Patients are making decisions about you and your treatment all the time.
When making a decision about a current item, we, as humans, use the available information around us, past experiences and histories, etc. In other words, external factors both present and past, contribute to your thinking at this very moment. A common type of thinking influence is ‘Anchoring.’ First described by Daniel Kahneman and Amos Tversky, anchoring involves laying down a premise, or a set-point, from which a thought or conversation will take place. The easy example here is that of the displayed price of a car. This is the set-point from which future negotiations will be referenced to.
So in patient care anchoring can be used as well. The concept of expectation setting is discussed by Harrison Vaughan, PT, DPT in his post here. Setting expectations, or anchors, for treatment can help a patient know what to expect and ease the experience for everyone involved. (ex. Physician says “this will just pinch a bit” *sticks needle*). Anchoring is great for new experiences for which a patient has no reference, or may have a warped reference. Manual manipulation techniques come to mind, dry needling as well, but even a new strength machine or movement can benefit from some set expectations so the patient has an idea of how things should go.
The negatives here could be putting words into the patient’s mouth. For example; post CTJ manipulation: “Ok, how did that make you feel? 80-90% better?” This is a slimy way to use the anchoring concept. That is leading, that will get you nowhere. Although if you did that, your patient will likely say a higher percentage of improvement, and you will inflate your ego, no doubt.
A better way to do this is to let a patient know that, while a position may be awkward (ex; Lumbar roll/osteopathic pull manipulation technique), that is should make them feel better when completed. Now some will put this statement into the ‘negatives’ category above. I suppose you would be right, semantically. I influenced them towards a positive outcome. Fact. But wielding placebo statements correctly and avoiding nocebo statements should be standard of practice for all physical therapists when interacting with patients. (although this is certainly not the case…).
The anchoring concept also plays an important role in the pre-Initial Evaluation stage. Patients often have NO idea what physical therapy is, or how it will help them. If they do have an idea, it is probably an idea similar to the “physical terrorist” type, with unwanted exercise exertion and painful manual techniques to beat up those tissues. Unfortunately for #SolvePT #BizPT and all that type of stuff, we are fighting a negative anchor in the public’s eye.
In public conversations; what set-point do conversations and thoughts about PT revolve around?
I had a patient today, I introduced myself and thanked her for coming in. She looked at me with complete alarm and said “ha, it’s not my choice, my doctor made me come in.” What’s her anchor, her expectation of PT? Do you think that she thinks she came to the right place to help her? The pre-eval anchors need to be laid out here. The image of PT has been discussed in the past, see here and here and here. I have my own ideas, which are developing and coming together, I’ll share them soon enough when I can find the time (read as :Family, internships, DPTschool, boards,journals, blogs, sleep, etc).
In the end this anchoring concept comes down to one thing. Words have meaning. They influence the present and future and how interactions will commence: this is easily seen in the Therapeutic Alliance, for example. So understand that your patient might not know what to expect (treatment or pre-eval), this may cause some anxiety, so set the stage for them. Positively influence their experience and outcomes with appropriate anchoring tools to best deliver care.
Patients are floating out there in a sea of information. Be the anchor.