This week, I’ve been engrossed in the enthusiastic tweets coming out of the American Physical Therapy Association’s Combined Sections Meeting. And so, I wanted to take an opportunity to reflect on what’s happened in the year since I spoke at CSM in 2016.
In 2016, Jerry Durham offered me a spot on his CSM patient panel to discuss my experience with persistent pain. I’d never met Jerry, but we were connected through a string of professional and personal acquaintances, and I agreed to do it. I’d fantasized for years about having a captive audience of physical therapists who would listen to my story, learn from it, and apply it to help their patients “What’s the worst that can happen?,” I wondered. Fast-forward several months to CSM: I’m standing on a stage in front of a roomful of PTs. (Enter: many people’s worst scenario = standing before a room of strangers about to discuss your vulvar pain.).
I’m an attorney, but after a brief experience with courtroom litigation in law school, I’d long ago sworn off public speaking as my life calling. So, I brought a bundle of nerves, a hefty outline, and a very personal PowerPoint presentation into the convention hall that morning. I was wearing make-up (which I never do), had my hair curled (which I never do), wore high heels (which I never do)… you get the picture. I wasn’t sure how people would react to hearing my story, and I felt very under-the-microscope. Surely, a roomful of PTs would be able to sniff out somebody who wasn’t really as healthy as she claimed. It’s as if I wanted my appearance to convince them: “I’m healthy now! Don’t think of me as a patient, because I’m not a patient anymore! See, I’m even wearing heels and have good color in my cheeks.” If it sounds nutty, well… I was really sick of being seen as sick.
I cleared my throat and nervously managed to spit out my name. My first slide, reading “Patients are people.” was displayed for the room. But as I looked down at my outline, I realized I didn’t need it. I already knew my story, and I had spent 10 years thinking about the lessons that my story represented for other providers. So, I walked away from the podium, kicked off my high heels, and told my story.
Some have asked me if it was cathartic to share the story of my experience. Strangely, no. But I didn’t expect it to be. I had worked through the trauma of my pain experience already and had recovered emotionally. In fact, the idea that it could be cathartic for me to share my story with a roomful of providers who I didn't know counteracted my very message. Many providers made me worse, not better, and as a general rule, I’d learned to not rely on them to help me. So why would I approach a room filled with providers to make myself feel better? I wasn’t there for me. I was there for the other patients in pain, out there in the world, who needed me to share my story for them.
The response I received to my talk was incredible. I’ve met providers from around the country, been interviewed on podcasts, and guest-blogged for organizations. I keynoted the Michigan Physical Therapy Association conference in October, I’m keynoting the New York conference this fall, and I’m speaking at PT conferences in Illinois, Missouri, and Florida in the interim. Thousands of people have visited my patient experience blog. I’ve spoken with pelvic pain patients from Australia to Colorado who have told me that my story is their story, and that in sharing my story, I’ve given them the words and tools to better communicate with their providers to advance their own healing. Physical therapists with pelvic pain have reached out to me!
Next came the law firm.
When I spoke at CSM, I introduced myself as a “recovering lawyer.” Until that point, my law firm jobs had been largely incompatible with self-care, so I had quit my high-brow job and gone to work for a dog daycare. But in the weeks following CSM, physical therapists started asking for my help with legal or compliance issues, and soon the demand for my help was greater than I could handle alone. My husband, Connor, left his law firm job, and we founded Jackson LLP, a healthcare law firm in Illinois. We soon also founded Jackson Compliance, which helps providers around the country with compliance and consulting issues.
About 90% of our clients are physical therapists, and we’ve become happily immersed in and familiar with the issues near-and-dear to their hearts: direct access, scope of practice, HIPAA compliance, cash-pay practices, the therapy cap. I spend most of my days strategizing with PTs about how they can make their practices more patient-centered (which in turn increases their revenues and the number of return clients they see). Connor has a finance and litigation background, so he works to create business plans that reflect their dreams and to minimize risk (which in turn decreases the chances they’ll get sued). It’s a perfect combination, and we’re delighted to work every day, all day with physical therapists.
2017: The Year of Relationship-Centered Care
After last year’s CSM, some proclaimed that 2016 would be the Year of the Patient, and with the reception that my talk received, I think it was. In 2016, I was asked to share my story on podcasts, as a guest-blogger, and at another conference. But if 2016 was the Year of the Patient, I think 2017 is the Year of Relationship-Centered Care. That is, while last year was about you seeing your patients as ordinary people, I think that this year will be about building relationships with your patients. The patient’s experience will be folded into the larger concept of relationship-centered care, where relationship-building will be placed at the epicenter of provider education and practice management. These relationships will improve the quality of care, increase providers’ at-work satisfaction, and stabilize patients’ confidence in their providers. It’s a win-win-win.
This is an evidence-based supposition. In 2016, I was asked to share my patient story in a very ‘human interest’ fashion; providers were waking up to the importance of listening to patients. But in 2017, I’ve been asked to teach ‘real’ educational sessions with learning objectives and measurable outcomes, and those talks will integrate my personal experience as illustrations of my lessons. I’ve already been asked to speak at a few 2018 conferences too, and those will be my first multi-disciplinary audiences, where I will broaden my lessons to include providers of all stripes. These trends, to me, represent the greater trend in healthcare toward measuring and grading quality based on patient experiences. And I find that so exciting.
Critically examine the nuts and bolts of your practice. Do you integrate relationship-based models of care into your everyday clinical practice? Does your secretary’s phone script and attitude reflect your values? Do your intake forms ask for relevant information in a non-offensive way that conveys to the patient that their answers matter? (I often create my clients’ intake forms to blend the technical with the relationship-centered, and it’s one of my favorite projects!) Is your office environment respectful of your patients’ privacy and their caregivers’ needs? What’s your process for offering referrals to other providers? Does your model of care encourage patients to ask questions and (gasp!) to challenge you when they have concerns? Do your PTAs and support staff have an easy-to-read policy manual that articulates your practice philosophy and the relationship you want them to have with your patients?
After examining how reflective your practice is of your relationship-based philosophy of care, it’s time for some action steps. Remedy deficiencies, get help when needed, and collaborate with your team to ensure that everyone’s on the same page:
Patients matter here, and our relationships with them matter the most. We listen, we reflect patients’ values in treatment, we harness the full scope of our professional expertise to help them, and we refer out when necessary. We build relationships here, and it’s those relationships that best serve patients, that create enriching professional lives for us, and that move healthcare forward.
If you want help, please reach out. I’m here to support you – just like your profession was there for me.