The psychological impact of an injury can be profound, and the way that injuries are explained to patients has a significant impact on outcomes. Patients sometimes come in with prescriptions and are left feeling hopeless or dejected by their diagnosis. Keeping the conversation positive and laying out the roadmap to recovery are imperative to create buy in to a plan of care.
Here are 4 terms you should consider minimizing in your Initial Evaluation, and suggestions for how to optimize patient education.
We often encounter those patients who have been told “You’ll never do ______ again.” More often than not, there is a way to at least partially restore the function in question. Never is a heavy word that should be approached with caution.
First, assess if there is any absolute contraindications or MD orders in the patient’s history. If there are no absolute roadblocks, assess relative contraindications and co-morbidities. Once a thorough physical therapy examination is completed, find a solution to either achieve the goal activity, or modify the goal activity so that it can be performed safely.
This one comes up a lot in patients with radicular symptoms. They have been told that they have nerve damage. When describing radicular symptoms, the word “damage” can imply that it will be there forever.
There are instances where a direct nerve injury (trauma, laceration, SCI) will cause permanent changes. However, patients with extremity symptoms due to inflammation, disc derangement, myofascial restriction, or facet dysfunction can perceive the concept of nerve damage as permanent and irreversible. We know this to not to be the case in many instances, and this terminology puts the patient at a disadvantage psychologically.
If a patient’s chief complaint is chronic “nerve damage,” find the cause and educate the patient. Alternate terminology to go to in discussing nerve involvement is irritation, inflammation, narrowing of space, or postural stress.
Tears are frequently dealt with in the orthopedic realm, but it is important to make the distinction between types and severity of tears. Many people will assume that a tear automatically means something ripped.
It is essential to determine the grade of the tear and/or the thickness level (partial thickness, full thickness, rupture). It is also important to describe a tear that happens due to wear over time vs. an acute rupture. Patients may fear that if they move incorrectly, it will tear more.
Patients who come in with prescriptions that say “tear” should be educated on prognosis based off severity level and reassured of recovery. Strain or sprain may have less of shocking effect then saying a structure is torn.
4. _______ is Out.
Even if a patient presents with significant postural dysfunction, telling him or her that something is “out” or “out of place” may create fear of movement and further the dysfunction. The most common context is either “I threw my back out” or “My disc is out.” The initial step here is to identify the structure involved, because it may not be the disc at all.
There are multiple causes of shooting pain in the extremities. If the disc indeed is the most likely culprit, still avoid using the word “out.” Explain the anatomy of how acute disc exacerbations can occur. Explain that lumbar MRI findings are common, even in asymptomatic people, and reassure your patient that your plan of care is going to help.
Why PT vocabulary is important
In summary, placing negative sounding labels on a diagnosis can have an impact on a patient’s motivation and compliance with plan of care. The physical therapist’s role is to help patients understand their diagnosis.
Personally, I use computer images, apps, or models to walk my patients through their diagnoses. You can really make it your own. Then, I create the plan of care to review with the patient. This way, they can be confident that they are capable of getting from Point A (the evaluation) to Point B (the goal at discharge).
Your patient should leave an initial evaluation understanding both what is happening and what will be done in physical therapy. Building rapport with an apprehensive patient, especially through the use of positive language, will go a long way towards starting things off on the right foot.