Setting Bigger Goals With Your Patients

This podcast will help you to become more confident with your patients , more successful in your practice or business and a leader in pelvic health , and we're going to have some fun along the way . Join us as we rise together .

We're Jesse and Nicole Cozine , founders of Pelvic Sanity Physical Therapy and the creators of the Pelvic PT Huddle , and this is Pelvic PT Rising .

We had a listener ask if we could talk a little bit more about this and you asked we deliver . Always love hearing from you guys , so we're going to dive into that today . Quick announcement before we get started If you are listening to this and haven't yet added yourself to our practitioner map , make sure you do that Pelvicptrisingcom slash map .

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This is something that's pretty I'm pretty passionate about , because , if you take a look at the patient journey , there's a lot of what patients go through that we forget as practitioners , and one of these areas is their shrinking worldview based on their pelvic health concern , and so we're going to talk a little bit about seeing goals for patients that they can't

see for themselves , and how we go about doing that and how we communicate to patients .

But you guys tend to take a pretty narrow again as a broad generalization at least to me as an outsider a pretty narrow view of what it is you're going to do . It's like oh , you have this problem , I'm going to fix that problem .

We are so focused on asking the patient what do they want and crafting goals based on what they tell us that we've limited our scope that way as well , where not only have we limited our scope to I can only help you with these very specific rehab goals that I've written perfectly so this insurance company doesn't deny me but then also only what the patient tells

me . And when we're asking patients , what do you want , what do you want to do ? What do you ? Who do you want to be ? What do you want to participate in ? That could be really difficult for somebody that has had this shrinking world when they've had a pelvic floor condition and it doesn't even have to be a dismal shrinking world .

I mean they can still present in your clinic as a very happy go-getter type patient , but they've limited what they're doing based on their pelvic health condition .

So , for instance I mean a classic example would be stress , urinary incontinence Someone that has that isn't getting the bounce house for their kids for the birthday party because they don't want their kids to have to ask them to go in it and then have them have to say no or to pee all over it and it's going to be a problem , as just one example .

But I think where this also comes in a ton is in our pelvic pain patients world , where they suddenly are not going out to dinner , they are essentially socially isolating and they don't even realize that they're doing it .

And I think that then when you ask them , what do you want to do , that's actually a really difficult question and it's hard for us to understand , like why that would be so difficult . Oh my gosh , don't you want to do all of the things ?

And I think that sometimes , if the answer is yes , they're scared to say it because they have failed so far at being able to get back to those things . They have ended up creating essentially this suboptimal life and then they can't see past that suboptimal life .

You want them leaving a better person having a better life . Talk to me a little bit . Where did that idea come from ? Because I think that it's almost like pelvic rehab is the vehicle it's your in . You're able to now work with that person and do more than what they thought possible . Would they even anticipated getting out of coming to see you ?

I think that a little bit because I've always been a little bit of a contrarian in a few insurance company . I am not seeing this person for only six visits . I was always the person advocating for more . I was in my hospital program director's office almost weekly with her being like Nicole , you need to discharge these patients , and I'm like absolutely not .

If I'm going to treat public floor patients like they're not going to be in your orthopedic world of discharge after six visits as soon as their symptoms start getting better . That's not how these patients function . So I think a little bit of that has come from just my advocacy for patients coming from there .

Because I started doing that so early , I was able to see them become literally become different people and I know that many of you listening to this podcast know exactly what I'm talking about .

But if you are someone that's a little bit stuck in the insurance model or not able to see patients through , where they literally become different people and then you see that another person walk into the clinic .

That's in that dejected , angry , sort of prickly phase of life when they first come into your clinic and you know that that's not who they really are . I feel like that's where this whole ethos essentially has come from is that I don't want to just help your pelvic floor . I don't want to just help your pelvis .

I'm here to help any other pain that you have adapted over the years , and I'm also here to help you have a better life . Your stress is going to be managed differently . You're going to advocate for yourself differently . You're just going to change by being involved with this clinic .

And so that's really , I think , something that I've tried to instill in anybody that works for pelvic sanity . That's simply doing some transvaginal work and releasing pelvic floor muscles , whatever that means , and maybe fixing a hip problem . That's not where our job ends . That's not where the patient's life is going . That's not a good goal .

