How To Build Trust With A Patient

Communication Tips for PTs

“It is recommended that every health professional establishes a therapeutic relationship with a client-centered approach with empathy, unconditional regard and genuineness.”

A key mentor of mine referred me to read “Chapter 3: Communication and the Therapeutic Relationship” from Maitland Vertebral Manipulation Management of Neuromusculoskeletal Disorders.


This is important to all clinicians because the relationship and tone set from the initial evaluation carries throughout the rest of the patients’ care. I have highlighted the areas that stood out most to me and will elaborate on my own personal reflection/experiences of each of these points. Some of these, I had discussed in my YouTube video prior to reading this chapter.


Goals should be created with instead of for the patient. During the subjective, goals should be determined based on current functional limitations. Discussing the parameters (time, level, or pain) should be established collaboratively with the patient. Goals should also be discussed between treatment sessions to ensure there’s progress towards the end goal instead of only at the initial evaluation and progress notes. 


Communication should be given at the patients’ level of thinking. Speaking in medical terminology may reduce the patients’ engagement. The use of metaphors or analogies have been helpful for me to describe a PT diagnosis. Be aware that patients may feel embarrassed to ask you to clarify something if the topic has already brushed over. Ensure there’s time taken to give patients time to ask questions before the end of the session. 


Clarify meanings versus assuming. Although we, as PTs, have a symptom list readily available, the patients often do not and have a hard time describing it. Ensure that you fully understand what it is they’re trying to say by asking specific clarifying questions rather than assuming.


“Hearing is passive, listening is active” 


Should pain be a topic of discussion? Some patients fixate on pain and measure their progress only by pain. So it is a choice for the clinician how to present this as a question and how often to discuss this topic. As a new grad, I used to ask patients their pain level at every session. I realize the number was slow to change. When I started asking about functional progress, I started to realize a faster change and fortunately, the patient would too. 


Letting the patient have a say in the decision on the intervention. I implement this technique after establishing a few sessions and if I’ve used different treatments, I will share with the patient my “agenda” for the day. I’ll list my plan for interventions and purposefully leave one out and then ask the patient if there’s something they’d like to incorporate. Sometimes they ask for the intervention I leave out, sometimes they go along with my plan. It empowers them to make decisions within their care or be able to voice if they’d rather change the direction.


Attention needs to be given not only in what is said but how it is said. Emphasis on keywords can be very impactful on a person. If you emphasize “abnormal,” the individual may fixate on that. Or, the tone in how a sentence is given can be interpreted differently between individuals. Also be mindful of body language because there’s a lot to be said with how your body is positioned, what your hands are doing, down to even the wrinkle between your eyebrows. 


Ensure the patient knows what and why tests/interventions are performed. I will never forget the one time I was being mentored and taking a patient through an exercise. My mentor asked my patient, “do you know why you’re doing that exercise?” The patient responded, “because Pauline told me to.” My eyes got so big and I felt so embarrassed. This was a big learning moment for me because I know why I gave the patient that exercise, but it’s equally important the patient does too. If the patient knows how that exercise is going to help him/her, the more likely he/she will do it as part of their home exercise program.


This chapter provides other insightful and researched evidence for the art of communication. This write up is to share my perspective and experiences on what I found to be key points. Please refer to the reading for more details. 


Considerations for Orthopedic Residency Program

After PT school, I spent two more years in an orthopedic residency program. Why? Because I want to give my patients the best PT service I am capable of an the residency was an avenue to achieve that. It is like an accelerated route into becoming a stronger clinician because you get to learn from other PTs and have a structured course work in a specialty of my interest.


150+ hours of mentoring by a skilled and experienced clinician. Mentoring entailed shadowing treatment sessions and evaluations with immediate feedback. The quality and relationship established with the mentor is a large part of the value you’ll gain from a residency program. Communicate early with your mentor your preference for learning.

Structured curriculum. I was pursuing my Certification of Manual Therapy and the coursework aligned with the residency program. This gave me funding, a timeline, and a commitment to completion of the certification.

Networking. Meeting other PTs in different locations and clinics added fun to the experience.

Cost is always a factor but consider it an investment in your career. I am more confident in myself as a PT after completion of the program.


Additional Considerations

Cost. See if your company will financially support you with some sort of tuition advancement program. Most likely it will be in exchange for your commitment to the company for a certain period of time. In my case, my paycheck was deducted for two years and I’d be paid back each paycheck for 2 years if I stayed with the company.

