Why “either, or?” Why not be an “and” profession – Jeff Moore, DPT
Present-day therapeutic care is affected by two ideal models: evidence-based medicine and patient-centered care. In the most recent decade, both models quickly rose in fame and are currently both expected to influence the clinical decision making process of physical therapists. Close examination demonstrates that these two models actually concentrate on various parts of therapeutic care and have very little in common.
Evidence-based medicine is based on the biomedical perspective. It only entered the scientific writing approximately 25 years ago and is rather young. Its attention is on offering clinicians the best accessible proof about the most sufficient treatment for their patients, considering therapy as only an intellectual business. In this cognitive approach, the uniqueness and individual needs of the patient are all too often dismissed as unimportant factors in clinical decision making.
Patient-centered medicine is not new, but in the “re-branding” age of physical therapy, patient care has attracted renewed attention. Patient-centered medicine comes from the biopsychosocial perspective. It has its roots beyond the physical aspects and goes into the emotion, psychological, and spiritual aspects of the human experience. Care puts a strong emphasis on patient participation in their plan of care so that treatment is focused around them and their life goals, as opposed to objective numbers that correlate to objective numerical values.
Caring more than curing may make the clinician feel less professional, but caring a part of the curing process. As therapists, we know that very few things can be fixed or “cured” in the first session. Something that can be done in the initial eval or even through marketing is giving care. Outcomes (the cure) usually improve if a good patient relationship first established through care.
We Can’t Know Unless We Ask
As healthcare providers, we regularly trust that we know everything about our patients and that what we want for their care is best without even considering their input. It is virtually impossible for us to precisely predict our patients’ impression of their own care and what is of value to them without asking for their input. If we don’t cumulate this information with the objective data we can’t know the complete treatment success.
Perception is reality. There is a huge difference in how therapy is perceived by both parties. The therapist administering manual therapy, modalities, or instructing therapeutic exercise cannot comprehend how the client is experiencing treatment. Therefore, it is not adequate to infer a successful treatment session based exclusively on the outcomes caused by physical therapist.
How the patient experiences your care during your “cure” is important to understand. There are thousands of physical therapists around the world who all think they’re all better than each other. Having that mentality will get you know where. Someone is always better. However, what will differentiate you is the quality of your care.
In the age of healthcare consumerism, Quality goes beyond traditional customer service, you must create an experience. Companies like amazon and Disney stand out because they project care in a few of the following ways:
- The care of detail in the aesthetics & feel of the business.
- The care of projected through their marketing.
- The care to follow up and keep in contact with the customer.
- The care to remember the basic details of their lives.
- The care to listen and put the consumers needs, and wants first.
As productivity demands increase to offset decreasing reimbursements, burnout has become a real issue. There is a high correlation between patient care satisfaction and provider work satisfaction. This is a no brainer across all customer service fields. Anywhere you go, you can sense when a service provider conveys an overall lack of care. Physical therapy is a customer service profession and the same applies to us.
When patients feel cared for, they will also help you with marketing, reviews, testimonials, word of mouth, and buying or scheduling after plan of care treatments. If they are cared for, they will help grow your business.
In the attempt to enhance the nature of care in physical therapy, we must actively seek after methods to increase customer satisfaction information and make this data readily available to all clinicians. FOTO is a great tool I have used. What tools do you use to measure satisfaction? Comment below.
The PT’s Parable: Cure vs Care
Regardless of your view on religion, there are great lessons to be learned from spiritual teachings. The best healers of any spiritual teaching were invested in the other person and showed care. The story from the Bible in Mark 2:1-12 gives a great illustration of the medical profession. Verse 9 poses the question “which is easier: to say to this paralyzed man, ‘Your sins are forgiven,’ or, ‘Get up, take your mat and walk’?”
As physical therapists, it is often times easier to tell our patients to just “get up and walk” (aka cure) and not breach other issues of non physical “comorbidities”. The story implies that the paralytic would walk after the sins were forgiven without being told to walk. I’m not saying how care alone will cure, but what if addressing the patient as a whole and learning about their view of their own healthcare can enhance the curing process and help the patient “get up and walk”.
Like in the story, many PT’s look at this topic like the pharisees did. “Who do you think you are to care for the patients? and what will that do?” The pharisees are asking the same question here. Should the patient be cured or cared for? In my opinion, the story showed that care is embedded in the cure.
Our outcome from care isn’t always visible. There is no emotional meter for how much care we’ve given. There is no billing code, goniometer, MET loading progression for care, so what is it really easier for us to give, cure or care? The pharisees needed evidence to see that the cure worked and in their love for evidence, they forgot about the bigger picture of how their customer would like to be cared for.
The Platinum Rule:: Treat others how they want to be treated.
The 5 Care Languages
How does the patient want to be cared for? what is their care language?Based on the book The 5 Love Languages:
- Receiving Gifts
- Words of Affirmation
- Quality Time
- Acts of Service
- Physical Touch
The 5 Care Languages:
- Receiving Gifts: The gift of listening
- Listen to what the patients want and not what you want with no distractions
- Listening with compassion
- Words of Affirmation:
- Encourage the patient that the problem can be fixed.
- Focus on the patient’s positive attributes and the progress they have made.
- Use positive words to prevent the nocebo effect.
- Quality Time:
- Healthcare is a factory. Make time for the patient and they’ll see and feel the difference. No rushing, no preoccupations. It’s understood that time is of the essence, but during the time you’re with the client, be fully engaged.
- Acts of Service
- Follow up with a simple call or text.
- Remember something unique about them from the initial call or visit.
- Give a lot before asking for them to buy your services.
- Physical Touch
- Have a firm handshake
- Manual Therapy: (not every patient needs it but..)
- Patients expect to be touched when coming to PT. If touch is not apart of the session, patients may feel satisfied with treatment.
In physical therapy, both cure and care are exceptionally important, however, they do not seem to harmoniously coexist. The call to action for the not-so-distant future is to unite these different models for a overall better patient experience. Advancements inside both standards can profit by trading thoughts and ideas, which everyone in healthcare benefit from in the long run.
Cures are invaluable. That is why patients are seeing medical professionals. As health care professionals, it is our goal to make patients better the best we can. We must remember to provide a cure embedded with care.
Thank you for your attention.
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Edited: Ffrancesca Famorcan