No one would ever look back at their experience at Pelvic Rehab and be like , wow , that hip mobilization was really awesome . They're going to be like , wow , I was able to do X and I never thought I could do that .

You've got to do this , you've got to have these codes on there and your job is done as soon as you can't find measurable pelvic floor dysfunction , to wait a second . You guys all went into the medical field because you wanted to help people . You wanted to do this .

I guarantee most of you guys listening are this kind of way in your personal lives too Somebody who wants to help , who wants to be there for other folks .

And this might be the call to action to say , hey , let's stop limiting , let's see goals that your physical therapy or occupational therapy school didn't see for you , but where you don't have to be limited by what's the diagnosis code for that .

And also , they don't know shit about what their life could potentially be because they're living in this limited world , and so I also don't care about what goals they think that they want . I care about the goals that I can see for them . And how do you get there ? How do you see those goals ?

And it's listening to their story and listening and getting clues from their history , because the way that they're presenting in the clinic is either through a birth experience or something that has a lot of baggage with how things should be and what should be happening and how my life is now going to change because I had a baby , or it's this limited worldview

that's shrinking and shrinking and shrinking because they've had to adapt to . I can't sit down for very long , I can't go out with my friends . No one understands . Everybody that I tell thinks I'm a whack job , right , so now . So I'm not going to say anything to anybody anymore because they're going to laugh at me , whatever .

So , like now , we have these shrinking views of what's going to go on , and then when you say , what do you want , that's the output that you're getting . So what we really need to do is step back and look at clues in their history of who they used to be .

What did they want to do , what were their hobbies , what happened before this that we can use to get insight into what their future life is going to be like .

Tell me about that .

This doesn't all have to be this like distraught , huge , crazy loss , but it certainly is in a state of change and a state of losing a function , right .

And so one of the stages of loss is bargaining , and a lot of times where this comes in is in their heads for a very long time they've ended up having to be like , well , I've been trying to run , let's say , without incontinence , and well , that's not working and so , but you know , if I could just jog with my kids , like that would be good enough .

And then like , if that doesn't work , then it's like , okay , well , I just need to be able to like walk and go to the store and wear whatever I want to wear and not have to wear a pad , and like that's it .

And it just keeps shrinking and shrinking and shrinking these goals because they're essentially bargaining with their life about well , that didn't work when I tried to do it myself , or I went to a poor rehab professional , or that doctor told me that that's not possible .

And so they're in this like bargaining phase , and then they finally are coming to you , and now that most recent low bar bargaining chip that they have is the one that they share with you , and that's where it's like well , what was that ? What was did that used to be like ? What was that first bargaining piece that you thought that you could do ?

I want to know that .

So but what did that goal used to look like two years ago ? Five years ago ? For some folks two weeks ago , because this can spiral downhill pretty fast .

You're actually looking at their past for clues to see who they really were not maybe who they want to be or think that they might be .

That's not that bullshit , but what it is is looking for clues to see what their past life looked like , what their , and not like past life , past life , their actual life before this condition what did that look like ? What do they love to do ? What do they used to do ?

And as an example , right , say , someone would come in with penneleuralsia and a lot of times that starts with intermittent tailbone pain , sciatic pain , hamstring injuries , groin strains , whatever , and so you might have somebody with that can't sit right now . That is in a pretty bad place .

But you start talking to them about three years ago , when they were working out consistently and they got sidelined by a nagging sciatic nerve pain problem , that it's like cool , what kind of working out were you doing ? Oh , I used to love going to blank . You know orange theory . Or I used to do these boot camp workouts with my sister and right .

So now it's like , ok , cool , you are building this picture of . There was this person that who , three days a week , used to go out and do some high-intensity interval training . That means squat , jumps and running and sprints and squats and lunges and whatever the hell else you do in those things , right . And so now , if you say what do you want to do ?

And they say , gosh , you know , if I could just sit and work without pain , that would be like so awesome . Then that's a good time to be like OK , and what about If we could do that ? Then what about getting back to exercise ?

Are those high-intensity interval training kind of boot camp things , something that you would love to get back to in a perfect world ?

Sometimes they say , yes , now , I will say this as a caveat this can backfire if you do this to the wrong person in the wrong mental state , right , you can't say that and somebody is like really having a hard time in a bad way and that can seem like too much cheerleader . You eat too much wishful thinking stuff .