When should you start. When you’re ready! I started one year after graduation after I developed my own style for treatment/evaluations. I attended the Level 1 courses through NAIOMT and the residency I chose carried onto Level 2 courses. So it flowed well for me. It’s valuable to work for a company for some time before asking for such a large benefit. Show them your worth and dedication. Also this is a time for you to ensure this is a place you can see yourself working long-term.

8 Things To Look For In A Job

I have accepted a new job at a different company. The pressure of being laid off led me to search for other opportunities. Within the first two weeks, I had applied for 15 jobs. Jobs of all different settings. I applied for skilled nursing facilities and home health which were intended to be temporary.

When I wasn’t getting responses from them, I started to apply for outpatient orthopedic settings and was offered an interview. Upon reflection of the things I value in my career, I realized this company could offer me more.

Here’s a list of items I value in my place of work:

  • Competitive salary: because 𝗜 𝗸𝗻𝗼𝘄 𝗺𝘆 𝘄𝗼𝗿𝘁𝗵 and I work 𝗱𝗮𝗺𝗻 𝗵𝗮𝗿𝗱.
  • Schedule: work-life harmony. How much work/stress is being brought home? Can I stay productive M-F so I can enjoy my weekends?
  • Continuing education: I need a company to support my thirst for learning. Opportunity, financially, and moral support.
  • Friends with co-workers: We spend so much time at work! I want to be able 𝘁𝗼 𝗲𝗻𝗷𝗼𝘆 𝘁𝗵𝗲 𝗰𝗼𝗺𝗽𝗮𝗻𝘆 𝗜’𝗺 𝘄𝗶𝘁𝗵 and be happy/laugh with them.
  • Commute: within reason but otherwise have some great podcasts to listen to.
  • Room for growth: Are the people around me motivating me to be better? Will I be able to become a Clinic Director?
  • Mentorship: [Can you tell I want to keep learning?] I want to have a role model to look up to and give me methods to become a better PT. I’m the type to need a pat on the back sprinkled in with constructive criticism.
  • Networking: Am I meeting 𝗶𝗻𝘀𝗽𝗶𝗿𝗶𝗻𝗴 𝗶𝗻𝗱𝗶𝘃𝗶𝗱𝘂𝗮𝗹𝘀?

Since COVID-19 has patient volumes still low, we haven’t set an official start date yet. I am anxious to see how I fit into the new place.

Waitlisted for PT School?

If you were waitlisted for your grad program… don’t lose hope. I was waitlisted up until the week of orientation. Yep. I got the phone call in August the week before the semester started.

I was in the middle of studying for a final (class I was retaking for a better grade) with Hung. I received the phone call at about 12pm and needed a response by 5pm that day so they could let the next person know if I declined. When I hung up, I started crying with joy. His response to me was along the lines of, “well obviously you’re going.”

I was in Eugene, OR renting an apartment and had a work shift the next day. My first call was my boyfriend at the time (now husband), Jay, who didn’t answer because he was at the gym. We were living 2 hours away from each other so I asked his mom to go find him to tell him to answer his damn phone.

I called my mom and she had the exact opposite reaction. “No, you’re not going. It’s too far and too last minute. You can try again next year.”

I called someone I knew from UO that interviewed the same time as me and was accepted into the same program. Monica ALSO was at the gym. When she got my 5 missed calls, she answered with warm support. She said she’d let me stay with her until I found housing. She even picked me up from the airport.

When Jay finally called me back, he said he’d fully support whatever decision I would make. He said he’d drop everything and move with me to California if I chose to go. By 5pm, I was on the road back home. Called into my job to quit and to find coverage for the rest of my shifts, emailed the professor for options on how to take the final off campus, and bought a ticket to California for the next day.

My waitlist story was INSANE but I still got in.

How COVID-19 Has Affected Me

I was laid off a little over two weeks ago. COVID-19 hit our clinic so hard that our schedules dwindled down to 5-7 visits per day when we were steadily seeing 12-14 patients per day. I understand where my director was coming from and knew that he had to do it to keep the clinic running.

However, it leaves me with a MOUNTAIN of PRIVATE student loan debt, a home mortgage, and NO income. Having a private student loan means that I don’t get the interest waived and I don’t get to postpone my payments like if I had federal loans. So I still have to somehow come up with monthly payments.

I’ve been beyond stressed and trying to keep busy. I am now in a weird transition looking for work in a time when hiring for PTs is at an all-time low.

I wanted to share my journey with you because it’s real and I think a lot of other people are going through this as well. I want to let you know that what you’re feeling is valid and that YOU ARE NOT ALONE.

I’m going to share what I’ve been doing to stay productive and what it’s been like to look for work again.

My husband encourages me by reminding me that this may be a blessing in disguise, so for now, I’m working on embracing this idea and taking it one day at a time.