No two patients are the same. They possess different experiences, values, and expectations; all must be taken into account. Yet, some tendencies are present across groups. Recognizing these tendencies can be useful when determining how to communicate with someone.
We have preferences for the manner in which we learn and communicate. Introverts prefer one-on-one conversations with low stimulation and ample time to critically assess. Extroverts prefer high stimulus environments and frequent interaction.
As an introvert myself, I am capable of working and interacting in an extrovert habitat, but my performance and enjoyment will suffer. The same holds true for patient preferences. If we try to engage and inform each of them with the same methodology, we will accomplish the objective, but the effectiveness will be poor in many cases.
The following subtypes are described in more detail in Your Medical Mind: How to Decide What is Right for You by Jerome Groopman and Pamela Hartzband. They write through the lens of a physician while I will take a physical therapy approach.
Understanding these tendencies and preferences of your patients can help you better tailor a message and understand the patient’s point of view and values.
I’m a believer vs. nothing does or ever will work (believer vs. doubter)
The eternal optimist versus the pessimist is not a new concept nor will the debate about the value of each ever resolve. The comparisons extend well beyond patient subtypes.
Optimists tell themselves that bad events are temporary and maintain a positive outlook. They are often viewed as opportunists who find the silver lining in any situation.
Conversely, pessimists tell themselves that bad events will last a long time and focus on the negatives of a situation. A pessimist will often describe themselves as a realist and keep expectations low.
In his book Barking up the Wrong Tree: The Surprising Science Behind Why Everything You Know About Success Is (Mostly) Wrong, Eric Barker explains:
Optimists told themselves a story that may not have been true, but it kept them going, often allowing them to beat the odds. Psychologist Shelley Taylor says that “a healthy mind tells itself flattering lies.” The pessimists were more accurate and realistic, and they ended up depressed. The truth can hurt.
Yes, blind optimism can lead to unrealistic expectations, so there is a balance to be had. How does this apply to physical therapy patients?
Believers are the eternal optimist, always believing a treatment option exists for them. They are more prone to trust most recommendations from the clinician. Conversely, the doubter is the skeptic, challenging the efficacy of the recommendation, and wanting to know all the facts. Knowing which one patients lean towards changes your education strategies.
The doubter will be resistant to treatments they are unfamiliar with or do not conform to their expectations, making them more likely to self-discharge at the beginning of a plan of care. On the flip side, we have more wiggle room with the believer, but therapists need to be wary of how this can affect their treatment decisions.
Unconditional trust in our treatments can lead to shooting from the hip and investing less effort into the treatment. The doubter creates vigilance while the believer can foster laziness.
Can’t Stop, Won’t Stop vs. Nah, I’m good (maximalist vs. minimalist)
The maximalist lives by the mantra more are better. This is the patient who wants every treatment you can possibly throw at them. The tricky part is knowing what the “treatment” is and where it is coming from.
A maximalist may be completely reliant on a provider and lack any self-efficacy, seeking every potential treatment for a condition, or a maximalist may live in the gym 3 hours a day and have a gym bag full of all the latest and greatest supplements. Maximalists rarely see the harm in treatments — or at least don’t put much stock into them — only the potential benefits.
The minimalist, meanwhile, cares about the minimum dose needed for a response. They are more apt to use the “wait and see” approach. They are more likely to ghost at the first sign of improvement.
Once they believe they can handle the treatment on their own, they no longer seek care. It can be an abrupt transition. Minimalists will question treatment decisions more frequently and keep treatment plans short, not wanting to commit to more care than may be needed.
Clinicians will likely need to reign in the maximalist and build appropriate self-efficacy. The maximalist will be all ears, but they will also be eager to jump into treatment. Clinicians must ensure the patient is fully aware of all potential risks and benefits.
The opposite will be true for the minimalist. They will require more convincing. Some clinicians will challenge their inner Barney Stinson and boldly claim “challenge accepted” while others will become frustrated at the patient’s lack of trust in their recommendations.
At the end of the day, the treatment goals are the patient’s decision. Our job is to help achieve it in a manner that aligns with their beliefs and preferences.
The latest and greatest vs. tried a true (technology vs. nature)
Technology-oriented patients want the latest and greatest treatment. They are not impressed by experience unless it directly translates to more effective use of new treatments. If a clinician expresses he has perfected a 20-years-old technique and refuses to use the new intervention the patient learned about after consulting Dr. Google, session over.
When speaking to a patient with a technology orientation, the statistics on risk factors and information about a lack of clinical trials for a new technique falls on deaf ears. They want innovation.
Conversely, someone with a naturalistic orientation believes the body can heal itself when provided the proper environment; no fancy technology needed. They seek to harness the mind-body connection and avoid invasive procedures. They are more apt to rely on herbal remedies, lifestyle modifications, and meditation.
In many ways, this can be ideal for clinicians, however, expectations need to be held in check. No herbal supplement will reattach a ruptured Achilles tendon. Meditation does not hypertrophy muscle.
A patient with a naturalistic orientation may also choose interventions outside the clinic that impedes progress in the plan of care. Ever see someone in the middle of a juice cleanse? Your pain and function scores are going to be a little skewed.
Being aware of a patient’s lifestyle and home interventions can help guide the plan of care and in-clinic treatment decisions. Technology oriented patients may even seek to replace physical therapy with the $300 Theragun.
Clinicians will need to highlight their use of the latest evidence, even if exercise and education are not “technology.”
One size does not fit all
While recognizing these categories are beneficial for tailoring patient communication, it is important to note that patients do not neatly fit into a single category; they lie along a spectrum.
Clinicians will often see a blend within a patient. For example, someone may be a minimalist doubter with a naturalism oriented. They will want the hard facts to justify treatment and prefer to allow the body to recover on its own.
Conversely, you may have a maximalist believer with a technology orientation. This patient will always believe a treatment solution exists for him and he continually seeks the newest treatment to try, often self-experimenting.
Knowing your patients’ beliefs and mindset will allow you to better refine your treatments. Groopman and Hartzband describe this process as “judgment-based medicine.” They wrote the following:
We are often asked who is the “best doctor” to treat a particular condition. One criterion is a physician’s knowledge about your condition and its treatments, his or her command of the scientific data, so-called evidence-based medicine. But we believe the best doctors go one step further and practice “judgment-based medicine,” meaning they consider the available evidence and then assess how it applies to the individual patient.
The heterogeneity of patients will always lend to challenges with translating research to clinical practice, but through refined assessments of patient beliefs and expectations, we can improve our chances of success.
