The PPD asked me to produce some tools and tactics from the battle lines of the clinic treatment area.
You’ll have to agree that client care is very different than what we get taught in school. In school we are given highly skilled tidbits of information to make us a machine in getting rid of pain. We are armed and ready on the Monday after our course to feverishly apply these skills. A few weeks later the enthusiasm drops, as the novelty starts wear off.
Then, that nagging question starts to pop up, why aren’t my clients coming back? Why is their attendance so spotty and why do they keep missing their appointments?
If you think of the long term implications of clients who “no show” (NS), you’ll soon discover that NS clients are silent killers to your schedule, eat away at your billable revenue and in most cases highlight a disconnect. Yeah that’s right, somewhere between them coming in for your expertise, you lost them between hello and see you next time.
But, all is not lost, today I’ll be showing you how to marginalize that disconnect.
The first part of my article will give you military grade tactics to bulletproof your caseload. The second part will deal with NS clients and how to deal with them. I’ve shared these tools and tactics with the younger PTs and clinic owners I mentor. They have found them incredibly helpful so I know you will, too.
Let’s get started.
In Your Initial Assessment, you must ask these two critical questions:
I am not here to teach you to be a better medical expert, that is what your CI’s and teachers were there for. But I wish someone shared these tips with me when I was a student.
Mastering the inner psyche starts with these two tactical questions.
1) Why did the patient decide to see you now? [Establish their call to action]
2) What are the two important things that are being limited by their injury? [Establish where their physical and emotional universe turns into a Black Hole!]
This is where you change from PT Phil, to Dr. Phil!
These two questions give you some serious psychological insight to your patient. Once you have the answers I need to you to circle it, underline it, and highlight it in neon pink. This info is better than any hands-on technique you know!
Why?
Because the patient doesn’t really care what you are doing, as long as it gets them to their goals, not yours!
Often patients will be dealing with an injury over a long period of time, so it’s critical to identify why they chose to come in now? Why did they decide to seek your medical expertise? What was their call to action? Is it because they want to ski in a month’s time for a race, want to body surf in Australia next year or just compete this weekend at the Cross-Fit Open?
Whatever the answer is, commit this goal to memory.
Every exercise, every hands-on treatment, every piece of education must tie into their call to action. Think of this as their North Star, be their navigator so they do not deviate from the destination and you can guarantee that you are their most trusted advisor.
The second question addresses what two things the patient is missing out on. As I’ve mentioned before people buy the way you make them feel, not by what you do. Your job is to give them pearls of your knowledge, your skill set, your physio homework to get those two things missing in their lives back! These two small wins for your patient are likely to result in a lifetime of gratitude.
Try revisiting these goals with your patients’ once a week, think of it as their mighty physio purpose and a great psychological benchmark to springboard off of!
IF You think they understood what you said, they didn’t.
My first assessment was 18 years ago at Mount Sinai Hospital in Toronto as a young PT student. I was having trouble articulating how my 96 year old patient developed a frozen shoulder months after breaking her wrist. It didn’t help that I had my clinical instructor give me the death stare when I used medical terms like “adhesive capsulitis.”
Well that instructor taught me some serious lessons, one being that we all need to dumb down our explanations, and then do it again.
Because we all live in medical bubble, it’s easy for us to throw out terms like ‘Disc, cartilage and tendon’ and expect our patients to know what this is. The reality is when your patient is nodding while you explain their injury with the plastic shoulder model, they are just too embarrassed to tell you they have no idea what you are saying.
The sooner you understand that most of, if not all patients, have absolutely no idea what you are saying, the sooner you can save this patient from not showing up into your schedule!
All the patient knows is that their [insert their body part] hurts and you are supposed to be the expert who can fix them. Making it easy enough that their kid understands what you are talking about is the key to winning their vote towards expertise.
Do an experiment. For 1 shift a week commit to using minimal medical jargon with all of your explanations and questions. For those patients, take the time to ask them to repeat back what they understand is actually going on. You will be shocked at the value of what clarity can bring to someone’s life.
Also don’t forget to use the incredible apps on your iPad or smartphone that display anatomy in 3D, a picture is truly worth 1000 complex terms!
Don’t TREAT and Street
I love very effective and efficient therapists, so I’m not knocking therapists who are able to see a high number of patients and do it well. What I am referring to is the experience where the patient is in and out with very little human interaction.
Advances in technology have allowed us to pretty much message anyone from your smartphone in a number of social platforms. But the stats are clear that as this technology increases, actual human contact, conversations, and most importantly human connection, decreases. In other words this world is becoming a very lonely place, despite how many followers you might have on Instagram or Snapchat.
