A Quick Guide To Evaluating Your Patients

Hi, welcome to the Pelvibiz Podcast. Are you a pelvic health PT or ot? Struggling to start your own practice? This podcast helps pelvic health PTs and OTs get out of debt, gain the income they desire, be able to treat patients without insurance restraints and learn how to create time freedom for yourself and your family. I'm your host, Dr. Kelly Alhui, founder of Ortho Pelvic Physical Therapy, Pelvic health Business grower and Pelvi Biz. Over the last two years I went from a solo entrepreneur to a seven person team in counting. I'm here to help provide a clear path to grow your pelvic health business as fast as possible so that you can gain the time freedom, decrease debt, increase income and live the life that you desire. Before we get started today, make sure you click the link in our bio to grab your ticket for pelvi biz. Now let's get into today's episode.

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I'm your host Kelly Alhoey. Today we are going to be talking about evaluations. Evaluations, evaluations. Lots of people get stuck on evaluations and I want to tell you kind of how I work through evaluations and how it works at a cash based physical therapy practice. So basically with evaluations, many of you guys think that you have to get everything done in the first evaluation, that you have to solve the problem in the first evaluation, that you have to know exactly what the solution is for the patient. And a lot of times that's not the case, especially when we treat pelvic health. Pelvic health is such an encompassing approach, it's a multifaceted approach. So on initial evaluation I'm just taking all the information in that I can. So I pretty much spend about 20 to 30 minutes on subjective because sometimes we have chronic pelvic pain, sometimes we have people with trauma that takes some time to tell a story. Sometimes it even takes an hour for someone to tell a story, like maybe they had a traumatic birth story that they want to share. And again, providing that safe space for a patient to tell us this is super, super important. So evaluation is not to tell the person at the end of it that this is their problem and you know it's going to be solved today. That's just not it. So what I wanted to do is go over number one pricing for evaluation. A lot of PTs and OTs and PTAs that I talked to, there is a misconception that they should charge higher Price for evaluation compared to a follow up visit. Number one, with that, you are already positioning your follow up visit as not valuable, as not as valuable as the initial evaluation. So you're already then subconsciously telling the patient, hey, this is really valuable, come in for it. But hey, don't follow up because it's not as valuable. And if all of us are so concerned, this is my other thing. If all of us are so concerned about time and like, oh, I'm putting more of my time, so then I'll charge this amount. Well, evaluation. When you're evaluating and follow up, it should be the same amount of time, by the way. So I know some PTs that I've talked to recently. They're like, hell, yeah, my evaluation is 90 minutes. Don't do that to yourself. There is no reason why your evaluation should be 90 minutes. You just have them come back and then you keep evaluating, you keep reassessing. You're basically doing an eval or well, you should be every single visit and reevaluating and seeing where's the problem? What can I solve better? Have we tried this? Have we tried this? There's many different things that we can give patients and it's like they got to take what we give them. Go try it, go do it. And then we tweak it. Like, that's how this works. So number one, to sum this part up is, number one, keep the price of your evaluation and follow up the same, because the perceived value to the patient make it all the same. Don't make it confusing. Number two, evaluation. I always believe that it should be around $200 for evaluation and follow up. Number three, make the evaluation the same time as the follow up. So if it's 60 minutes that you're doing follow ups, do the evaluation for 60 minutes, don't do it longer. I think that's very important to note. And then again, remember, everything does not have to be done in that first visit. It does not. What you can do as I like, you know, walk through my evaluation. So let me walk through that. Okay. So patient comes in the door. I tell them, hey, you can put your stuff over here, go ahead and have a seat on the table. And then I start asking them the subjective part and I really just say, hey, what's going on? Tell me what this is stopping you from doing. What else have you tried in the past? What has worked, what hasn't worked for you? Start really getting into really their why, why are you here now? I think that's an important question. Understanding if they're ready to make the commitment now. That's good that they came in for their first evaluation. But what is going to make them be committed to their plan of care? That's super important. So as I start talking and start getting all my information, then what I'll do is I'll step out of the room, come back in, and start doing some visceral stuff on their abdominals. Once I do that, then I'm also assessing and talking to them of, hey, there's some tightness here, or, hey, is this painful? So I'm treating and assessing at the same time. And I truly believe that that's how you should do all your sessions after that is assess and talk and treat and put all the pieces of the puzzle together. Ask them questions when you feel certain things. Don't be afraid of that. I think we should, you know, combine it all. And I know, at least in PT school, they taught us, just do the evaluation, do all these tests, and then that's going to be the outcome. That's not really how it works. It doesn't work actually at all like that. It just. You've got to treat, evaluate, and have feedback from the patient, I believe. So I go through everything as I'm working on the patient. I'm kind of like planting seeds of, hey, we need to work on this. Hey, we need to do this. Hey, we should try this. And I'm always kind of getting the patient's feedback. So together we are coming up with a plan. I don't wait till the end, and let's just say I did all my stuff, and then they put their clothes back on, and then I'm like, okay, so this is what I think. I don't do that. I do it while I'm actually treating, assessing them, because I feel like then that's when they can provide feedback. They can feel certain things that maybe I'm feeling at the same time. And it takes away that overwhelm at the end when we just, like, slap everything on them, and we're like, okay, you're good to go. See you next time. And it can be very overwhelming. So a lot of times I'm planting seeds throughout