Patient Not Improving or Returning? Here's What To Do!

Welcome to Pelibiz Podcast. I'm your host, Kelly Elahuey. Today I want to talk about how to handle when a patient doesn't get better or just completely drops off their plan of care that you booked out and all of a sudden, after four visits, they just go bye, bye. What do you do about that? So, number one, I audit what currently kind of happened in the sessions. So I think back to what did I say to them? Was their expectation set? Meaning, did I show them where they're at and the path that they're going to be going on and how we're actually going to get there if we end up working together? I'm also going to clearly lay out expectations, meaning, Sally, if you have a hair appointment or your kid's sick and you can't come here because of time, we're going to do telehealth. Also, just so you know, around four to six visits, you're going to start feeling better. And when you do that, you're going to want to start to quit because you think that you're better, but you're actually not. Because we know truly it takes 12 weeks to have a muscular skeletal change. So I need you to be here for 12 sessions consistently so that we can truly get that change to happen. And how this is going to look is around again, four to six weeks, you're going to start noticing some changing. That pain is going to go away. And then around visit six or eight to nine weeks, you're going to start to notice that you actually feel pretty good. But that's our opportunity to really test out what you truly want to get back to maybe climbing Mount Kilimanjaro and maybe running that marathon and maybe jumping on that trampoline or whatever it may be. We're going to test it out in those, the later part of the plan. But we cannot quit, and we have to be consistent as we go through this journey. Are you down for that? Yeah, I'm down for it. Cool. Okay. So now I got their consent on that. Okay. Also, I'm thinking, what did this person say to me during the sessions? So maybe this person is a very quiet person and you think that they just want to sit there quietly. And they just sit there quietly because they maybe are trying to relax. And you're like, okay, cool, just let them relax. But what I have found, even if a person is trying to come to you and relax, that you still need to talk through everything you're doing each session so the patient understands what's going on. And if you don't. The patient's just kind of left to like figure out, oh, I wonder why she's doing that. I don't really know. I don't know if this is valuable to me. And then that's when they tend to drop off. So every single thing that you're doing, audit yourself. Are you explaining why you're doing an internal exam? Are you explaining how you're doing things this way? Because this is what we're going to get the result of. Are you explaining why we need to be consistent with blank? Because that's actually going to get you your ultimate goal. So, so think about how are you communicating to the actual patient to get them to understand how we're going to keep getting them there and keep them on the path going forward. So I think that's very important. Otherwise, like, think about it this way. If you go to a personal trainer and they're like, good job, Kelly, you've been coming for four months. And I'm like, yep, great. Like, when, when am I gonna lose weight Now? And they haven't really given me any feedback. Do you think I'm gonna continue to do personal training three times a week if no one's giving me feedback and I'm not yet seeing results? Because, you know, it takes time or whatever else. Right. So do you think I'm gonna continue to go back? No. So this is the other thing I need you to audit is are you actually each time the patient comes in thinking about their goals specifically for them and asking very specific questions to that actual goal. If you're not doing that, that also may be a reason why that patient just decided to go bye bye and not finish out their plan of care because they are not seeing results and they're confused about where they are in the path and it just seems like they're going to be in never ever land forever and ever. And this path leads to nowhere. So that is very, very important. Okay, let me see, what else do I have here? Like I said, explain. You got to explain. Explain. Explain why you're doing things. Why is this important? If they decide if you book them out for 12 sessions and then all of a sudden they called and canceled in your front desk answered and they were like, yeah, I want to cancel all my appointments. Well, number one, always ask why so that we can aud and understand why they want to drop off. It may be, you know, their family got busy or it may be they have to move funds towards their kids school or whatever. It may excuse that they kind of Give. Basically they're saying, I don't want to put myself first and I don't have time for myself right now. So I'm going to put this on pause and I will get to it when I get to it. AKA meaning it's not as important as it once was when they originally called to make the appointments and come in because maybe they are feeling better because maybe they are not seeing results. Like, there's so many different reasons. And so this is why you have to go back and audit your sessions and what they talked about and what you guys talked about together to truly get to why the patient hasn't gotten better or has quit. Okay. And so if they were to drop off completely, I personally like to call them or have the therapist call them and be like. Because the therapist knows more than the admin. The admin doesn't know why the person's really coming in as much or the whole plan of care the therapist does. So I have the therapist call the patient and say, hey, like, I know we are making progress here. Or maybe you guys weren't making progress yet. I know we weren't making progress just yet, but I know if we continue for at least another three sessions, you, you will start to see progress and you're gonna be very happy with the results. And so just to be able to talk to the patient and get an understanding of where they're at and showing them that we truly are the go tos to bridge that gap is massively important. And sometimes those patients will be like, you know what, you're right, I just had a freak out moment. I didn't think I was making progress. But you are right. Like, I am gonna come back in because I do think I can make progress with you and let me keep going. And then they're like, okay, I'll