Thursday, November 4, 2010

Questions Are the Answers

Two golden questions that will ensure client compliance, great outcomes, and promote client loyalty!


I believe that in clinical practice there exists 3 golden questions that any client undergoing a course of treatment should be asked with-out fail and with-out exception! I have trained my clinical staff that failure to ask the following 3 questions will seriously jeopardise a client’s outcome, and jeopardise the opportunity that the practice has of developing word of mouth referring and loyal clients.

The 3 golden must-ask (without fail) questions are:

1. What is your expectation of me today?

This must be asked by the practitioner at the start of the initial consultation. I recommend that it is asked after the practitioner has given the client a brief overview of what the sequence of the consultation will entail (eg. history, examination, treatment, and recommendations).

Remember that our client’s will judge us not on how well we manipulated their thoracic spine or mobilised their talo-crural joint but rather their judgement will be based on did they get what they expected? If your client has raging discogenic lower back pain and they have heard that their friend with ‘the same thing’ was ‘fixed’ with one session, than it is critical that the client’s somewhat unrealistic expectations be put in perspective.

I can think of numerous examples where clarifying my client’s expectations in practice have resulted in great clinical outcomes and compliance with the proposed treatment. Conversely I can recall my earlier days of practice where I did not ask this question or clarify what my client expected of me and I was surprised to find that the client had not rescheduled or was not ‘over the moon’ with what I believed was a great start to their care. Fortunately I learnt the above lesson early in practice and I now ensure that my physio team ask this no matter what!

If you do not ask this question and even better clarify the client’s expectation by paraphrasing it back to the client (which shows you have been listening and are attentive and engaged in their care) than you are about to start the therapeutic relationship based on your often incorrect assumptions! Remember unmet expectations are the sole cause of disappointment in clinical practice and all areas of life.

For even greater effect after you have listened to the client’s expectation (and hopefully noted it in their case notes in BOLD!) ask the following question…..

2. Why is this (the client’s expectation) important to you?

The answer to this will reveal the why behind the ‘what’ or in other words the client’s ‘buying motivation’- the reason why they drove themselves across town, and allocated an hour of their day’s valuable time to come and see you. This buying motivation is synonymous with the clients ‘goals’, however a wise clinician will make clear distinctions between the client’s goals and that of their own goals for the client.

In life people will be motivated by either pleasure or pain. In allied health (especially physiotherapy) it is normally pain that prompts a client to seek care. Discovering the client’s ‘driver’ or ‘motivation to get better’ is critical in ensuring compliance with the administered and recommended care that you prescribe.

Imagine the client who is scheduled for an international 5 hour flight next week and would like to be able to sit without back pain, and not have their lower back pain hinder their first holiday from their small business for 5 years. How compliant would you envision this client’s to be with your recommendations. Or, are the client’s grandchildren visiting form interstate next week meaning that grandma will need to repetitively bend and pick up their grandchild? No matter what the client’s ‘buying motive’ for seeking your services it is our job to discover it, record it (also in BOLD), and tattoo it on our eye-lids such that we make reference to it a every session through the episode of their care.

The recording of the client’s expectation and the reason why their expectation must be met can be recorded simply in the client’s case notes. Even better is to give the client a written copy of their expectations/goals for their own home reference. The Back In Motion Health Group ensure that every client has their goals recorded for their own take -home use by way of presentation of a personalised ROADMAPTM brochure in which the therapist in consultation with the client develops a pathway of care that will reach set goals in order to meet (and ideally exceed!) the client’s initial expectation.

Asking these two questions will ensure that you get off to a great start with the client practitioner relationship. If the client believes that you have not just a ‘good’ or ‘rough idea’ of the outcome they want from your services, but rather you have an intricate understanding and appreciation of their reason for seeking your care. Remember you can paraphrase the client’s expectation back to the client initially and then skilfully make further references to it at the time of future appointments. I caution any health practitioner from commencing an initial consultation without asking these two questions.

Next blog I will reveal the question that MUST be asked during follow –up appointments for the ongoing fostering of healthy client-practitioner relationships and the minimisation of the client dropping out of your prescribed care plan.

Jason Smith

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