The myth of the micro-managing client

We’ve all had clients or patients who seem to want to script or control the session, telling us what to do, how long to do it, and always asking for different levels of pressure—telling us how to do our job. What to do about this person??

How about listening to them?

I used to see that patient as controlling and keeping me from doing what I was trained to do. But lately, as I dive into newer models of intervention, I see what they are trying to do as contributory to the session’s benefit. Many models, be it manual therapy, exercise, or pedagogy, set up the clinician as the expert, the one who knows how to figure it all out. These same models also tend to diminish the patient/client’s input, as they are not experts in the clinical domain, which the therapist excels. Many patients sit silently, allowing our expertise to shine through while others never shut up. That latter patient used to drive me crazy. Now I encourage all of my patients to be verbal and take a stance. 

We are all experts in our domain, which allows us a certain latitude of judgment. But no matter how much I know, how many years of training and experience I possess, I will never know what my patient is feeling, is fearing, is expecting, and hoping for until I ask for their input. Does patient input alter the outcome of a clinical encounter? There is a fair amount of evidence to say that it does. The evidence-based practice (EBP) model is set up to allow patient input regarding their values and expectations, but I see most clinicians as downplaying patient input significance. “How’s the pressure” does not meet the standard of clinical excellence for applying EBP principles. It takes a lot of work to pry feedback from some patients, but little effort at all with others.

So, what about you? Do you get annoyed by your micro-managing patients? Or do you see them as helping you do your job better?

Cheers,

Walt Fritz, PT

Foundations in Manual Therapy Seminars and The Pain Relief Center

www.waltfritz.com

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