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Episode 6: Experts Do The Soft Skills Well


Nate Reynolds 0:00

Welcome to this week's episode of the cross talk Podcast. I am with Dave Finkelstein. He is a physical therapist in Arlington, Virginia. And our topic today is going to be about developing better communication techniques to build better rapport with patients. So welcome, Dave. Thanks for having me. So give us a little bit more about your background kind of where you're from. Where are you then what you're doing right now?

Dave Finkelstein 0:23

Absolutely. So I'm from Long Island, New York town called Lynbrook, I went to Stony Brook University for physical therapy school. From there, I went to Austin, Texas to pursue my orthopedic clinical specialty through a residency program, through the through evidence in motion, loved it really, really great program, highly recommend it. Then I made my way to Los Angeles, where my wife achieved her neurological clinical specialty through the University of Southern California. She loved all the sleepless nights and articles I was reading. She's like, Hey, I really want to do that, too. So she ended up doing that as well. And then we ended up going back to the east coast now working for Virginia Hospital Center in Arlington, Virginia.

Nate Reynolds 1:15

Yeah, so you've pretty much been all over, you know, you've then in the South outwest. Now you're back east. So I feel like you have a lot of valuable input just because in my experience, I did clinical rotations in Boston and South Carolina. And you know, the more places that you you go, the more the different treatment philosophies and different ways of looking at things. So just to get things going. Talking about communication, you know, why do you think this is an important topic that is often overlooked?

Dave Finkelstein 1:47

Yeah, absolutely. Great question. So I think we know as clinicians that the most information that we're going to get from our patient in terms of what's going on is going from the subjective, I think it's starting to be a little better known, but it's where information is going to come from, and we kind of refine our hypotheses with the objective. And then we kind of tested various trial treatments. But right now in terms of like, continuing education, even in my experience with PT, school, I wish I we had dove more into learning more about different communication techniques in terms of building rapport, how to actually know if the patient is really getting the message that's coming across or not. So I think it would be really great to kind of connect with physical therapy audience and even everyone else, patients like to really start to develop more communication techniques, or even identify certain communication techniques that people are using now and see how we can refine it to really get better rapport, get better information, and really help our patients along their journey to recovery. That's a great point. And I think one thing that makes communication, especially in healthcare hard, is that for most, most people, you know, healthcare is a foreign language to them, you know, they're not proficient and understanding exactly what's going on. And so that you really have to build rapport and trust. I think sometimes people blindly trust their healthcare providers, and they kind of like shake their head, like, yeah, I understand. But they really don't. And so I think, you know, to your point, you know, we really have to simplify and kind of spend more time in subjective and kind of explain what we, what we're finding what we're going to do and build a better rapport. Yeah, absolutely. So what do you think are some important tips for developing like effective communication? Yeah, so I definitely want to establish first off that, there's no way that I'm going to be able to cover all the different kind of communication, communication styles, tips on improving, but at least a few communication snacks, if you will, to try to really take into the clinic, or just even start discussing with your loved one later on today. So that way, we can all become a little bit better at communicators. So some of the things that I want to touch upon and talk about, just making sure that you have the general knowledge when you are talking to a patient, really work on developing trust, developing empathy, and then the importance of listening. So the first thing that I really want to jump into is really having that general knowledge. So please, don't lie to your patient. When, you know, you're really trying to formulate a hypothesis and what's going on, let's say you're doing, you know, x, y, z test, and like things really aren't adding up or you really think that, you know, it's this particular tissue despite the evidence showing that we don't really have great evidence in terms of like imaging and specific tests, connecting to certain tissues, especially in this shoulder, especially in the back.So you know, if you're telling your patient like, Hey, I really think it's this disc, that's like pressing up on this nerve, or, you know, it's definitely like this specific muscle with the rotator cuff because of a positive like Hawkins Kennedy test. You know, that's not necessarily like you trying to fabricate anything, but it's just that that's not quite what the evidence is showing us. So something that we can do First off, is really diving into the, you know, your anatomy, Book your literature, knowing exactly what tests mean, one thing or what particular structure can actually really relate to what that patient's feeling. And if you don't know, like, please just be brutally honest with with people, people, especially myself, starting off, was afraid of that kind of vulnerability piece of not seeming like I know the answer, or have the exact answer, but being kind of brutally honest with the patient and tell them hey, Barbara, you know, I know that, you know, you're really hurting from this, a few of these different movements really recreated your symptoms, you know, there's a lot of structures going on a lot of structures in your shoulder. But I know that raising your arm in this way, lifting in that particular way really creates your symptoms, we tried a few of these things, and you actually felt a little bit better from that. So even though we don't know the specific tissue, that's really creating that, I'm really confident that if you follow along this program, you're going to feel a lot better. So in that way, we're really being honest with our patient knowing that, you know, even though we don't know the specific structure, we know the course of action that we're going to take. And I think it really develops that, that trust with that patient.

