The Easiest Change You Can Make to Take Your Practice to the Next Level

The Back Story:

As healthcare providers, we tend to have a strong drive to provide excellent care to our patients. This can be driven by altruism and empathy, or more selfish reasons like measuring our self-worth by how “good” at getting patients better we are and the “healer” mind set. Regardless of your driving force (please don’t let it be the latter) we usually begin to do this by focusing on improving ourselves. We go to years of school, take on student loan debt, give up our weekends for courses, take hours of paperwork home with us, listen to podcasts, learn the latest technique, buy the latest rehab trinket, etc. However, further down in this article I will argue that there is something very basic you can do to reframe how you treat patients and shift your paradigm to one that will bring you more success than you may be having now.

But First Let’s Talk about our value:

Despite all of the years, effort, sweat, and emotion we drive into our practice, it has been my observation that on the whole physical therapists have a tendency to vastly undersell ourselves. This is a realization I came to even about myself a few months back. I feel VERY confident in saying I read A LOT. I have the tendency to be an information whore, standing on the street corners of the internet asking for full texts and scrolling the social media pages to see what the smart people are posting and talking about. Yet, even with this mentality of information consumerism, a doctorate, and hundreds of hours of solid evidence based con-ed under my belt, I would often under value my treatments. I had such a burning drive to be non-biased in my patient interactions that it was strongly detracting from the efficacy of the treatments I did provide.

Relationships and Therapeutic Tone Matters:

There is no shortage of literature demonstrating the value of a strong therapeutic alliance, patient provider dialogue, and the effect of language on patient outcomes. The newest research focuses on the negative impact of thought viruses and the nocebo effect. However, we aren’t giving enough attention to power (or lack-there-of) related to patients not “buying in to a treatment”. What effect might it have on our extremely effective treatments if a patient doesn’t feel like we even value what we do? What are your adherence rates going to look like? Will your treatment lose value? Will this patient refer you other patients because they bought a product with good results that had confidence and gusto behind it?

Give’m the business:

We have a tendency to feel like selling ourselves is in some way inappropriate. We feel like healthcare isn’t a business…but it is. Healthcare (physical therapy included), is the business of helping people feel, move, and function better. I am in the business of getting people a better better faster than they could on their own or with other interventions. Why should I feel bad charging for my knowledge and skills? Why should I be hesitant to have a little positivity and say YOU WILL get better with this treatment? Set what I like to call a “THERAPEUTIC TONE” that facilitates positivity, energy, progress, and measurable outcomes.

The Short Sell:

I was recently listening to a podcast by Jeff Moore that made all of this really click for me. He talked about selling the patient 2 weeks of treatment instead of 6-8 weeks. It’s a lot easier for people to wrap their mind around 2 weeks or 2-4 visits than 3-4x this much. People want results yesterday, and if they are in front of you they have decided to make a financial and time investment. People usually like to invest in products of services they believe in or at least have confidence will work. People will even keep their investments in products they believe in despite losing on the ROI. Simply reframing the way you explain and “sell” the treatment plan to your patient can drastically change buy, adherence, and subsequently outcomes both with patient improvement and clinic volume numbers.


The Purpose:

To quote Jeff: 

The point of the short sell is to ultimately encourage the patient to buy in to the whole plan of care (if indeed more than the short period is needed). We should use the short sell almost as a form of advertising.

• "I'll explain......I've always envied people who sell physical objects, like let's say bicycles. Imagine how easy that would be! "Yes, take a good look at how beautiful the bike is, by all means sit on it and have a feel for the comfort? Not convinced yet? Take a ride around the parking lot!" We don't have these luxuries because the customer can't physically see, feel, sample the product....cue the short sell. By getting them to receive treatment for three to four sessions they literally get to test drive the product, and when they are impressed with both how they are treated and the results of said treatment they say without hesitation "Dr. PT I definitely want to finish out whatever treatment plan you think is best"."

Bingo, full blown sale. It's tough to sell what the customer can't see or experience, So help them make that first challenging decision by taking some pressure off with the short sale, once they have experienced it selling the rest is usually shooting fish in a barrel. So in summary we want to make sure we are emphasizing that the short sale is a way to ultimately get the patient to see out a comprehensive full plan of care.

What does it look like?:

So, what would this look like in the clinic? It can look as simple as saying “Jack, it seems to me that we have some great things we can work on to really help your pain. I feel strongly that you will be 30-40% better by the end of next week”. It could also sound like “Jill, I’m really confident that this problem is going to get a lot better. If you take these home exercises I’ve prescribed and do them how I’ve instructed over the next 2 weeks you will easily be 50-75% better”. It could even be more short term than these examples such as “Alright John, let’s see if we can work on that decreased nerve mobility right now with some of those manual nerve glides we were talking about. I have a feeling you’ll see at least a 25% immediate increase in your pain free range”. Below I have listed a couple of case study examples of how this could look.

Case studies of What This Can Look Like:

The Easy Case:

Patient: So, what do you think Doc?

You: Well, after evaluating you I can see you have a lot of really good things going for you. You still have really good motion and don’t seem to have too much swelling or inflammation that would slow down your recovery process. You do have a little bit of weakness, but that’s something we can easily improve and you will notice quick improvements in the way you feel.

Patient: Really? That’s great to hear! So how long do you think this will take?

You: Well, everyone has a little bit different healing times, but how about we get after some strengthening for the next two weeks and see how you feel? I feel very confident that you will be noticing great improvements by then and we can decide if you need my continued help to progress or if you’re ready to take over on your own!

Patient: Alright! That sounds great! This has been bugging me for a while and I’m glad I found you!

The Harder Case:

Patient: So, what do you think Doc?

You: Well, after evaluating you I can see you have a lot of really good things going for you. I don’t think you are weak like all those other people told you. This injury has been around for quite some time, but the good news is that we can be sure that your body has healed up those tissues in that time. To me it appears that your system is a little sensitive from having to deal with all of the stress and pain from this injury.

Patient: Well, if it’s healed why does it still hurt?

You: Lay down on the table and let me do a little bit of this treatment I’m sure will help you feel better. (wiggle, crack, wobble, mob, desensitize)

Patient: Hmmm…. That’s crazy, I can turn my head twice as far now with half the pain! What the hell did you do witch doctor?

You: All I did was help your nervous system calm down a little bit to allow you to move more with less threat from your body. Why don’t we keep at this and progressing your movement over the next two weeks? After that, we can sit down and re-evaluate how you’re doing and decide where to go from there?

Patient: Alright, I can buy that.

Conclusion:

The “short sell” and reframing the way I sell treatment to patients has been the single most valuable change to my practice in the past 6-12 months. It sets the therapeutic tone of patient interaction and creates a situation in which people are much more willing to fully commit to your treatment advice and exercises. The key to capitalizing on this will be focusing testing and re-testing. You have to focus on objective measurable and demonstrate these to yourself and patients with regular retesting of their signs and symptoms. Try implementing the short sell and creating a therapeutic tone of positivity and value over the next few months and see what happens with your interactions, patient buy-in, patient adherence, and visit counts.

Thanks for reading,

Jarod Hall, PT, DPT, CSCS

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