come back in. The other thing I think that's important is keep providing them with tips. So if they drop off, keep providing them with tips that you would potentially give to them next time during their session with you, even if they're not with you anymore. So send them something in an email that's like, hey, I know you're going to in network or whatever else, but I really want to give you these tips because I know in network isn't going to provide this and I know that we are on a good path to get you the results that you're looking for. And please reach out if you have any questions. Keep nurturing them, keep giving things. It does not hurt you to keep giving things, even if they're not paying you, if you truly want to help someone, give, give, give, give, give. I always say that because eventually it will come back to you. So I think that is really, really important. It's just really important to make sure that again, the outcomes are front and center, no matter if they're paying you or not. I think that's huge. And let's just say someone just, you keep seeing them, you keep seeing them and they're just not getting better. So how do you handle that? Well, you then have to look at the patient from a broader spectrum. Meaning if you're strictly just looking at them from a musculoskeletal standpoint, just trying to treat it from a muscular, like, you know, maybe their, their pain from a muscular skeletal standpoint, that doesn't do it anymore. It does not. Meaning you've got to learn new skills, you got to learn pain science, you got to learn maybe supplements, you have to learn maybe hormones, you got to learn maybe some psychology. Now I'm not saying you have to be the best at it. And if you don't want to learn that clearly, then you need to build a network so that you can refer people out to these providers so that you create the team for them. Meaning I'm not the hormone expert. I can talk a little bit about it to at least give them knowledge of why they basically need this person. But I'm not the one prescribing the estrogen cream. I'm not the one doing the Dutch test, I'm not the one doing all that. But I do know people in the network that then I can send them to so that we can get them the help they need. Does that make sense? So I'm basically acting almost like the primary care and the connector in my community because I know these people. That's very, very important. So that ultimately you put all the pieces of the puzzle together and you like look like the frickin miracle worker because you came up with the whole plan. But you don't have to execute and implement the whole thing. So if a patient isn't getting better, look at another approach. Not just hitting from a muscular skeletal piece. I think that's super, super important. And most therapists, especially ones that I bring on or that I talk to, they don't get that because they haven't had mentorship around understanding how to do that effectively. So that is super, super important. And so, yeah, or maybe you would also potentially have another colleague if you work in a larger office. Hey, can you see Johnny over Here, because I'm just not quite getting where I want with him, and we're not making that progress that I really want to see with him. So can you kind of put your head in on this case? Also? What we tend to do is if you do have a team, we have group meetings about patients, meaning we will say, this is a case study. What would you guys do with this patient? What else would you do? And so we're able then to put all of our heads together in the clinic to get the best outcome for that patient. Because four heads are better than one head thinking just one different way. Or if you don't have a group like that, get a mentor. I'd be happy to help with that. Yes, I do clinical. Yes, I love business. But yes, I also do clinical. So if you have a question you're stuck, please ask me, because I've probably seen it, been there, done it, all the different things. If you are stuck trying to be like, I'm the only one out of. I was only one therapist out of 100 that did pelvic floor therapy, and it was felt like I was on an island. I couldn't ask anyone. And so you don't want to be that way. You want to have a group of people that's supportive, that understand the work and can help you really navigate hard cases or cases that you're just kind of stumped on so that patients can get the results. So that's huge. So basically, I want to kind of summarize here is the first thing you want to do. So if a patient isn't getting better or if they drop off, couple things you want to audit how the session went. Did you lay out the path? Clearly, you want to make sure that they understood it and that they think that they can actually do the path that you laid out for them. And then you want to make sure that people are compliant with it and they're able to do it and not just be like, oh, I don't have time. You gave me 50 exercises. I don't have time. I'm going to quit this. They will quit. They 100% will quit because it's too hard for them. Make sure they're interpreting it the way that you're explaining it to them. Over explain rather than under explain. And then if they do drop off, make sure you call them, try to talk to them, make sure you still are actually treating them like a patient, sending them certain things to make sure that they continue to progress, whether or not they're in your care or not so so that you can just help them get to their goal and no matter whatever happens, if they're paying you or not, it's a win win situation. Because who doesn't want to help someone that needs help from us? Like who doesn't want to do that? If you're a good person, you typically want to do that. So why not help them and get them to understand that you really are the go to to solve their problem compared to maybe where they're going currently. And then you're also top of mind because they're like oh yeah, she did help me. She actually helped me more than my therapy session today. Okay. So just remember that that's what we want to do. So hopefully guys this was helpful and hopefully you don't have people just quitting your plan of cares or just not getting better. And then again, last thing is make sure you have colleagues and or a mentor to help you be able with those hard cases or ones that you feel like you're stuck on. Alright guys, we will talk soon and if you have any questions about this please DM me at Pelvibiz on Instagram. Be happy to chat with you for any questions. Talk soon. Bye guys.