Nate Reynolds 6:43

Yeah, and I also think that talking about trust, also knowing like when to kind of just be upfront and say, Okay, this is something I haven't seen before, I may not understand this, but I'm gonna find someone that that does, or I'll get you in the right direction. Like I had a patient that had tremor. And she's like, yeah, I keep getting these tremors, keeping these tremors. And then one day she had in the clinic, and you normally think of like, you know, the rolling pills like that. But she's literally like shaking her hand like this, going back and forth. And I'm like, I'm like, I've never seen that, before I took a picture, I took a video of it. I sent it to, I was like, do you mind if I send this to some of my friends that, you know, work or that are neuro specialists. And it was the first time that she was diagnosed with like, functional neurologic disorder. fnd. And it's a it's a software issue, it's not a hardware issue, meaning that, you know, it, it's how her brain interprets things. And that was, and she went and got sent to therapy, and, you know, all of a sudden, she actually had treatment for and her symptoms went away. And it was all stress related. And so I think, the build on what you said, like, you know, it's not just knowing when you don't know, like, what tissue or that it's also knowing when you don't know, or haven't seen something before and you're like, I will find a way to get you answers, even if I don't know right now and asking someone else.

Dave Finkelstein 8:04

I bet you because of that, that you develop that rapport that much more, because that patient knew that, you know, even though we don't have all the answers, right now, I'm confident that my therapist is going to do all they can to really find that answer, as opposed to that person that when you don't know something, and then you're starting to stumble over your words, and then you're kind of making up certain things, the patient knows, you feel like you might have outsmarted them, but you haven't. Exactly. So in that in terms of kind of developing that trust, that kind of segues me to kind of that second tip that I want to talk about, and it's developing trust. So there are certain things that you really can do to increase trust with that patient. So definitely building rapport, right, that That goes without saying, that's one of the things that everyone tells you, it's like, definitely build rapport that helps increase therapeutic alliance with your patient, there's a lot of boutrous showing that the more therapeutic alliance that you have, but the outcomes, so really using non task communication, so really, it's just more of like talking about certain things like sports, you know, whether anything that's not particularly related or specific to their diagnose, though, you know, if you're doing certain manual or if you're doing you know, just the warm up before the, the the exercise or workout, if you will, really just kind of engaging in that particular conversation, calling the patient by name. That goes a long way. I can tell you how many times early in my career that I was just so focused on getting the person better that week three or week four, I was like, I really don't know this person's name. I mean, I know them like on my schedule. I know that they're coming at 1230 I know it's it's shoulder at 1230. And that really wasn't doing the the patient service but really calling people by their name and have them calling me by my name like it. I have to look at the exact quote but I know it's from. It's from the book 12 ways to win people to your thinking, what was that book night? Oh, okay.

Nate Reynolds 10:18

Dale Carnegie's How to Win Friends and Influence People.

