Do you have any questions before we start?”)
- Body Position
- The arms act as a block between the body and the external environment: crossed arms plus withdrawal may indicate discomfort/disinterest.
- The direction of where the feet are pointing indicates intention – if they are faced towards you, then you have their attention. If they are facing away from you, then they are disengaged.
- Head movement will also give you a clue to what the other person is actually saying – “approach” movements (such as nodding) tend to indicate agreement and understanding, whereas “withdrawal” movements (such as retraction or tilting backwards) may indicate suspicious and disagreement.
3.8 Rock-Solid Rapport Building
Building great rapport with your client is essential to creating a successful therapeutic alliance. This has its many benefits including:
Be Well Groomed
There are two chances to make a first impression:
Imagine walking into a store that sells luxury items (Louis Vuitton, Hermes, Mercedes-Benz, Rolex… take your pick) which cost thousands of dollars. How are you greeted? How are the sales consultants groomed? What attire are they wearing? How do they smell?
People who look good are already perceived as more competent, even before any words are spoken. For this reason, you should:
The second chance to make a first impression is how you greet your client for the first time. This process is extremely quick and only takes a few seconds for your client to make a decision if they are comfortable with you or not!
The best way to make a great first impression is:
“Hi there, my name is [YOUR NAME]. What’s yours? …”
“It’s great to meet you [CLIENT’S NAME]! How did you find out about us? …“
“So you’re seeing [THERAPIST] today, is that correct? …”
“Fantastic! [THERAPIST] is great so you’re in great hands!”
Discover Two Commonalities
Humans are geared for survival and therefore hard-wired to sense danger in unfamiliar situations. This includes meeting someone for the first time, so it’s very important to develop trust in order with each client at your first meeting.
Being able to share two commonalities allows your client to “let their guard down”. It changes the interaction from “strictly professional” one that is more relaxed, allowing the client to be more comfortable and hence share more information about themselves.
Some topics you can share commonalities in include:
People don’t remember what you do – they remember how you made them feel.
If you welcomed a client and made them feel safe and good about themselves, chances are that they would enjoy coming back to see you again. The opposite is also true – if you treated them poorly and they felt coldness and distance, they definitely would not come back to see you!
Sharing a laugh with your client promotes warmth and is a great way for you to develop a connection with your clients. Being positive and enthusiastic, and being interested in what your client is saying can make all the difference in creating good rapport with them.
You should also look for something that you admire about the other person, however big or small it may be. If you are able to give them a compliment, this would help to further increase your rapport with them (but only if it is genuine!)
Use Touch to Build Trust
Using touch with a client can be a very powerful way to build trust and rapport, but only when used correctly and appropriately.
If there is adequate rapport and touch is warranted, some examples of appropriate touch include:
Remember that many people do not actually like being touched so there MUST be good rapport built beforehand, otherwise it can be viewed as inappropriate (and potentially result in legal action).
Obvious signs that touch is unwanted include:
CONSOLIDATION:
- Improved response to treatment
- Improved client compliance
- Reduced client drop-off rates
- Higher client satisfaction
- Greater enjoyment and job satisfaction by the therapist
Be Well Groomed
There are two chances to make a first impression:
- When someone looks at you
- When you open your mouth to speak
Imagine walking into a store that sells luxury items (Louis Vuitton, Hermes, Mercedes-Benz, Rolex… take your pick) which cost thousands of dollars. How are you greeted? How are the sales consultants groomed? What attire are they wearing? How do they smell?
People who look good are already perceived as more competent, even before any words are spoken. For this reason, you should:
- Brush your teeth each morning
- Make sure your hair is always well-groomed each morning before you leave the house
- Wear perfume/cologne (1-2 sprays is enough) to make sure you smell fresh when working with your clients
- Dress smartly with well-fitted pants, dark-coloured shoes and a plain watch.
- Hold a tall posture and keep your gaze around eye-level or slightly higher for most scenarios
The second chance to make a first impression is how you greet your client for the first time. This process is extremely quick and only takes a few seconds for your client to make a decision if they are comfortable with you or not!
The best way to make a great first impression is:
- Lift up your energy and enthusiasm
- Smile, then shake their hand while matching their grip.
- Introduce yourself
- Ask for their name, and confirm their name immediately.
“Hi there, my name is [YOUR NAME]. What’s yours? …”
“It’s great to meet you [CLIENT’S NAME]! How did you find out about us? …“
“So you’re seeing [THERAPIST] today, is that correct? …”
“Fantastic! [THERAPIST] is great so you’re in great hands!”
Discover Two Commonalities
Humans are geared for survival and therefore hard-wired to sense danger in unfamiliar situations. This includes meeting someone for the first time, so it’s very important to develop trust in order with each client at your first meeting.
