Time for a new paradigm

As I travel around the country, teaching the various modalities that we cover in our courses, I often find myself having the same conversation with clinicians, about a very real challenge that they face.
That challenge is tied to the realisation that when they learn something new, and decide to change they way they work, that their patient population may not be entirely happy about that change.

Perhaps you are a Massage Therapist who now wants to incorporate Dry Needling.
Maybe you are a very hands on Physiotherapist, who now wants to use more pain science education.Your might be an Osteopath who wants to begin incorporating cupping into your consultations. Maybe you are an Myotherapist who now believes that exercise prescription should be a bigger part of what you do.
All of these changes are common, realistic and potentially very valuable. 

But if that is not what your patients are used to you doing, then what will happen???

When I put myself in this position, anytime that I have learned something new, or come to a realisation that I want to change the way I operate clinically, I have found myself being a bit unsure about how that change will be perceived and if it will result in my patients wanting to go somewhere else.
Well, the truth is, it might. And that is ok.
But there is more to it than that.

Every patient who has come back to see you after their first consultation, has come in with a degree of expectation based on their first experience with you. If you reinforce that experience with another consultation that was very similar to the first, then this is the beginning of the education you are providing to them about who you are and what you do.
Let’s not forget though, that there is likely to be many occasions where you’ve sat down with a long term patient and said something like “ok, I’d like to try something different today”, and they have been absolutely fine with that. 
Their comfort with that change of direction comes from you framing up the reason why, and doing it in a way that inspires confidence in them.

Change can be scary, especially when it is unexpected.
If you just suddenly start doing and thinking like a different practitioner than the one they have become accustomed to, then there would be no wonder that they might be caught off guard or even turned off.
However, if you explain that you are planning to use a different approach, because as you’ve undertaken some further training, you’ve come to realise that there may be a better way for you to help them, then this will change the expectation they have.

It may even but not linked to further education. Perhaps you have just come to realise that you feel you can serve them better if you make these changes.
This is an excellent reason to change what you do.
Reflection, is and should be the hallmark of a great therapist. 
Reflection without implementing change is of little value to anyone.

TIPS FOR IMPLEMENTING CHANGE:
1. Get very clear about what you want to change, update or alter.

2. For each new patient that you see, don’t fall back into old habits. New patients are the perfect place for you to begin establishing new expectations, and a new version of who you are as a practitioner.

3. Be clear with old patients about what change you are making and why. The “why” is key. If for example you suddenly start using less soft tissue therapy, and start using more dry needling, it may be perceived that you are looking to be less hands on in your treatment. Explain WHY you believe this will be the best approach for them.

4. Stick to your principles! If you have decided to change the paradigm of how you operate, but switch back every now and then, you will have a hard time teaching your patient population about the kind of practitioner you are.

5. In any first consultation, explain that the approach you are suggesting for today’s treatment is based on what they are presenting with, and that as things change, your treatment likely will also. This sets the expectation from the beginning that change is normal and necessary.

Lastly, let’s not think that a change in the way you approach your patient consultations means that you are locked into only doing certain things.
We certainly don’t want to develop a STYLE of treatment, as this is evidence that we are doing what WE want, and not what THEY need.
What I believe we should do for our patients, is to design their treatment and our approach to it based on their current presentation, with clinical reasoning being the driving factor for treatment design.
Making changes to the way you treat means implementing new ideas, updating old ways of thinking, considering improved or more effective approaches, and not falling into old patterns due to habit.

So please, don’t be afraid to change your clinical paradigm. It may be just the thing your patients need.