Dave Finkelstein 10:21

That's the one. So Dale Carnegie's How to Win Friends and Influence People. So one of the quotes that he has in there is like, remembering people's names. And the quote is something along along the lines of the sweetest sound a person getting here is like their own name or something along those lines, because it really lets that person know that, you know, you're talking to them, or you know, their name, like, the first thing I did at my job, when I moved to Arlington was know everyone's name, call them by name every day, give them a wave and say, like, hey, Giovanna, hey, Tiffany. And it, I think it really helps them start to know that I valued who they were, and you know, I want to take the time to get to know who they were. So that's, that's rapport, warm warmth. You know, sharing personal stories, concerns, kindness, if your patient comes in, and they're like, pretty down in the dumps, or they're not really, you know, feeling up to doing that warm up, and you can really kind of start to take that kind of asking them a little bit more like unpacking the, okay, what's going on? Is there something that's bothering you, is there something that you want to talk about, before we get started, it really shows that you're treating them more than their diagnosis or treating them more than, you know, another patient of that day, but they're an actual human being. So that really increase that that trust with them. And then the last thing is a quality, so demonstrating to them that you're treating them as an equal. So if you really value their time, making sure that you're taking them exactly back at 1230. If your schedule allows, it really means maintaining eye contact, calling them by the name that they want to be called, not just assuming that they like to be called a certain name. So something I like to ask is like, Hey, you know, Mr. Dillon, so do you prefer to be called this are your first name, just because I want to really want to make sure I'm calling you by the name that you want. So really establishing a quality and that's and so those, those three things are at least a good place to start off in developing trust?

Nate Reynolds 12:26

Yeah, I think that one of the things that I really tried to do and show I think it makes a difference is like, I really want to show them like genuinely interested in the person. And, you know, that might be knowing, like, either what they're doing like in their career wise, and just trying to figure out, like, you know, what made them do that, and just try to find one way that I can connect really deeply with. And so it just turns out right now, like, I have a lot of nurses or I have, you know, teachers, and one of the conversations that I was bring up, you know, we kind of talked about the pandemic, and just trying to say that, like, it must be really hard what you're doing and try to show that understand the stress of their job. And that way, it shows that I'm interested in them as a person. And that I know that they're, they have a lot of stressors outside of just, you know, their shoulder hurting. And then when you talk about equality, I think one thing that I've learned, and Dave and I know each other from working at, or volunteering at empower spinal cord injury. And one of the things I've always done now is, as someone sitting in their chair, I get I level with them. And it's just showing that we're on an even playing field, because I don't, I don't want to talk to someone and look down on them. And I think just being at eye level with them, it just makes the conversation much more easy and more comfortable. And that's not just for someone who has a spinal cord injury, it's just for anyone, you know, you always want to be at their level.

Dave Finkelstein 13:55

Yeah, I couldn't agree with you more on that, and even in the clinic to some things that I see is like, I totally understand, and I know, I'm gonna get flack for this when I say this, but when you're behind a computer and you're like trying to have a conversation with someone and you're like looking over the laptop, or looking around the corner, like I know, you want to get home on time, I know that you have to document because we have a limited amount of time. But even if you just take a few extra seconds during this objective, and just like asking the person like Hey, is it okay? If I take a few notes cuz I really, really value your time and I value the words that you're saying, I just really want to make sure that I'm putting it down on these notes. That way I can give you the best care possible, as opposed to starting typing and just start going, you know, even at that point, you're really telling the person okay, but they're not just typing or they're not just taking a note they're doing this for a particular reason.

Nate Reynolds 14:48

Yeah, you know, you know what I do? First thing I tried to do first thing is that, you know, in my subjective because my notes carryover from the previous day, is that I have functional limitations section that I put on this objective where it's like three or four things that they told me. And so I talked back to them. I'm like, Alright, so the last time you said this, has that improved. What's going on? And then it shows that like, I'm actually intently listening each session, but also, I can be like, yeah, like you are getting better. Your pain was a seven out of 10. Now it's a five. And they're like, Oh, I didn't realize that. And they're like, Yeah, it looks like yeah, you're getting better. And so it can build report that way, just by showing those small improvements and taking quality notes in your subjective section. And just being able to read it back to them.

