How many of you have thought that you didn’t have enough time with the patients you believed really needed it? Or experienced the pressures of productivity standards and competing responsibilities? I most certainly have. It is not uncommon in rehabilitation settings for patients to be scheduled every 30 minutes for a 60 minute session, This results in an entire treatment session doubled with another patient. Perhaps you work in a clinic where you only have 20 minutes with each patient. Or, maybe you are expected to have primarily hands on time and less face/talking time. Concerns about how limited interaction time can affect therapeutic alliance are valid. And though you may feel that there isn’t nearly enough one on one time for the person experiencing persisting pain, there are many things you CAN do that can help. The evidence supports the benefit of better interactions. Promoting better exchanges and engagement with people can contribute to better health and functional status. It is also associated with both patient and practitioner satisfaction.
Here are some ideas to help maximize your time and therapeutic alliance, support the patient, and find success.
1. It can’t hurt to ask. If your patient needs more one on one care in a setting where the model doesn’t typically allow for that, perhaps you can talk with the clinic manager about the needs for this particular patient. You’re not asking for accommodations for every patient, just this one. Understand that they have a boss too, and are expected to run a clinic and achieve “the numbers.”
2. Scheduling. Some creative scheduling could offer more time with the person who needs it. In the “2 people always overlap” model you have some options. The person could be scheduled as the first or last patient of the day. This could allow for extra one on one time. Or if they come as the last person before lunch could offer 30 minutes of solo time. You could consider asking the patient who is scheduled prior, if they’d like to come in a little earlier and then they can finish a bit early. I’ve had patients for whom this was music to their ears. It may be able to give you an extra 15 minutes of one on one time. And though that may not feel like enough, it will have an impact.
3. Use your support staff. If you have an aide working with you, teach them. Emphasize to check in about how the person is tolerating the activity (more on that here) and how to modify it if it is leading to a flare up. Instead of asking if they hurt (they likely do) ask if they need a break. Teach them to have FUN with the patient as this can have a really positive impact on care.
4. Take a stand. If you are managing multiple patients in a clinic gym setting, position yourself closer to the individual who would benefit from more support. It makes it easier to give a little more oversight and facilitates engagement with them.
5. Technology Part 1. Use your work email. It’s quick and extends your reach. I’ve even emailed outcome measures to patients to fill out and bring in so they don’t have to fill it out during the session. It also gives them the time and space to fill it out without pressure to get it done so they can move on to the next activity. I email words of support, reminders that they are strong and robust, on the right track, and to check in on how their strategies of self-management are doing.
6. Buddy System. There are times when seeing more than one person at a time can be beneficial for them. For example, sometimes I have 2 patients with ACL reconstructions who are at a similar place in their rehabilitation. I might purposefully schedule their entire session together as they enjoy the camaraderie and motivate each other. This could open up a one on one time slot for another person who would benefit from it. Even if the two patients you are seeing at the same time have different diagnoses, they may be a great pairing. Perhaps there are a few interventions they could perform together. Patients encourage each other, have fun with each other, and become clinic buddies.
7. Music. Does your patient have a favorite artist or type of music? Play it during their session. This can enhance the session and takes minimal time to implement for them. It is a strategy for self-management and can help the person feel that their care is individualized, because it is.
8. Technology Part 2. There are several apps I use clinically including for laterality and breathing. If there is a clinic device that you can load the app onto, you can incorporate it into their treatment session. You can teach your support staff how to set up the program on the person’s own device and how to progress the program. And if your patient can download it and do it at home, you can then see the results on the app.
9. Technology Part 3. Using apps for strategies for self-management. This goes a long way to making strategies accessible. Breathing, art apps, YouTube, inspirational quote apps, are all ones I have used for people. After you’ve done the work to help identify a strategy that is useful for them, trial it during your session. This can extend the benefits of your time with them, outside of the clinic.
10. Accessibility. Not everyone has smartphones or the means to download apps. Or they may struggle to find ways to incorporate the strategies that are successful during your time with them. You can help to make the strategy for self-management accessible to them. Think outside the box. I’ve printed out pictures for them to post around their home. I now have about 35 pre-made documents that I can quickly print or email. I’ve helped people to set up daily reminders in their phones. Sometimes it’s useful to link the strategy to a place. For example, it might be effective to have them perform heel raises and hip abductions every time they are at the kitchen sink. Or, they might be able to utilize a mindfulness strategy first thing in the morning before getting out of bed. Help to reduce barriers to their success.
Hopefully this list has helped to foster ideas for you to embrace opportunities to enhance your care when you feel the system just isn’t set up to fit the patient’s needs.
Dugdale, D. C., R., & Pantilat, S. (1999). Time and the Patient–Physician Relationship. J Gen Intern Med,14(Suppl), 1st ser., S34-S40.
Miciak, M., Mayan, M., Brown, C., Joyce, A.S. and Gross, D.P., 2018. The necessary conditions of engagement for the therapeutic relationship in physiotherapy: an interpretive description study. Archives of physiotherapy, 8(1), p.3.
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