Four roles for physiotherapists in their conversations

Communication skills for physiotherapists are becoming more and more a topic in the international physiotherapy. Just execute a short search on the internet and on social media and it will be clear: how you communicate and what you say matters….a lot!
I wrote a book about it (in Dutch!), it’s almost 300 pages! And it’s more than clear that the content of this book fulfils a need in physiotherapy education in The Netherlands. It describes how you could approach the conversation with the client in a structured and methodical way. And by doing this it makes clear what you can do to be effective as physiotherapist.

An integrated model with four roles

In my book I formed a model that describes the different roles and tasks in a structured and integrated way. All this in close relation to the physiotherapeutic consultation. The model provides a fusion of evidence based approaches like shared decision making, motivational interviewing, client education, pain-education and more.
The core of this model are the main tasks every physiotherapistsexecutes during his consultations within the diagnostic and therapeutic process. Silverman (1996) described these main tasks for medical consultation; for the physiotherapeuticconsultation I adjusted them a little bit. That’s because consultations of doctors and physiotherapistsdiffer from each other. Eventually this resulted in 7 main tasks:

  1. Initiating the session
  2. Gathering information – history taking
  3. Gathering information – physical examination
  4. Explanation, shared decision making, goal setting and planning
  5. Treatment (including explanation, instruction and education)
  6. Closing the session
  7. Closing the treatment episode

Some main tasks are carried out every consultation, others are not. All in all, these main tasks nicely reflect the ‘flow’ of our consultations as physiotherapists.

Four roles

Within your consultation you have four roles. You alternate these roles with each other.

Four roles for physiotherapists in their conversationsYou choose a role based on what you want to achieve in the interview and based on the main task of that moment. Maybee it is even better to say that you choose your role because of the (implicit) question of your client.

Here are the four roles, you probably recognize them immediately:

  • confident,
  • coach,
  • communicative detective and
  • teacher

In the coming months I will write four articles in a row, an article every role. In each article I will then elaborate all sorts of details of a role and, of course, discuss the necessary practical implications.

Attitude

Before I close this article, I want to describe the last and probably most fundamental part of the model. This part is about the attitude in our communication. Attitude is, if I put it simple, the conviction and the feeling you have about your assistance and about your client. Attitude is always difficult to describe because it can be quite abstract. In order to make it as clear as possible I have described five views, all based upon literature. Here they come:

  1. As a healthcare practitioner, I focus on the partnership with the client and I act from the conviction that the client has the need to:
    • understand what his health problem entails and is looking for logical connections within it;
    • know what he can do to solve his health problem, reduce it or deal with it differently (Leventhal, 1980);
  2. As a healthcare practitioner I facilitate the client to make choices based upon his own values and I hold the client responsible for solving his health problem (Deci, 2004; Elwyn, 2012).
  3. In the balance between vulnerability and resilience, I support the client to fully address his personal competencies (Huber, 2011).
  4. By exploring and strengthen the intrinsic motivation of the client, I enable the client to change his behaviour permanently (Miller & Rollnick, 2014).
  5. Professional physiotherapeutic communication is methodical (purposeful, systematic, process-based and conscious) and based on scientific evidence (‘evidence based’) (Smith, 2013; Donaghy, 2000).

I can imagine that you have had to read some of the above views twice. In any case, I found it quite a job to describe this well. Our attitude can make or break your conversations. Some people say that our attitude can break a conversation even if our skills are perfect, and vice versa. Something to think about….