“It takes a while to hear a person’s story and for that person to tell it, and like most stories it bounces all over the place before you know what the plot really is.” ​
Lori Gottlieb

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When I order a coffee, I want a coffee.
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Preferably, a single-origin pour-over from Kenya or Ethiopia.

I don't want a conversation about politics, theology, or Andy Reid's unwillingness to move away from an RPO-style running game.

I want coffee.

Patients don't come to us looking for caffeine, but they do come with expectations about how we will work together.

What's this really about?

In school, you are taught that patients want answers to four questions.

• What's wrong with me?
• How long will it last?
• What can I do for it (patient)?
• What can you do for it (provider)?

Straightforward questions that are important to cover with any new patient.

Most patients consult clinicians seeking a simple fix for their problems. Runners are analytical people who want reasoned, practical solutions.
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Typically, they seek exercises, stretches, different shoes, or some small training tweak to solve their problems.

Most patients assume these simple fixes they've often seen on social media are the answer to their problems, and sometimes they're right.
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As I've spent more time with people, I find these simple solutions are less common, likely because runners have so much information at their disposal through their phones.

Let's make sure we're on the same page

I start every patient encounter with the same question.
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​"What are you looking to get out of our time together today?"

Patients come to us looking for something. We'd better make sure we know what they're seeking.

Charles Duhigg describes three kinds of conversations we have and how miscommunication occurs when people engage in different kinds of discussions.

Duhigg classifies conversations as coming from

• A decision-making mindset
• An emotional mindset
• A social mindset

We can apply those same three mindsets to what patients require when seeking treatment for an injury.

• A decision-making solution (treatments, exercises, training modifications)
• An emotional solution (expressing how they feel and having someone listen)
• A social solution (a change in their relationship with something)

When you sit with a person, you can feel when there is more going on than what's written on their intake sheet.

Duhigg states,

"There comes a time in many conversations when you have to decide, will I allow this conversation to turn emotional?"

How do we feel?

Patient encounters can turn emotional.

It's not uncommon for runners to cry during an evaluation as they share their frustrations with their injury and current situation.
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Running injuries are often whole-body experiences.
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Sometimes, simply having a heartfelt conversation is the best intervention we can provide.

But you have to be willing to move from a conversation based solely on what interventions can solve a patient's problems to an open dialogue about things beyond running.

Runners are rarely heard when entering the medical system. Before we rush to intervene, we need to shut up and listen.

Who are we?

The most challenging patient encounters occur when an athlete's approach to sport no longer works.

This can happen as they move through different stages of life, face greater demands at work or at home, or are at a different mental stage than a previous version of themselves.

Answering "Who are we"? may require an athlete to actually see a doctor, change their approach to nutrition, or develop a new relationship with training.

Are you a clinician or a chatbot?

If you treat patients, you have to be willing to have difficult conversations.

The author Shane Parish states, ​
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"Kind people will tell you things a nice person will not. A kind person will tell us what holds us back, even when it's uncomfortable."

It is very easy to smile, prescribe a few exercises, and send them on their way, without ever addressing an underlying problem that likely exists.

If we look at the future of PT, the ability to call it like it is (in a kind way) is a rare skill that sets us apart from the AI-generated providers coming in the near future.
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Before you know it, AI will happily share out the best exercises, self-mobilizations, and a return-to-running program for every condition you currently treat.

The only thing that will set providers apart from our devices is the ability to listen and connect with the person across from us.