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Kerry Kittson, PT

Patient care extends beyond clinical skills to something that is mostly second-nature for physiotherapists: communication. Research shows that there are strong positive relationships between a health care team member’s communication skills and a patient’s capacity to follow through with medical recommendations, self-manage a chronic medical condition, and adopt preventive health behaviors.

Many of us have had moments where we realize that there should have been better communication with our patient, physiotherapist assistant, or other member of our health care team. The question is: how can a reflection on communication propel you to improve your physiotherapy practice?


The case for communication

An experience as a new grad might help explain. I treated a patient in private practice--we’ll call her Sally--for persistent low back pain.

Sally presented with lumbar hypermobility and core weakness and we worked diligently together over the course of about six months to develop a tailored exercise program to strengthen her core and surrounding musculature.

Sally was highly motivated; she diligently performed her exercises at home and within the clinic during follow-up visits. When those became easier to accomplish, Sally was thrilled to advance to more difficult exercises.  


Strength increasing, pain remaining

Despite getting stronger, Sally’s back pain levels were still high. The lack of improvement in Sally’s pain levels was not due to a lack of compliance with her home exercise program. When trying to brainstorm about the best next steps, I thought about how an important component of core strength is the base: the pelvic floor.

We had spent months strengthening the core, back, and glutes without addressing this important part of the core. Perhaps this was the missing link!

I discussed with Sally that a possible reason why she was still experiencing pain could be weakness in her pelvic floor muscles. I recommended that she receive an assessment, and referred her to a trusted pelvic floor physiotherapist colleague.

My reasoning was that if there was no involvement of the pelvic floor, it could be ruled out. If there was involvement of the pelvic floor, then Sally would be in good hands.

Sally booked an assessment, and I prepared a two-page progress summary for the pelvic floor physiotherapist for her to bring to her first appointment. In the hustle and bustle of the busy clinic, I quickly told Sally that this appointment would involve undressing so that the physiotherapist could assess her pelvic region.

She seemed nervous, but I assured her that the physiotherapist was professional and would help her feel at ease.


The missing piece

A week later Sally came in for a follow-up with me and I was keen to discuss the results of the pelvic floor physiotherapy assessment with her.

When we sat down together, Sally expressed that she had been surprised when the physiotherapist said that they needed to do an internal exam, she had no idea that would be involved.

I immediately realized that I should have been more thorough with my communication leading up to her appointment. While I was not sure if an internal exam would be part of the first appointment, I still should have informed Sally that this could be part of the assessment; this oversight in communication was partly due to my lack of knowledge about pelvic floor physiotherapy as a new grad. The consequence was that Sally didn’t have an opportunity to mentally prepare herself for an exam that is very personal in nature.

I apologized profusely. Thankfully, Sally reassured me that the appointment was conducted with utmost professionalism, and it went well. In hindsight, I should have asked my colleague prior to Sally’s assessment about whether an internal exam, with patient consent, is a typical component of the pelvic floor physiotherapy assessment.  I learned after that assessing the pelvic floor without doing an internal exam is like doing an orthopaedic assessment through clothing – not ideal.

The ability to apologize in itself is a skill I think; imagine how Sally would feel if I had deflected and said something like “I must have warned you--besides that kind of assessment is no big deal.”

An apology can bridge the way to further trust. As the health care practitioner, you are showing that you are human and that while you may try your best to avoid it, oversights in communication can happen.


The centre of patient care

What I remember most clearly from this humbling experience is that communication should be at the centre of patient care.

I urge you to take the time to ensure that patients have all, not just some, of the information they need regarding their care.

Good communication and other ’soft’ skills are what foster patient trust and are arguably just as important as clinical skills.

If your patient doesn’t trust you, their goals and outcomes will likely not be achieved.

I also recommend Physiopedia’s effective communication techniques to further hone your communication skills!


Over to you

When you share your stories, you help your peers learn from you and continue to improve. Please take a minute and share your experiences to help others:

  1. Have you ever had any communication missteps with patients?
  2. What are your tips for making sure you keep communication open with patients?
  3. What articles or stories have helped you improve your communication skills?