Last year, my brother (who is also a PT) told me about a neurosurgeon who left 33 of his patients dead or maimed. I listened to all episodes within a week. It was crazy to me that someone would be so terrible and how he convinced so many patients to go under the knife. What was even crazier was how he got away performing heinous crimes for so long. That made me wonder: what convinces people to turn to one clinician more than the other? And more importantly: what should people look for in a clinician?
We live in the day and age where shopping for healthcare providers is almost as simple as hopping on Amazon for batteries. You can google “physical therapy in Boise” or “back pain Boise” and a myriad of clinics will pop up. You also see when referrals from close friends or relatives trump all. Hear a good thing from your BFF about Dr. so-and-so, and you willingly sign up for an appointment. Get some good gossip about how much pain a certain therapist put you through and you’ll never sign up. Even in this pandemic, you may be scared to visit a clinic crawling with excessive patients putting you or others who are immunosuppressed at higher risk. With all that’s said, I believe picking out a healthcare provider should be an expert. An expert in bedside manners, results, and guarantee those results.
ELI5
We all avoid the awkward medical provider that can’t tell you anything that makes sense. Or the one that doesn’t talk at all. We’ve all been there. We long for someone that can explain what is going on to a 5-year-old. A clinician should be able to take something very complex and break it down into layman’s terms. You should be able to know your diagnosis and what it means. Plain and simple. Next, they should know their results.
Before even starting this next part- if your healthcare provider cannot give you their results, run far away. Every clinician needs to collect their results, good or bad. If they aren’t, they can never improve. This is why most clinicians in almost every research study end up performing the same or worse after practicing for 20 years.
Focus.Feedback.Fix
Clinicians need to create systems that give feedback on whether the choices they make are correct or not. If these systems are not in place, the ability to improve drops dramatically. Take an ER physician for example. When you drop in the emergency room hoping for your back pain to get better, you mostly see the physician for about 15 minutes and they ask you questions to rule out any terrible diseases that might make you have back pain. Then they send you to imaging and have someone else read the X-ray, MRI, or CT scan. He or she will give you some pills and refer you to someone else. At this point, they have done nothing that improves their skill. They will probably never hear about you again and so they won’t get feedback on what the actual pain generator was.
Now, don’t get me wrong, ER physicians are really good at not letting you die and have saved countless lives that might have otherwise been lost (not letting someone die is pretty good feedback). But don’t expect them to focus on diagnosing your low back pain when they have people who are cut up, beat up, and on the brink of death. It’s not their focus. And they’re also not trying to sell you on this brand new tool to relieve pain. This is another form of selling treatment, not results.
Sell results, not treatment.
In Boise, I see a sign for a physical therapy clinic I drive by every day that reads, “Dry Needling Now Available.” If “dry needling” is a new term for you, it’s a procedure in which tiny needles (the same as acupuncture needles) are inserted into a muscle. Sometimes the needle is pistoned, meaning it is pulled out and back in several times like a piston in an engine. Other times, electrical currents are run through several needles still inside the muscle. It may not seem appealing the more I talk about it, but the least appealing part of the ad is that they are selling results.
There is not a guarantee that poking you with needles will make you feel better. The treatment should never be the selling point if the results are not better (and guaranteed) or the path is more painful (dry needling can muffed me up). Orthopedic conservative treatments, about 90% of them, should show results in and after each session.
Is your therapist checking at every visit and during each visit how much progress you’re making? How are they checking? Is it numerical-based, or the simple “how do you feel today?”. Like I said up top- if your healthcare provider is not getting you better or even asking you inter- and intra-session, that’s a red flag. This is the data that needs to be collected for clinical improvement. Because at the end of the day, if you don’t have results, then your provider can’t guarantee you or anyone else effective results.
I Can’t Guarantee it
Another common phrase with clinicians is: “Everyone heals different, so I can’t guarantee anything.” Again, another red flag. This is like buying a TV and asking the salesperson how well it works and getting the reply, “you know, every TV is different, so I can’t guarantee it’ll work.” It seems like healthcare is the only place you can say this and get away with it. To me, it sounds like they haven’t found the correct diagnosis, or they can’t trust their skills enough to assure effective treatment. If anything, ask your clinician what guarantee they have on their work and see if they can back up their results.
Conclusion
At the end of busily shopping out the right healthcare provider, know that you are in control. Find someone that you can communicate well with and they can back up their results. It’ll be the kind of person you can refer your grandma and nephew to without hesitation. It’ll be a blessing knowing you can get back to what you want to do, faster.
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