Being able to share two commonalities allows your client to “let their guard down”. It changes the interaction from “strictly professional” one that is more relaxed, allowing the client to be more comfortable and hence share more information about themselves.
Some topics you can share commonalities in include:
- Sport and sporting teams such as basketball, golf, cricket.
- Fashion brands, including shoes, jackets and hats.
- Food
- Cars
- Movies and TV shows
- Music
- Travel
- Kids
- Hobbies
People don’t remember what you do – they remember how you made them feel.
If you welcomed a client and made them feel safe and good about themselves, chances are that they would enjoy coming back to see you again. The opposite is also true – if you treated them poorly and they felt coldness and distance, they definitely would not come back to see you!
Sharing a laugh with your client promotes warmth and is a great way for you to develop a connection with your clients. Being positive and enthusiastic, and being interested in what your client is saying can make all the difference in creating good rapport with them.
You should also look for something that you admire about the other person, however big or small it may be. If you are able to give them a compliment, this would help to further increase your rapport with them (but only if it is genuine!)
Use Touch to Build Trust
Using touch with a client can be a very powerful way to build trust and rapport, but only when used correctly and appropriately.
If there is adequate rapport and touch is warranted, some examples of appropriate touch include:
- A pat on the upper back (not neck or head)
- A pat on the upper arm/deltoid region
- A High-Five or fist-bump
Remember that many people do not actually like being touched so there MUST be good rapport built beforehand, otherwise it can be viewed as inappropriate (and potentially result in legal action).
Obvious signs that touch is unwanted include:
- Withdrawal or flinching away from the outstretched hand
- Shuddering
- Raising of the arms over the face/torso (protective mechanism)
CONSOLIDATION:
- Out of 10, how would you currently rate your rapport-building skills?
- Which techniques are you currently using to build rapport? Which techniques aren’t you using?
- What are the 3 ways that you will improve your rapport-building skills?
3.9 Power Language
When communicating with your Patients using the right language is one of the most important things that separates a confident and respected practitioner from the rest of the pack.
Using power language is about structuring your sentences and using words that are clear and get straight to the point. If you are not using power language, you are not the best practitioner you can be.
A practitioner that uses power language:
So what is “Power Language”?
DO NOT make comments like:
Note how the above statements are general in nature, vague, passive and promote uncertainty. If your trusted advisor said this to you, how would you feel about their competence?
You SHOULD make comments like:
Note how these statements compare to the previous ones. These statements are clear and direct, specific, and promote certainty. If your trusted advisor used power language, how would you feel about their competence?
What To Say When Recommending The Needed Visits For The Patient At The End Of Their Consultation:
Using power language is about structuring your sentences and using words that are clear and get straight to the point. If you are not using power language, you are not the best practitioner you can be.
A practitioner that uses power language:
- Shows confidence in themselves
- Shows confidence in their message
- Delivers a clear message
- Improves compliance in their Patients
So what is “Power Language”?
- Communication that is clear and definitive. It includes words like “must”, “need” and “will”. It also utilises specific instructions/timeframes for times, dates, places, numbers and recommendations.
- It is NOT communication that is general in nature, unclear or vague, or open to interpretation. It does NOT include words like “maybe”, “may”, “a couple”, “a few”, “suggest”, “a bit”. It does NOT involve general time frames, vague recommendations and ballpark numbers.
DO NOT make comments like:
- “I’d like to see you…”
- “You might need a couple of goes…”
- “Maybe we can check it after that…”
- “What I’m thinking is that…”
- “What I’m going to suggest is another session…”
- “So, do you feel you need to come back at this stage…”
- “Give me a ring in 2 weeks if it is still a bit sore…”
- “Just make an appt. for next week & if you feel OK just ring & cancel it…”
Note how the above statements are general in nature, vague, passive and promote uncertainty. If your trusted advisor said this to you, how would you feel about their competence?
You SHOULD make comments like:
- “You need to get treated twice for the next 2 weeks…”
- “You will need to get that checked on Monday or Tuesday next week at the latest…”
- “You need to make an appointment in 2 weeks to assess how you are going…”
- “You are not 100% yet so you need to book back in a week…”
Note how these statements compare to the previous ones. These statements are clear and direct, specific, and promote certainty. If your trusted advisor used power language, how would you feel about their competence?
What To Say When Recommending The Needed Visits For The Patient At The End Of Their Consultation:
- Mrs. Jones you need to come back…
- Mrs. Jones the tests performed today indicate that you require…
- Mrs. Jones the clinical impression tells me that your next appointment needs to be scheduled for…
- Mrs. Jones to get the best results in your case schedule your next appointment for…
- Mrs. Jones how you are progressing tells me that to continue to progress your case you will need to be seen…
- Mrs. Jones my clinical experience tells me that you need to be seen next on…
- Mrs. Jones the latest research on your condition tells us that to get the best results you are required to…
