Announcement

Collapse
No announcement yet.

Chatting with the patient during therapy?

Collapse
X
  • Filter
  • Time
  • Show
Clear All
new posts

  • ??? Chatting with the patient during therapy?

    Hi everyone,

    as of right now I'm doing a placement in an office where there's a lot of work done with athletes and people who suffer from chronic pain.
    I had the chance to watch all of the therapists over the last five weeks doing their work – all of them quite experienced and seemingly successful. But there's something I've been wondering for a long time now:
    During therapy all of them are chitchatting a lot with their patients.Additionally, there's a radio in nearly every room, playing music.

    As I am not the smalltalk-guy (really, I don't know how that works - „Nice weather?“), I tend to be more quiet while doing therapy. Actually, though I'm normally kind of a cheerful guy, I'd rarely smile, but I try to concentrate on what I am doing when there's a patient in front of me.

    Also, I believe it to be a little distracting for the patient. Because the way I see it, the patient is supposed to concentrate as well. To feel, be aware, see and give me feedback. And how can he or she be aware of a certain spot, when there's always talking going on? And how am I supposed to communicate with their bodies, when - to speak figurally - all channels are blocked otherwise?

    I don't know if this is nitpicking – what do you think about it? Or how do you handle it?

    All the best
    thomas
    "What you believe is what you see. The label is the behavior. Concepts determine percepts." - Michael Shermer

    "God was never on your side" - Motörhead

  • #2
    If the patient initiates what seems to be chat,it is sometimes a useful gateway to whatever problem their neuroendocrine immune systems have failed to address to their satisfaction.

    My personal preference is for a clean warm room, no contrived smells and no music.

    Pan pipes,lapping waves,waterfalls and whale music make me want to go for a wee.
    Jo Bowyer
    Chartered Physiotherapist Registered Osteopath.
    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

    Comment


    • #3
      Music, lighting, clutter, clothing etc....all these things are noticed by the patient. And it affects them. To do it haphazardly is to do so at your own peril.

      Beyond that, I prefer a quite space, well lit, no music, free of clutter. Perhaps it's my Zen fetish, but I find something about minimalism sets me in the right frame of mind.

      Also, what Jo said.
      Dan
      Tactile Raconteur

      Comment


      • #4
        I found club music with a strong bass component very useful for fencing footwork sessions, it takes your mind off the discomfort. For strength training, heavy rock music helped me lift and push with more aggression.

        My skills based training with coaches and trainers were often cued with a movement of their blade and very little verbal.

        Instead of giving a detailed explanation to the patient,I cue them with touch and say "Try this" and then say "How's that" Their response determines what I say and do next.
        Last edited by Jo Bowyer; 08-11-2013, 10:21 AM.
        Jo Bowyer
        Chartered Physiotherapist Registered Osteopath.
        "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

        Comment


        • #5
          Originally posted by thomas_c View Post
          During therapy all of them are chitchatting a lot with their patients.Additionally, there's a radio in nearly every room, playing music.
          Who chooses what to listen to?

          Originally posted by thomas_c View Post
          As I am not the smalltalk-guy (really, I don't know how that works - „Nice weather?“), I tend to be more quiet while doing therapy. Actually, though I'm normally kind of a cheerful guy, I'd rarely smile, but I try to concentrate on what I am doing when there's a patient in front of me.
          There is more of you that speaks than your mouth. How you enter a room, where you stand in relation to the patient, eye-contact, the cadence, volume and tone of your speech, what you are wearing, how your hair is done...it is all part of the care that you provide. Someone can walk into a room and be the most affable personality and/or the life of the party, but that is not what the patient expects. Rather, the patient expects care. Don't mistake me, you can be that person and provide care, but you can also be successful being someone else altogether.

          A while back, I wrote that this type of clinician mindset is probably a built-in product of the college admission process that likely filters out the quiet and passes through the overly outgoing types...I am probably wrong about that.

          Originally posted by thomas_c View Post
          Also, I believe it to be a little distracting for the patient. Because the way I see it, the patient is supposed to concentrate as well. To feel, be aware, see and give me feedback. And how can he or she be aware of a certain spot, when there's always talking going on? And how am I supposed to communicate with their bodies, when - to speak figurally - all channels are blocked otherwise?
          Joe has been using the term "noise" lately, and I think we may have to borrow that from him as it makes complete sense in this context. What you seem to be hitting upon is the understanding of the soma- "the living body in its wholeness". Hanna says, "the soma is not a thing or objective body, but rather is a process. That is another reason for holding the word soma rather than body [when working with a patient]. The latter word suggests someting that is static and solid. The soma is neither static nor solid; it is changeable and supple and is constantly adapting to its environment [read: EVERYTHING]...[Additionally,] I realize that my body is not exactly a single body. I could also look at it as a collection of one-celled bodies. It is a soma made up of somas."

          You are on your way to being a dead man.

