Trust

Recently I presented to a group of motivated Private Practice Podiatrists at the OSGO Live 2017 conference in Manchester. Whilst the session was entitled “Assessment and Diagnosis in Private Practice”, much of the subject matter was around building trust with your patients, and creating an environment where they were willing to engage and participate in the process.

To successfully assess a patient, they need to feel confident that they are in the right place, and that you are the right person to solve their problems. Contact with the patient prior to their consultation is essential, and should advise them of what to expect, addressing any concerns they may have. Remember that in all likelihood they have already been online and diagnosed themselves, and that you are simply providing a second opinion to Dr Google. Being direct and asking the patient if they have searched their symptoms online, or if they think they know what is wrong, is a good way to open the conversation about why they may or may not be correct, and to explain the process you will go through to in carrying out a proper and thorough clinical assessment.

Once you have established that you are more trustworthy than the websites they have visited, they will be more likely to share the full background and history to their condition, which gives you a better chance of a successful outcome.

During your discussions and assessment you may come across an elephant. We all sometimes encounter the “elephant in the room” – something obvious that people are often uncomfortable talking about.

It is important that as health professionals we are able to confidently give the elephant a pat and talk to it openly. Be willing to address issues like poor personal hygiene, obesity, mental illness or neglect.

Establishing the true motivation behind your patient’s visit is key to a successful outcome. Their fears and frustrations are the reason they are seeking help, not the skin, nail or musculoskeletal problem. For example, they may be afraid of losing fitness or becoming incapacitated, or they might be frustrated by their inability to participate or compete.

You will gain most of the information you need to make an assessment using just two things, your hearing and your eyesight. Actively listening, and letting your patient do most of the talking will always reveal more than second guessing what they are about to say. Wait for them to finish speaking before you ask your next question, and leave a few seconds of silence which will give them an opportunity to speak further. You may choose to make notes as they speak, but keep regular eye contact to show you are listening. Spend time on this, prior to any physical examination, and the knowledge you gain will facilitate a sounder diagnosis.

If you need to order further tests, or consult with colleagues, then be clear about the reasons why. Your patient should not be given the opportunity to think that you haven’t got a clue about their problem, but rather should feel that you are working hard on their behalf to get the most accurate diagnosis and most up to date treatment options.

Setting treatment goals should be based on real life functional outcomes such as playing a round of golf, or walking the kids to school; and not on clinical measures such as pain reduction or range of motion. Once your patients understand that you are also invested in those goals, you form a partnership, and they will respond more positively to your interventions and advice. This engages with their hopes and aspirations, which become real and tangible when they are shared with somebody who is equally committed in working towards them.

 

When things don’t go to plan, and your patients are not getting the expected results, it is a time that some of us can become defensive, or focus on the negative. At this point your patient is looking to you for guidance and leadership. Acknowledge that things aren’t going as well as expected, and reset the process of assessment and diagnosis. You patients need to understand that you are not giving up on them, and that you are working with them to find a solution. Focus on any improvement, and it will be amplified. Try to use that improvement to build a plan for further positive outcomes.

In summary, I had just 15 minutes to speak in Manchester, and probably bombarded people with too much information, the essence of which was this.

• Build trust
• Listen
• Make goals
• Form a partnership

Use the opportunities that Private Practice gives you to make the best diagnoses and treatment goals, with the most appropriate equipment and technology, and partner with your patients to achieve their hopes and aspirations, whilst exceeding their expectations.