Dave Finkelstein 15:35

Yeah, I couldn't agree more. And I think there's a lot Well, in terms of really establishing those those goals. I think having that specific to the patient and having it that salient, you know, that bike rider that wants to get back to I'm not a bike rider, so I can tell you, like normal distances, but that was a bad example. So let's say you know, runner that wants to get back to a 5k, or, you know, a marathon or an Ironman something along those lines, and really making the goal specific to them, you know, ask them like, hey, running this far really bothered you How, how much better how much worse that is that just really, just to reiterate what you said, and how important that is, really makes just everything in terms of like the treatments that you're focusing on the the reasoning behind, like, why that person is coming in how much value their time, it's just really demonstrated to the patient. So yeah, I wholeheartedly agree.

Nate Reynolds 16:37

Yeah. And I think that transitions well to your next topic of, you know, talking about empathy and listening, and showing the patient that you care.

Dave Finkelstein 16:46

Yeah, for sure. So definitely developing empathy. And I think this is also a point at which people start to feel a little bit more vulnerable, which now if you guys know, the, or you, you and your listeners know, the name, Renee Brown, like vulnerability is her her big thing. And I think that also goes a long way when it comes to developing empathy. So really, understanding your particular emotional state, if you will. So some of the things in terms of kind of developing your emotional awareness is self awareness. First off is like really understanding if you know how you're how you're feeling in that particular moment. So if I'm talking to a patient, I'm really confused. And I am like really afraid that they have no idea why I'm giving exercise and all these things. I may be like clenching my fists, and I may be like, piercing my lips, and how well Am I able to detect that? How? How well, am I able to see how I'm reacting at that time? Can the patient see them afraid? Can the patient see that, you know, I'm really happy when they're getting better. Things like that really dives into self awareness. And then in that to self management, so let's say I do that I'm feeling particularly said something along those lines, what am I doing that really helps modulate or modify how I'm feeling that moment? Am I meditating? Am I getting enough sleep? Am I practicing certain things to really help understand whether or not I'm able to mitigate, you know, my sadness, my anger, my anxiety to provide the patient with with the best care possible? The third thing about kind of emotional intelligence is social awareness. So how well Am I able to detect those kind of things in another person. So when a patient comes to me, and they're feeling, you know, they have like tears in their eyes, or a better example is, let's say, I'm walking to work. And I see fellow coworker, she looks like really said, you know, tears going down her eyes, and I say, hey, Betty, you're doing okay? And she's like, no, Dave, I'm actually pretty sad. And I say something along the lines of, well, going to work is probably gonna get your mind off of that. And then I continue walking. I mean, that's obviously a gap in my social awareness. So in that sense to like, I have incorrectly recognized that Betty may need something in that that moment, which then ties into my, to manage relationships. So in that particular moment, me recognizing that Betty is said, I can do something along the lines of, you know, really asked me like, Hey, you know, is there anything I can do or grabbing a tissue and just giving her an ear to listen to So between self awareness, self management, social awareness, and relationship management, those are four real big components that clinicians can can build upon to improve their ability to develop empathy and that's going to make them have better better relationship with the patient in the long run?

Nate Reynolds 20:03

Yeah, I don't think that just, you know, working with patients, you know, that applies to, you know, working with people, personal relationships, you know, I think the more that you you're able to be self aware, and have some sense of humility, like know, when you know, you may not be the most pleasant person to work with, or be around that day, or whether you know, you are wrong, and then you quickly admit that, in that moment, you know, I may have been wrong. But now at least I'm admitting to you that, you know, you were right, and I understand where you're coming from, and being a good co worker, a good, significant other spouse. I think that goes a long way.

