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Since he improved after the last visit, I saw him for this follow up only 2 weeks after the last treatment. Pain mostly a 0, at worst 1, morning stiffness 0. Wow!

See how much he smiles? He is so much happier. It took a while, he is believing he can have good future.

Dr. Brady exit interview: Work the case to zero, or maximum medical improvement. Please don’t quit becaue they are just ‘much better’!

6 Comments

  1. Seth Schultz, DC

    Man, seeing how you communicate the importance of sit, slide, lean and rehab exercises etc is phenomenal. Using the phrase “it’s easy to not to (insert postural advice or exercise) when you’re feeling good” helps build the mental model that they need to continue to do the things that got them to this point. Too many times have I had to have the conversation after a patient regressed because they weren’t keeping up with their routine. Phrasing it like that plants the seed before they would even think about not doing what they need to. Once again, thank you for that!

  2. Paul Nottoli

    Thank you, Dr. Brady. This visit especially showed that I have ‘quit” on successful cases I thought were just good enough and not communicate the importance of the strength load management etc to make sure we pursue the score of zero or close to it as much as we possibly can.

  3. Adam Holen D.C.

    Your exit interview is great. The tragedy is that we know how much of a shit show the medical system is, but patients do not. They have to find out the hard way or just assume sub-par care is as good as it gets. Johnny was happy with 60 PT visits and still being in pain with more “rest” as the treatment plan.

    This whole case study has been phenomenal for communication purposes. When you address problems in a clear and concise manner, there’s so much less blowback. That’s where I’ve failed a lot of patients, so thank you for posting these.

  4. Brandon Cohen DC, CSCS

    At the end of the video at about 7 min, when you were going through the close and final instructions, Johnny appears to be giving all the signs of understanding and buy-in. He is nodding, and saying, “yep.” It looks to me as if he already understands the things you are communicating. When is it appropriate to continue to communicate these points, and how do you know when the patient has a complete understanding of the concepts? I thought this part was overcommunicating.

    I have come to learn that patients don’t understand much of what I say, and repetition is key. We have implemented a “perfect 3 x” exercise review to make sure the patient understands.

    Is it that he is feeling so good, you want to make sure he doesn’t get too froggy and do something that could cause a setback? That seems unlikely due to the point he made in the beginning about the shelter at home.

    Was the “I have a friend with a tricked out gym” comment the indicator to remind him?

  5. William Brady, DC

    Thanks for the great comments. To Brandon’s point about possible over communication: Re-watching this part of the video I can see how it might look like I am beating a dead horse but… We are agreeing on EVERYTHING. This was a combination of recap, big picture, pitfalls, future steps, concepts and action steps and took less than 3 minutes. He stayed engaged and is smiling. If he were agreeing but annoyed, looking away, picking up his keys or heading toward the door I would have addressed it differently. It will also be 2 months until I see him again- I want this part of the encounter to be the part he remembers. I also can’t know he understands until I see the agreement.

    Yes, I want to avoid setbacks. He is feeling great, I pointed out a few possible pitfalls and he stated he wouldn’t do any of those things. Successful exchange. I can’t assume he is thinking this or rely on the fact that I said this 6-8 weeks ago.

    Also this is an exceptional patient. He is smart, serious and honest. With a normal patient I would have expected at least one of my points to be met with a challenge, skepticism or least a clarifying question. So this appeared to be a continuous string of complete agreement. Good. Just don’t skip these steps because you think they already get it. Confirm it with the conversation. If you have a ‘perfect 3x’ for exercise why not do the same with communication?

  6. Matthew Lytle

    “Let your body be a zero” Was a great statement. It sums up making sure you keep a healing environment, don’t be in a hurry to get back and made sense because of all of the previous discussions.

    I also realize how much I don’t use the SLPF test as an evaluation procedure outside of the exam. I really need to go back to that especially if it’s a provocative test.

    Lastly treating habits can be created with IAR that make your treatment incomplete. I rarely treat cluneal nerves from superior to inferior. What that really means is I’m not palpating with my hands and the instrument as well as I could and just treating they way I “usually” do, which does not always maximize treatment.

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