Why words matter in patient education

I'll never forget the worst patient experience I've had in my life. I was a 15 year old kid at my first appointment with a surgeon after dislocating my shoulder for the second time. If you've ever had an appointment with a surgeon, you know that a lot of your day is spent in the waiting room. The only question I had on my mind was, "When can I play hockey again, doc?" I spent my morning waiting eagerly to hear good news.

When I got into his office, the appointment was over before it started. As quick as it was, the following words stuck with me for years: "There's a 100% chance you'll dislocate your shoulder again unless you quit hockey." Of course he was right, as the rest of my hockey career would go to show, but what I'm sure he didn't realize was the fact that his dead pan delivery would affect the way I played hockey for a long, long time.

In essence, he was only doing his job by educating me of the risks. What he didn't tell me is that many patients with recurrent shoulder dislocations continue long careers in contact sport. He had somehow made an injury that I had already experienced scarier than it already was. In attempt to protect me he created a "thought virus"--an idea that burrowed into my psyche and wreaked havoc on my confidence in going back to sport.

These dialogues happen in physiotherapy sessions all the time. We're a safety focused bunch, mitigating risks to protect our patients (and ourselves) in all decisions. On the other side of the conversation we have nervous patients whose fears are heightened by our (albeit good natured) fear-mongering.

It took quite some time to realize that I had been projecting my own fear and insecurity regarding my clinical reasoning onto my patients. As a new clinician I worried that someone would get hurt as a result of a decision I've made. What I've come to realize is that planning a return to work or play is a team discussion rather than the therapist giving their permission.

I keep my own experience in mind when having these difficult discussions. I stay aware of the worst case scenarios, but I do my best to keep things realistic. It's our job to outline the risks, but it is just as much our job to build patient self-efficacy and confidence.

#patientexperience #empowerment