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“Oh Crap, He’s an Intern”

There are few better ways to petrify an intern than for a patient to say “oh crap” after you introduce yourself as a student on their clinical rotation. This happened to me on my first clinical rotation and I vividly remember the entire encounter.

Following my practiced, yet unrefined, introduction, the patient —I’ll refer to her as he Ashley — begrudgingly walked from the treatment room to the evaluation area. During this brief walk, I had the pleasure of experiencing little eye contact, witnessing an eye roll and smear, and being told about the two previous encounters the patient had had with students.

As you can probably guess, they hadn’t gone well.

I’m not dumb and know when to use the recourses I have.

I quickly pulled over my clinical instructor to comfort the patient that I would not be the sole clinician on the case. This helped to convince Ashley to give me one shot and allow me to complete the evaluation before making a decision whether or not to continue under my care. Now the real challenge began.

Ashley was coming to therapy for recurrent tennis elbow. Immediately, my focus was on building a rapport and demonstrating I had some semblance of a plan.

I sought to simply listen and understand.

My treatment decisions were influenced by her past experiences and her expectations of what treatment should be. It provided insight into what treatments to avoid.

Yes, I was the clinician — albeit an intern but still more knowledgeable on treatment than the patient — but shared decision-making is vital during patient care. Physical therapists are not dealing with life-or-death snap decisions like emergency department physicians and paramedics do.

If a patient is not bought into a treatment or has had a poor previous experience, the effectiveness of that treatment plummets. The opposite occurs when a patient fully embraces an intervention.

There are many ways to rehabilitate from an injury, and I was focused on gaining her perspective to increase compliance and effectiveness. Slowly the barriers came down and she began to trust me.

Two lessons that stuck with me throughout my career

By the end of her plan of care, the elbow pain was gone and Ashley resumed playing tennis three days a week for her local league. It was one of the most successful and memorable treatments from any of my clinical rotations.

When I reflect on that case, two things stick out.

#1 — I would use different treatments today

I was very clearly a student and applied several outdated treatments. Even the “correct” treatments were applied inefficiently. I am confident I could have reached Ashley's goals quicker than I did as a student.

#2 — My efficiency was a distant second in importance

Yes, I could have chosen more effective treatments, by my primary goal was to address Ashley’s concerns about being treated by a student. I can continue to improve my treatment selection, but patient satisfaction and expectations are a priority from day one. While exceeding her expectations was not difficult, given her past encounters with students, I hope I restored at least some of her faith in student clinicians.

People want to be understood

There are many reasons for seeking treatment from a healthcare provider. In my career, the most common complaint I hear from patients is pain. Pain may be the primary complaint, but it is the interference in life that matters. Being distracted at work, unable to play golf, avoiding getting on the ground to play with grandchildren, and considering giving up running are the real reasons patients seek my help.

Pain infringes on the activities that we want to do (Ashley’s love of tennis) or need to do to make a living. This is why short-term “fixes” such as medication and injections don’t work. Short-term pain relief is nice but falls well short. If I just gave Ashley ice, ultrasound, e-stim, massage, or low-intensity exercises, I could have reduced her pain. It then would have returned during the first set of her next match and she would have resigned from her post as president of the physical therapy student fan club and sworn of student clinicians forever.

Rapid pain relief was not Ashley’s main goal on day one; she wanted to know that the elbow pain could be addressed. She was struggling to focus at work and was unable to play tennis. Those were the real reasons for her seeking care. Despite my lack of experience, when I was able to demonstrate that I could help her achieve her goals of working and playing tennis without the distraction of pain, she was fully bought into the treatment plan.

I share this story to outline the power of expectations. It is easy to assume we know what somebody wants. It is easy to chase the short-term “fix.” This doesn’t only apply to healthcare.

No matter what profession you are in, don’t forget the power of building relationships and helping others feel understood.

*The patient’s name was changed for this article

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