the treatment to say, okay, so this is what we're gonna work on next. Then we need to work on this. This is connected to this. This is what I think. And then I also have a multifaceted approach. So this is why Elise Orthopelvic has a puzzle piece, is because we are connecting all the puzzle pieces. We're connecting all the Dots. So during that time, I'm talking about nutrition. I'm talking about bladder schedule. I'm talking about sleep habits. I'm talking about what they do for exercise. I'm talking about what their work requires them to do. I'm talking about all those things so that we can have a very encompassing plan going forward and start to see, like, I'm kind of filling them out, like, are they willing to try this? Are they willing to try this? Like, where do they stand? Do they feel overwhelmed? Do they not feel overwhelmed? Where are they in their journey? And how quickly do they want this problem solved? Okay. At the end of the session, what I tend to do is I think there's three things that you should provide on the initial valuation. I think you should provide hope. I think you should talk about your method. For those that know me, I talk about method that makes people unique. And I think you should provide accountability and commitment. Okay, I guess I just said four, but really, commitment is the number three. One. Okay, are they willing to commit to this? And you have to get them to say, like, a micro commitment of, yes, I'm willing to commit to this. Yes, I'm willing to take an hour a week to come see you. If you're committed, then this is the path that we are going to follow. Because I know if you follow this path, we've treated thousands of people like you, that you will get to your result that you're looking for. I think that's super, super important. And even getting micro commitments in the actual session. So how I would do that is as. Let's just say I'm working on their abdominals. I'm like, man, this is tight. We got to really lengthen this. And they're like, yes, I can feel that. And I'm like, okay, so would you be willing to stretch this out for one minute a night? And if they're like, yes, that's called a micro commitment. They're already committing to the plan of care before I get to the end of my evaluation of saying, hey, this is what it's going to take, and you want to do that. I think that's very, very important when it comes to getting the patient to kind of buy in and understand that this is actually what it's going to take. Physical therapy is something that requires work from other people. You know, it would be a lot easier if we had, for instance, the Kegel chair. Right? Which maybe I'll make a whole nother episode on the Kegel chair, but Kegel chair, it just requires someone to go into the office, sit on the chair, and they're not doing anything actively. It's more attractive to clients because they don't have to do the work. The chair does it for them. Well, so it claims. Right, okay. And for us, they actually got to put in the work. So you want people and you want to attract people that actually want to put in the work to solve the problem. And so that is why getting a commitment is huge on day one. That's literally what you should be focused on. A lot of my pts are like, Kelly, so I need to tell them the solution and I need to give them feedback. No, no, no. Provide them hope, commitment, make them have a commitment and tell them about our method. So you guys probably thinking, well, what the heck's your method? Our method at orthopelvic that I came up with and everyone that I coach, I have them create a method because it makes it unique to their practice. So our method that I came up with is called the LSR method. The LSR method, there's a lengthening phase, there's a strengthening phase, and. And there's a return phase. Pretty much in all diagnoses of a muscular skeletal condition, you need to lengthen the muscle, then you need to re educate the muscle, and then you get the patient to return back to running without peeing or sitting without tailbone pain, whatever that may be. Right. So it pretty much applies to every single diagnosis. And because of that method, we have been able to track pretty much all of our patients using this method to see how effective it is and when they typically get better, when they start dropping off, when they actually return back to their activities. And for us, what we found is around the sixth visit is when patients will really, really start to feel good. They're going to start to feel amazing and their pain starts to go away. They're feeling like they can return back to some activities. And for us, that's the strengthening phase. So we gotta make sure that they're committed to doing a couple more sessions in the strengthening phase before we get them to the return phase. And the return phase, like I said, is that getting them back to actual sporting activities or whatever, you know, life activities they want to get back to. And if they're not committed, what we have found is that their pain will return or their dysfunction will return, and it won't go away completely. And so what we try to do based on our method, is get people committed to 12 sessions, because we know from a science perspective and a muscular skeletal perspective, it takes three months for you to have visible change in the muscular skeletal system. That's just straight up facts. It's science. So for us, we base planet cares off that because we know that that's what it takes to get someone to get their quad better, to return back to sporting activities. We know for their abdominals or pelv floor to truly function that way, it takes that long. So we're explaining in our method that this is truly how long it takes. Are you committed to that? And so having a unique method makes you unique in your area, because Sally down the street does not have that method and patients are confused about how you're actually going to solve the problem. The method makes it very clear on how you're going to get them from point A to point B. Okay, so that's really, you know, what I think about evaluations and how we should be treating evaluations and how it looks. And again, the biggest things is, are they committed? That's number one. Number two, have you provided hope to them? And number three, have you showed them a method? I think that's very, very important. So hopefully you guys are doing that and you're continuing to evaluate each session. And again, you don't have to get everything done like, there's no rush. Don't try to get everything done the first session. And please do not make your sessions 90 minutes. Just stick to 60. You're good with that. All right, guys, hopefully you learned something about evaluations today. Bye, guys.

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Let's go, Sam.