What You Say and How You Say It

Megaphone Yelling

This January, I was given the privilege of assisting in an orthopedic lab for a local PT program. I was present for 8 of the labs and had the opportunity to work with a number of great up-and-coming students. At the end of the semester, one of the students asked me “How do you tell your patients what is wrong with them? Do you use medical jargon?” I told him that I use medical jargon on a daily basis, but not without explaining exactly what the terms mean, how it relates to their functional impairments, and how we can address those impairments. I don’t do it to sound smart, I do it because demonstrating that you’re knowledgable can go a long way to getting a patient to put their trust in you and their recovery in your hands. But how much does what we say matter and how much does how we say it?

Depending upon which therapist you talk to, you’ll hear a variety of terms to classify or diagnose a musculoskeletal dysfunction, which greatly depends upon their training. Some elect to use pathoanatomic diagnoses (supraspinatus strain, meniscal tear, tendinitis, etc), while others choose to utilize syndromes (contractile dysfunction, articular dysfunction, derangement). Does the terminology matter? No, not in the big scheme of things so long as what you say conveys that you are knowledgable, understand what they are experiencing, and are fully capable of helping them return to their normal activities. This is where the how comes into play.

Think Positive

When you give someone a diagnosis or an explanation of why they’re in pain, how you present it makes all the difference. It can both make or break their plan of care. You can paint them a positive picture where recovery is both common and expected, or one in which recovery happens but is not expected. It’s all about your presentation. Let’s say you performed an initial evaluation of a patient who you suspect has a supraspinatus strain. How do you present this to the patient?

  • Option A: “Mr. Smith, based your history and your examination findings I believe you have a supraspinatus strain. We see this fairly often in the clinic, but not everyone fully recovers. Some respond well to therapy and some don’t.”
  • Option B: “Mr. Smith, based your history and your examination findings I believe you have a supraspinatus strain. The good news is, we see this fairly often in the clinic. The better news is, the majority of patients respond well to therapy and many will return to their normal activities.”

Which option inspires confidence in the physical therapy program and which inspires doubt? Both are similar and both promote a different outcome. What we say to our patients and how we say it have a profound effect on the efficacy of our physical therapy interventions. Never take for granted the power your words and attitude can have on a patient.

– Zachary Huff, DPT, PT

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