          Originally posted by thomas_c View Post
          How do you handle it?
          (1) They choose the music. And not from over-the-air stations...Pandora, Rhapsody, something like that where the patient begins to shape their environment in a way that is most comfortable to them. People are a lot more comfortable with your silence when they are listening to something else that are invested in.

          (2) Are they in an individual room? If so, how do they get back there? Is there natural lighting? If there is, I leave the lights off when they are brought back to the room and ask them later is they want to have the lights turned on (most prefer to avoid fluorescents, even if the room is "dusk-like". If there is no natural lighting a dimmer-switched halogen light provides a warmer environment with more control...again, I would have the room dimly lit when the patient is initially brought back to their space.

          (3) Get mesodermal posters off the wall...the direct conversation in directions that are often un-productive. Pull them out of the closet when you need them.

          (4) Re: persona - I try to match the patient's positivity and contradict their negativity...without being a cheerleader; sometimes I have to be a cheerleader anyway. For instance, I am working a with 40+-year-old refugee who speaks very little English, his wife won't let me use a translator because she says she is good enough to translate (she is mistaken), and he is bed-ridden after a 2 month hospitalization stay. He is depressed as he is only a shell of his former self...the only language that I can use with him is body language. I have pumped my fists in the air more in the last 2 weeks professionally than I have in 2 years personally. It is exhausting...but I am pretty sure he wouldn't be swinging his legs independently off the bed so soon if I haven't been trying to push him through (and out of) the fog.

          This, of course, is just a start. What works for me won't work for other therapists, and what works for some patients won't work for others. I cannot help but think, however, that if you are listening to the patient from the beginning, they tell you what they need. And like you, I have doubts that the "chatty-Cathys" in the clinic are establishing the optimal therapeutic alliance.

          But...the patient doesn't know any better when they consider what we do as a commodity, often without understanding that there is value in who we are.

          Respectfully,
          Keith
          Blog: Keith's Korner
          Twitter: @18mmPT

          Comment


          • #6
            Thomas,

            This is not nitpicking. It s a great point. IMO consant chatter is distracing and takes away from the treatment. The fact that you are quiet and don't chat is not a fault. It's how you interact with the patient. There will always be those patients that want an outgoing bubbly personality to talk about gossip etc. They'll seek out therapists that offer them this. Patients will also seek out what you have to offer as well. And, being a quiet reserved person myself, I think what we have to offer is more effective.

            Have you read this article that Diane provided?:

            http://articles.latimes.com/2013/apr...heory-20130407

            The patient being at the center of the rings. Your job as therapist is to listen. I think in our case, our job is to not talk about ourselves and personal lives with the patient. I think we should be offering an environment that allows the person at the center of the rings to talk and express themselves. Your job is to listen.
            Last edited by advantage1; 08-11-2013, 01:48 PM.
            Rob Willcott Physiotherapist

            Comment


            • #7
              Thanks for all the feedback. That really encouraged me. I guess my problem is that I want to be liked by my patients. But I guess I can't make anyone like me

              Originally posted by advantage1 View Post
              Have you read this article that Diane provided?:

              http://articles.latimes.com/2013/apr...heory-20130407
              Yes, I read that. And it immediately came to my mind yesterday: I was watching one of the therapists working with an older man, who is suffering from achilles tendonitis (or what is believed to be a tendonitis). He had been in pain every single step he took for the last five month - when finally, last week, we worked out some stuff and made progress. Meaning: He was able to walk painfree.
              So he came in the office, quite enjoyed about the improvement. And what was the first thing the therapist said, after examining the foot? "Yeah, it may feel better. But it still looks really, really bad!"

              And I was thinking: "Why in God's name are you telling him that? How is THAT going to help him?"
              Left me astounded about the insensitive behaviour of an otherwise experienced therapist!
              "What you believe is what you see. The label is the behavior. Concepts determine percepts." - Michael Shermer

              "God was never on your side" - Motörhead

              Comment


              • #8
                Thomas, I hate to be cynical, but there may a little thing like "maintaining caseload" on the mind of some PTs when things like that come out of their mouth.
                Or, of course I could be wrong and it is just ignorant interaction.

                Neither option is excusable.
                We don't see things as they are, we see things as WE are - Anais Nin

                I suppose it's easier to believe something than it is to understand it.
                Cmdr. Chris Hadfield on rise of poor / pseudo science

                Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

                We don't need a body to feel a body. Ronald Melzack

                Comment


                • #9
                  Yeah, it may feel better. But it still looks really, really bad!"
                  A nasty response from a therapist who does not know the first thing about pain or patient interaction. Very disturbing to have to hear that in front of others as well.