Dave Finkelstein 20:45

Yeah, a really great book or reference that my mentor during my residency gave to me was emotional intelligence. 2.0. You know, I don't get any sort of commission for advertising this book. But it really was great, because it gives you, you know, the ability to answer a bunch of questions that dive into the different categories, and it gives you a score on all these different categories. And some of the things that I noticed about myself was that my social awareness and relationship management was pretty good. But my self awareness and my self management was not so good. They can politely, but in doing so I was able to really start to recognize certain things about myself, like really like Chrissy, my lips, clenching my fists, and I was getting frustrated with certain treatments, or certain conversations I was even having with with loved ones, and people can can see that, and I think it was actually brought up in conversation with me a few times, and they were like, hey, like, are you? Are you mad at me for a reason? Like, no, I'm so sorry, I'm mad at myself for not being able to connect the dots are. And I really thought that that was going to help and it didn't, I didn't wouldn't have those necessarily specific conversations with a patient, but it was something along those lines where, you know, my, my self awareness didn't, really wasn't really up to par. And I think because of that, my my patients, my friends, my family, they saw that in my particular communication.

Nate Reynolds 22:14

Yeah, and I think that's something that, you know, we all pray, think like, oh, like, I'm very self aware. But then, as soon as you have someone watching you, or recording you, and then you're like, Oh, this is what I actually look like. Like, it humbles you. And you're like, Okay, like, this is, this is what other people see, and it kind of flips a switch in your brain. And because I'm always like, yeah, like, you know, I think I am a feedback really well. But at the same time, I'm like, it comes from someone that like, maybe I don't necessarily agree with or, you know, I don't get along with that, well, I get a little bit more defensive, I can sense that and I can, I can feel my body tense up, then I'm like, I shouldn't be that upset. I should, I should be better at that. And like, later on, but in the moment, like, like, Who is this person? Like, why are they saying this to me? Like, who do you think you are?

Dave Finkelstein 23:04

Yeah. And to that point, too, I know, I definitely still exhibit those same feelings. But I think to what you're saying to your credit, is kind of afterwards taking a step back and be like, okay, even though it was like, kind of annoying at that time, because it's coming from someone that you know, I really wouldn't expect that feedback to come come from. If I really had to critically think about it, like, what about my particular personality? or What did I say that could could lead to that? Because I've noticed that in other people that I've talked to, and they've come up to me, and they said, like, deep? I don't understand why these four patients that I had said that, you know, I'm, I'm really aggressive. And I'm, you know, I'm very short with them. And I don't think that and I told them like, well, if you've heard that from four people, like, even if it was wrong, even if you're like, no, there's no way that can be really take the time to dig apart in question. All right, if there was a tiny percentage that they're right, what about my particular communication style or practice? analyze to modify that a bit, just to make sure that you know, next time it's only three people complaining about me. I say that in jest, but you know what I'm saying?

Nate Reynolds 24:25

Yeah, I think that, you know, if multiple people are giving you that feedback, then you really got to take the time and reflect and be like, Okay, this is me. And I think sometimes, some people play like the victim card, either the victim or the problem solver. I feel like in certain situations, and I think sometimes people that have more of like a victim mindset are like, okay, but this is about them. Like this is something that they're doing wrong, not me. And, you know, I think there takes there's a maturity level that comes with being able to take that feedback and reflect and be like, Okay, yes, in the moment that sucked. But there, right, I need to kind of get away from that victim mindset and really take ownership, Extreme Ownership of every action that I have, even if it's, you know, something's indirectly related to me, you know, if you're in a leadership role, and it's a colleague that works underneath you, you know, whatever they do, I still reflects on you and you just gotta take ownership of it.

