Thursday Thoughts: What Would You Do For Patient Buy In?

Maximizing patient expectation/placebo in our interactions to improve outcomes is very important. Many of us do that without even realizing.

Saying things like, "Oh don't worry, I have just the technique that will help you move and feel better," plus presenting as confident and compassionate really go a long way.

However, what would you do if a patient is not buying into your assessment, explanation, etc?

Even though I have long since adopted a more modern view of manual therapy mechanisms, pain science education backing my standard MDT toolbox, I still have to go old school on occasion if the patient doesn't "buy" what I am trying to explain.

Example 1: Patient has seen a bajillion specialists who are all concerned about their facet joint degeneration, disc protrusions, etc... Every other word out of there mouth is disc.

I try to explain about repeated movements and directional preference leading to relief
I try not to mention disc or explain about false positives, or that the MRI does not change, but the symptom levels often change, especially when intermittent (most patients have intermittent complaints)
however, they are not buying it
you can sense this rather rapidly that you're losing them because they're at your office for their "disc problem"
so when they inevitably ask, "But is this good for my disc?"

not always!

I sigh inwardly, feel a little bad about the explanation, then say, "Yes, this will help your disc problem

Pt buys into the treatment plan, no harm, no foul... right?
I agree with Moseley's research that shows we underestimate patient's ability to understand Explain Pain strategies and neuroscience, but some just do not have the proper mindset to absorb it
or they refuse to "believe it's all in their head" - which I am quick to explain that is just part of it

Example 2: Patient for knee "arthritis" only wants you to treat their knee

you explain about regional interdepedence, research supporting looking more regional, but they still want only knee treatment
oblige them by doing some local treatment
give them repeated knee extension as an MDT based local reset
then with some "extra time" offer to work on some other findings that will "help their knee move and feel better"
if their doctor is concerned about you working on something other than their knee, no problem, (or if it's an issue with the HMO)

call up the doc, say, "I know you wanted me to work on the knee, but the patient complained earlier about their hip/ankle etc being stiff as well, and they said you thought it would be a good idea if I also addressed this." 'Mind updating the script for me?"

inception... now it's their great idea, not yours

It's been a while since the local HMOs started honoring our direct access and covering everything without a prescription, but the second strategy is something I used to do.

Thoughts?