                  My preferred room ambience when I worked:

                  Low, non-fluorescent lighting;

                  low background music without lyrics or sudden changes in tempo;

                  no skeletons, muscles or innards posters; no useless plastic knees and shoulders;

                  no advertising of how wonderful PTs are (yes, in the clinic where I last worked, the entrance was covered with glossy photos of cheesy therapists with cheesy patients or pseudopatients - I removed them all and got into a bit of trouble over that!)

                  calm pictures of beaches or oceans on the floor under the treatment plinth hole;

                  no talking with the patient unless they initiated it first; certainly no talking about myself or family and friends!

                  And yes, our job is to listen and make sense of what we hear. It is not a tea party.

                  Nari

                  Comment


                  • #10
                    Originally posted by keithp View Post

                    (1) They choose the music. And not from over-the-air stations...Pandora, Rhapsody, something like that where the patient begins to shape their environment in a way that is most comfortable to them. People are a lot more comfortable with your silence when they are listening to something else that are invested in.
                    Regarding music: I know that everyone has thir own ideas about this. I honestly think that if one is going to have music in a room, it should not be over-the-air stations or with advertisements coming through.

                    When one has over-the-air stations, they don't have a clue what the next music that is going to pop up will be. A thoughtful content is key, in my opinion. Something that will flow properly.

                    I also think that one should know their music library well and find appropriate music for their clients/patients and if a client/patient doesn't like a style of music, we should be prepared to change it for them or turn it off.

                    That said, I do have a few clients/patients who prefer to bring their own music into a session. If it allows them the ability to relax, then I am willing to play it (except for rap... no rap music allowed). I worked in an office that actually played rap in the background (gives you an idea of my surroundings when I was working for others and trying to build a peaceful practice on my own ). Everyone that came there loved it . But, I am sorry, I just can't listen to it.



                    Originally posted by nari View Post
                    My preferred room ambience when I worked:

                    Low, non-fluorescent lighting;

                    low background music without lyrics or sudden changes in tempo;

                    no skeletons, muscles or innards posters; no useless plastic knees and shoulders;
                    Mine too.
                    C.O. ( gender: ) - LMT, BS(Anatomy), DC
                    Music Fog... pick a song to listen to... you can't go wrong.
                    Need relaxation samples for your office? I have made a Deep Relaxation Massage Music Pandora Station and have others that may also be useful - about 8 massage music stations and about 49 other nifty options.

                    Comment


                    • #11
                      Originally posted by nari View Post
                      My preferred room ambience when I worked:

                      Low, non-fluorescent lighting;

                      low background music without lyrics or sudden changes in tempo;

                      no skeletons, muscles or innards posters; no useless plastic knees and shoulders;
                      Alas, that is the exact opposite of every PT-office I've seen so far :sad:

                      Originally posted by nari View Post
                      no talking with the patient unless they initiated it first; certainly no talking about myself or family and friends!
                      That's how I handle it. The only time I start talking myself is when I feel the need to explain what or why I do certain things, or when I want to get feedback about what I do.
                      "What you believe is what you see. The label is the behavior. Concepts determine percepts." - Michael Shermer

                      "God was never on your side" - Motörhead

                      Comment


                      • #12
                        Thomas,
                        I am sure that most clinics/offices round the world are similar to those you've ever been in.

                        Most offices/clinics suggest the the PT is the Boss no matter how welcoming they are to patients. It is a meme that is also imbued in the minds of patients ever since they started kindergarten and had to obey the teacher at all times. (Parents are negotiable).

                        Nari

                        Comment


                        • #13
                          small talk anyone?
                          I prefer to engage the person a lot like Nari does, starting with mostly neutral aural ambience. Chat happens naturally as a result of patient curiosity, their history, what they want me to know and what I plan to do about it. Some are busting to talk and can't be stopped, although the word "relax" does wonders then.
                          Sometimes my patients are moved to explore the science of pain, though rarely to any great extent, in which case it is my job to know when to shut up and just get on with it.
                          I see no benefit from stiff formality, or the other extreme , glib matey pub talk.
                          Words make a difference to most however, not as a method that fixes anything, but as the answer to questions and the means to alloy effective treatment to understanding.
                          vox clamantis in deserto

                          Geoff Fisher
                          Physiotherapist

                          Comment


                          • #14
                            When one has over-the-air stations, they don't have a clue what the next music that is going to pop

                            When one has over-the-air stations, they don't have a clue what the next music that is going to pop up will be. A thoughtful content is key, in my opinion. Something that will flow properly.

                            I also think that one should know their music library well and find appropriate music for their clients/patients and if a client/patient doesn't like a style of music, we should be prepared to change it for them or turn it off.

                            Comment


                            • #15
                              I'm a therapist, not a hairdresser.

                              Comment

                              Previously entered content was automatically saved. Restore or Discard.
                              Auto-Saved
                              x
                              Insert: Thumbnail Small Medium Large Fullsize Remove  
                              x
                              x

                              Please enter the six letters or digits that appear in the image below.

                              Registration Image Refresh Image
                              Working...
                              X