Dave Finkelstein 25:25

I like your kind of quick plug for Jocko Willink book there, the Extreme Ownership, but I read it too. And you know, it really made a lot of sense. It really does change your mindset from that kind of victim mentality to like, okay, let's actually problem solve this. And let's see what, what that could be. But I think that also ties into my clinic. Last thing that I really want to touch upon was kind of listening. And I feel like that's something that it's really easy to say, like, yeah, listen, you might be listening, but like, are you hearing what the person is saying? So I think that's, that's kind of like the difference between those two things. And one thing that I wish I could emphasize more to people and one thing, I'm still actively trying to get better, is just getting comfortable with the silence. So when you ask someone something, like, trying your best to not jump, and be like, No, no, what this is actually what's happening in your back or like, No, no, this is why I did that. Because in that sense, you're coming off, almost defensive or aggressive, instead of giving the person the opportunity to let them know where they're, where you're coming from, or where they're coming from, rather. And I think it also has really great power when you're trying to make a point with with someone. So one of the things that I really like to do is when people come to me, and they say like, yeah, I have, you know, that bulging disc in my back, it's just jutting out, like crushing my, my nerve and send signals down my leg. I'm like, Oh, yeah. All right, well, let's see what we could do about that I go through my exam, you know, we'll do some repeated motions, or will do some, some sort of intervention that will centralize their symptoms. And then it could be as simple as the repeated motion. So let's take that example. If they're doing repeated motions, let's say they have ridiculous apathy down their leg, they do some, they do 10, press ups, they stand back up their symptoms of centralized a bit when they do 10 more press ups, and then their symptoms centralize even more into the glue. And then 10 more press ups, and now it's completely gone. And I sit there and I'm like, yeah, that's that's kind of weird. So what do you think happened? And I just wait, I just waited out, I wait for that sweet, sweet taste of I don't know. What do you think happened? Or can you can you tell me what happened? Or, you know, if they're like, Well, you know, obviously, whatever you did worked. And I'm like, Yeah, and I guarantee you, it's not me pushing that disc back into your back or something along those lines. Because by taking that extra time, and not kind of jumping in being like, Whoa, no, no, we're flushing out the inflammatory chemicals in your back, it gives the person to think what's going on, and really start to create those synapses and those connections in their brain. So that way, it really makes whatever just happened, become that much more important in their lives, or they have that much more hope, like, Oh, my gosh, I don't have to live with this. So maybe I can get back to jogging, I can get back to lifting I can get back to carrying things.

Nate Reynolds 28:32

A huge point that you made is that you can lecture someone and educate someone as much as you want. But it's not nearly as powerful as someone making their own connection themselves. That's gonna stay with them a lot longer than what whatever we tell them.

Dave Finkelstein 28:50

Yeah, and I think the big buzz thing now is motivational interviewing. And I think with that, too, it really is important to take those moments to pause, ask the person really open ended questions. So that way, they're coming to those conclusions on their own. Because even though at that moment, it might feel good to give that person that whole giant spiel about pain, neuroscience, you know, you just learned it from that weekend course. You're like, Oh, I'm gonna, I'm gonna bust this out, I'm gonna definitely tell this person everything about pain science, and, you know, having that little extra time and be like, you know, what do you think is going on? Or you went from an eight to a four by doing this particular activity? Like, what are your thoughts on that, that really gets them thinking that really makes it more salient. It makes your information that much more valuable to them, because it's allowing them to be curious about their own care. And at that point, then that's when the education can start because there's a difference between educating someone and talking at someone and I've seen both and I've done both and I am very, very confident that teaching someone is more effective than then talking to people?

Nate Reynolds 30:02

Yeah, I think we're all guilty of talking about people. And definitely talking about patients. You know, I think it I think a good clinician is someone that can look at themselves in the mirror and be like, that was my fault. I should have done this better, I should have done that. And I think if you reflect after kind of like each eval, I think you're going to get better at developing rapport a lot quicker.

