Soft Skills Are Important Too

I am not a psychiatrist or psychologist. But sometimes as a DPT (Doctor of Physical Therapy) the patient has to be engaged at a different level to establish rapport and improve prognosis.

60+ year old female referred for bilateral knee pain. Prior medical history explained history of low back pain. Patient was very firm on no treatment for the low back due to her low back being “frail.” She stated that she has had physical therapy many times before. She didn’t expect anything different.

During the subjective interview when asking about how she hurt her knees and why physical therapy now–since it seemed like it’s been gradually getting worse since the last couple of years–she explained that she was moving a bed for her sick mom. The patient elaborated that she did this all the time but that it wasn’t until a couple years ago that she first felt pain. Her mom had recently died.

In learning more about her prior medical history, I noticed her demeanor and tone when answering my questions. I thought it was because she said that she had physical therapy many times before. But I pointed out my observation anyways. She was amazed that someone was paying attention. She also stated–with subtle curling of her upper lip–of how much resentment she felt for her family not helping her take care of her mom. She added that she was recently widowed. “There! I said it!” she exclaimed.

I paused and looked at her face and her eyes. There was so much misery. There was moisture building in her eyes and her trembling hand covered her mouth. Bravely, I told her that the one word that came to my mind when I was looking at her in that moment was “forgiveness.” Her situation needed either a letting go or a making of amends. And that “forgiveness” was her path to healing.

She lightly cried and happily said with a surprised–but genuine–smile, “I’ve never had this kind of physical therapy before.”

I quickly redirected the conversation to my scope of practice by telling her of what I thought the problems were in regards to her knees. I further did some physical testing procedures to make sure that we were not missing anything. Patellar femoral pain. Meniscus was okay. Some quad weakness due to pain and mild swelling. But this would resolve with treatment soon. Squatting and kneeling mechanics needed a lot of work, not to mention her posture. Hips were weak. Ankles were tight.

At the conclusion of her evaluation, unable to fully read her face and body gestures at this point, I needed to confirm a good prognosis. So I explicitly asked her, “Do you think that your knees are going to get better?”

She said yes.

3 physical therapy visits later, she conceded to getting physical therapy for her “fragile” low back.

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