Another very lonely place is the world of injury and pain.
Most Great PTs can tell you about a life altering injury, and how it has altered their practice. From my own experience it took me to dark places and made me realize what some of our patients are truly going through when they step into the clinic. And more importantly how lonely their world is irrespective of the number of family or friends in their life.
Pain is isolating, and gets pretty depressing if it seems like there is no end. So before you let your patient go for the day, ask yourself did you take the time to listen to them? Did you take the time to make them smile? Did you take the time to emotionally connect with them? Did you make the most critical transition for a patient from indifferent to important?
Ensuring your patient feels valued, emotionally lifted and leaves with a smile is a surefire way to guarantee they make their next appointment
You’re the Captain of your caseload, don’t let the crew steer the ship!
So you delivered an EPIC performance, the happy patient exits the treatment area and then heads to the front desk. Your front desk angel settles the financial details and then asks the question that is the equivalent of the Titanic hitting the Iceberg!
He/She asks: “So when did you want book back in?”
At this point, if you were an alien watching from above, you would think this was a case of the blind leading the blind!
Being a patient is an overwhelming process, you’re the expert and that is why you need to understand it is your responsibility to direct current and future bookings. You need to tell the patient what to do.
To execute this you need to take on both of the following:
- Develop a communication card, with the patient’s name on it, diagnosis and future appointments and/or products recommended. The patient takes this to the front desk. If the patient is not booked in as prescribed, the card is flagged and given back to you, with the reasons why so you can follow up if necessary.
- Block Book. When the patient is assessed, make sure they book into 3 weeks of treatment recommended from day 1. This ensures that they follow your treatment, get appointments that work for them, and validate their commitment to you as the expert.
Build a tribe and remember that every patient is Tribe member 001
The single lesson I’ve learned from treating patients for the last 18 years is that you really need to check your ego at the door. I think the longer you work, the more patients you see, the harder it is to do this. So the level of experience and clinical expertise seem to be inversely correlated with being humble.
The reality is, your success as a therapist is not just measured by the abbreviations after your name but will be based on your ability to build your tribe. Your tribe is your past, present and future caseload. You need to understand that almost every single patient that sits in front of you for medical expertise is your next biggest raving fan.
So I’m going to get off my pulpit and get tactical on how to engage with your next big fan! All you need to do is…master the letter P!
Master the Letter P to Create Raving Patient Fans
With every client experience, mastering the letter P is the sure fire way to make your tribe grow!!
Punctual – This requires no explanation but their time is as valuable as yours, so if you are going to over-deliver to your patients, make sure you plan your time accordingly. The days of waiting are as dead as your VHS player.
Pupils – Make as much eye contact with your patient, especially when they are trying to tell you something. This isn’t a staring contest, but making eye contact is a key pillar to understanding your patients’ body language.
Present – Pay attention to the person in front of you and what they are saying and feeling. Be present, even if you have 4 other patients in the clinic, because they are the most important person at that moment. Develop strategies to ensure the rehab world is running smoothly beyond the closed curtain.
Posture & Positioning – Eye contact leaning in, sitting off to the side of your client are two key ways to communicate to the patient that you are all in with their clinical conquest. But what is also important is to learn the fundamentals of body language – zoning in on what your patient is silently trying to tell you. Being able to read their body gestures will help you determine your line of questions, abandon clinic exams and ensure your patient is truly comfortable and confident in you. Here is a quick tip, pay attention to your patient’s feet when you are talking to them. If your patients’ feet point towards you, are jumping, or their toes are pointed to the ceiling, they dig what you are saying! If their feet are facing the exit or tucked under them, they are not buying into it.
Personality – Don’t forget that being memorable is all about being outside the norm. We are all unique so don’t forget to highlight your best attributes. There’s nothing worse than a RoboPhysio.
Predict – Get good at predicting the types of questions and concerns your patient is thinking but hasn’t said out loud! You need to be that Guy/Girl who says … “well [Insert patient name] this is when you are supposed to ask me…” and give them the answer they were wanting to know but never asked.
There’s so much more we could talk about in terms of caseload management and performance optimization, but there’s only so much space on this blog post!
The reality is, the better we are individually, the more our profession will prosper. It is my humble wish for all of you to be true ROCKSTARS in your practice.
I would love to further this conversation or get some feedback about what you thought about this article, send me a message over twitter at @physiokarim, on Linkedin @KarimMeghji or at physiocalgary.com – all green lights to an epic 2017!
PS. See you in Part II – where I will deconstruct No Show Clients, why they happen, exact scripts to win them back and tactical strategies to use in your clinic to make this a non issue. Stay tuned…