So you need to definitely assess your patient's readiness to see the life outside of their current situation , right ?

So that might be something that you are tabling for now in your own brain , talking about the goal that they are telling you they want to do right this minute , and then you're going to take away some of those other things that you know from their history , and you're going to be like I'm going to bring that up a little bit later , when they're a little bit

more ready to hear it , when we've gotten a couple of quick wins out of their case , and then we're going to bring that back up right . So you got to be a little careful with this , but the goal is to get clues from their old situation .

And putting that aside in a perfect world , if everything goes perfectly , what happens ? It helps to frame . It helps them to get out of their current situation and think just a little bit into this alternate universe situation that I'm working out of . Right . And so , in a perfect world , what would that look like ?

And every once in a while you'll get a person that's like actually no , that's long gone for me . It's something like , too , if you heard that somebody used to do a marathon or whatever , then you'd be like okay , is that something you like to get back to ? In a perfect world , would you sign up for a marathon two years from now ?

And there are no , my days have passed , I have a bunch of old knee injuries and whatever else . I actually don't like running that much . I was just doing that for my sister and that was in the past .

It's like okay , cool , well then , now we can talk about something else , that knee pain , for instance , and how that might influence some of your foot and pelvic floor symptoms . Or you can be like and what else would you do for exercise then ? In a perfect world , what would you really want to do now ? And then you can get into .

Oh , you know , I've really looked into yoga and I feel like that really makes my body feel better and my best friend does it , and but there's no way I could do that now with this penenal pain or whatever it is .

And so those are the kinds of things that where you're just starting a conversation and then going from there and taking the patient's lead on that .

. So if someone is listening to this , nicole , and is a little bit convicted by what you're saying and say , yeah , that's the way that I want to practice , I want to help people not just have a better pelvis , but a better life when they are done working with me , what's the step ? How do we get from here to there ?

If this is kind of a new idea for somebody .

So go back to them , so be like hey . So I know that when we talked before , your goals were ABC . We're working on this one , we've achieved that one , but let's push pause for a moment . And I also say that let's push pause , let's push pause for a moment on the current situation . I want you to think ahead .

You know , a year from now , six months from now , and what does blank look like for you ? What does exercise look like for you ? What does work look like for you ? What does that look like for you in the context of your current symptoms ? Like , what do you really want ? And then use that perfect world language .

In a perfect world , where would you be working ? What would you be doing ?

And you can do some true like , essentially like life coaching a little bit out of that , because , by the way , you're all life coaches , you're all health coaches in addition to being physical and occupational therapists in pelvic rehab , and so part of that can be used then to work backwards into what you're gonna work on , and you choose things that you can work

on with them , and then that becomes the new thing that you're working towards . But I would just go back to everybody and just be like hey , I don't know if I did a good job of this , maybe you did , but like , let's revisit it regardless , because people are in a new state now .

So if you've been working for somebody for three months , for instance , their worldview has now changed , hopefully because of the positive changes that you've made in their pelvic health , and so now we just need to take a step back and be like hey , what else do we wanna work on here ?

Also , that goes into some phrases that I think sometimes we forget to talk to people about and to talk to our patients about . We've already done a podcast on you're doing a good job . We've also done a podcast on hey , I can help you . Don't forget to tell your patient that .

So in this way , if someone says , oh , I think I wanna get back to this gym situation , then you can be like awesome , I can help you with that if you want me to , and we can certainly make sure that you can do that , and we can monitor to make sure that these pelvic health symptoms that we've been working so great to get to go away will now stay away

even when we're working on that goal . And then they're gonna be like oh my gosh , this is so great . I didn't know you could do that . I didn't know you could do that . I thought I was gonna have to work with a personal trainer or something . Be like nope , we can totally do that right now .

And there is that partnership then that you have through their lifespan . That's it , that's our gig , you guys . That's what we are meant to do in

this field .

I love that phrase that see beyond this suboptimal life that they've adapted to and help them to see something a little bit beyond that . So we love that idea . I love that for you guys . I think that is so satisfying . It's really interesting to even just see that within the clinic and see that in the faces of those who come into pelvic sanity .

So I hope that is helpful for all of you guys . As always , we'd love to hear from you . Let's keep this conversation going .