Assessment And Reading Your Patient
I think it’s safe to say we’ve all had this happen.
That person comes in, and as you try to have a chat with them and do an assessment, they’re looking at either the clock on the wall or their watch.
They give you that look of disdain and just want you to let them get on the table.
They are basically coming in with an expectation that they booked an hour and expect a FULL hour on the table.
Well…not so fast, there eager beaver!
I wish I could say experiences like this were isolated incidents, but sadly this happens all too often.
So, what do WE do and how do WE handle this?
Reading Your Patient
The idea for this blog post stems from a Facebook discussion (why do I keep getting ideas from these?).
Someone commented that assessment is essential, but hands-on is what they’re paying for. I would say this is true in some instances but not all.
This is most likely the case in a spa environment. I should preface this by saying I have absolutely no experience working in a spa but have been a customer. When someone is going to a spa for a strictly relaxation massage, and nothing stands out on their intake form that could be a red flag (I’m not sure, do spa’s check for those things?), then by all means, the person should get an hour on the table within reason.
However, if you’re working in a clinical setting, the rules change.
Doing some sort of assessment is a necessary part of treatment, and we are responsible for doing this. Now, this doesn’t necessarily have to be a bunch of orthopedic tests, it can simply be a conversation, but it’s still necessary.
This is part of our responsibility as healthcare practitioners, and it is part of what we should do to protect the public. It’s one of the things that differentiates healthcare from a spa setting. Now don’t get me wrong, I’m not saying there is anything wrong with working in a spa setting and working on strictly relaxation massages. I’m just saying there is a difference, and that difference needs to be taken seriously. And yes, there are people who come into clinics for a relaxation massage, but there should still be some aspect of an assessment.
Let me lay out a little scenario for you.
You and I work together with a bunch of other Massage Therapists in a clinical setting. For example, I work with a patient who had been in a car accident for several weeks but never really do any kind of assessment because the patient just wants to get on the table.
When they try to book their next appointment, I’m full but you have a spot open the following week they can book, so they jump at the opening.
When they come in you start doing your assessment (cause you’re a rockstar at it) and the patient gets really annoyed because they want to get on the table.
Then you end the treatment about five minutes early so you can go over some movement and homecare.
This makes the patient even angrier because they want that entire hour of massage.
They leave the clinic infuriated and call your regulatory body and file a complaint against you because of your treatment. Then, because their responsibility is to protect the public, the regulatory body HAS to investigate. So you get the dreaded phone call from them and have to talk to investigators over the next month, all while being worried you’ve done something wrong, and your career is in jeopardy.
Believe it or not, this has happened, and fortunately, it didn’t go anywhere.
Could you imagine this happening to you?
Now, don’t get me wrong, I have some patients that I’ve seen for years where it’s a quick conversation and they’re coming in for the usual thing and they say:
“just the usual thing.”
I’ll simply ask:
“nothing new going on?”
This comes after years of seeing the person and having an excellent therapeutic relationship with them, all the while knowing at other times they open up and tell me something new is going on, and that trust is built with them.
With this is the ability to read your patient.
This is an important skill to develop and is crucial to building a good therapeutic relationship.
There may be times when that person who has been in a car accident comes in and is just dealing with too much that day, where the best decision is to get them on the table to help deal with the stress they’re dealing with. However, the next week they come in, their mood is better, their body language has changed, so you can do more assessment and homecare. The ability to read what is going on with someone takes time to develop. Understanding that person’s body language, what they say to you as soon as they walk into your treatment room, and the look on their face as they talk can all be clues as to how today’s treatment will progress.
However, we cannot take the approach that everyone who comes in is going to get their full hour on the table because we have a responsibility to help these people to the full capacity of our ability. Let’s face it; you’re better than that!
Culture Change
The example we used above probably happens more often than we’d like to admit.
I mean I doubt people are getting reported to their regulatory bodies on a regular basis for doing an assessment, but the patient’s expectation that they should be able to come in and get right on the table is likely quite common.
While this can be partially the patient’s issue, I think we also have to look at ourselves. This isn’t an expectation in the other MSK professions, so why would it be in ours?
If this is commonplace it’s because we have allowed it to happen as a profession.
To truly be accepted as a healthcare profession we must use the tools we have to fullest of our potential in order for the profession to step forward. Quite simply, if it is commonplace where patients expect nothing but purely passive treatment, a culture change is necessary.
And that starts with each of us. We can sit back and blame schools, regulatory bodies, and associations (don’t get me wrong they play a role here too) but the only way we can make this shift is by each of us making this change (if we haven’t already) and OUR patients expecting something different when they come in for treatment.
The greatest way we can influence a culture change is by starting with ourselves. When other therapists see us doing it, hopefully it will influence them to change. More importantly if a patient is booking in and expects assessment, treatment, homecare because that’s the norm, it’s also what they will expect when they see other therapists.
As Ghandi said “Be the change you wish to see in the world”. For us: “Be the change you wish to see in the profession”.
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