Dave Finkelstein 30:24

Yeah, for sure. And I do want to even tie this to some literature. So like, Bishop in 2013, talked about patient expectations. So listening to exactly what, but they want that physical manipulation would help whether they manual therapy or would help. And based on that, based on what the patient perceived that would be most beneficial to them, if they received that particular care, their prognosis or their outcomes in their pain was wasn't that much more improved, their, their their outcomes were better. So we won't even dive into that article, you can see how powerful listening to your patient and providing them with the care that they think is going to be best for them can really help their outcomes. But I do want to dive into, you know, what are the action steps? What can we do from here to really make sure that we're utilizing some of these communication techniques. So one of the first things is kind of analyzing your emotional intelligence. So one of the things that I talked about is really looking into that either emotional intelligence 2.0 book, if you've taken a personality exam, I know that's also a big thing. Now, the Myers Briggs, the inia grams, kind of using those particular tools to see where your strengths are, where your weaknesses are not really living and dying, but what number you are, what four letters you are, but just seeing kind of how you are at that particular point in time, journaling, meditation, all these things help benefit you in terms of recognizing your emotional, where you are with emotional intelligence. The second thing is, yeah, go ahead.

Nate Reynolds 32:04

Yeah, as I say, I highly recommend, you know, looking at your daily horoscope, I mean, that's basically how I determine whether, well, I'm always gonna be like that day. So yeah, definitely, definitely check that out.

Dave Finkelstein 32:15

Yeah, do you have a good horoscope? Is does there's someone that you go to,

Nate Reynolds 32:19

You know, I just Google horoscope for the day, whatever comes up first, that's what I go with an Aquarius. Now to continue with the more relevant topics.

Dave Finkelstein 32:34

Yeah, so the second thing that you can do as well, and it's really painful, but it's probably one of the best things that you can do is record yourself. So whether that means getting an audio recording, or even better a video recording of yourself, so that way, you can see exactly how your body languages how you're talking to your patient. And then you can also see in real time, and even in slomo, the painstaking degree, how the patient is reacting to what you're telling them. And one of the things that I it's, it's like a weird hobby for me, but it's actually analyzing people's faces and emotions. And there's really great research by Paul Ekman and Dr. Much moto of San Francisco. And they've done a lot of research with the FBI, with the CIA in terms of being able to detect certain facial expressions, body language, to see if it matches exactly what they're saying, which, you know, we don't have to be experts in that. But I think it's really interesting to see if the patient is reacting to the information that you're giving them, you know, if you feel super satisfied that you gave them this whole big spiel about, you know, whatever their you felt, like, they benefit in terms of education, and they're like rolling their eyes or their arms are crossed, or they're looking away, or their faces more fearful than it is kind of hopeful or happy. Seeing those things, in addition to what you're saying, and how you're saying to the patient can be really valuable in terms of how you're learning from that patient, and then also really critically analyzing that video. So that particular video or even asking friends and family like, hey, do you feel like, um, this particular way? Or like, how do you feel I am as a communicator, it may be actually really refreshing to hear that from someone that, you know, may have been a little bit hesitant to tell you that, you know, you're you're actually pretty aggressive or, you know, I feel like you know, more than I think you do, so you can definitely a little bit more confident in this area. And at that point, you're talking to someone that you really value their opinion, and it really helps boost you along your way to be a better communicator.

Nate Reynolds 34:48

Yeah, I think that's that's a valid point right there where we want either if we're someone that you don't need it, I think it's like a spectrum right? Like your competence, like, you're there's someone that is probably, you know, probably a little more aggressive, and you're probably a little bit more overconfident. And he needs to dial it back a little bit so that you know, you, you aren't talking to patients, or if you're someone that's very passive, and I think that's kind of where like new grads fall, where they don't have that confidence yet, and you need to be like, hey, like, you know, more than you think you do, you definitely know more than the patient, you know, you need to, you know, kind of step it up a little bit and be confident and talk with some assertive so that way, the patient believes in what you're saying. because like you said earlier, you know, patients can see right through you, but they can also, if you're too confident, especially in healthcare, where everything is proof, it's not black and white, it's more gray. If I had a provider that was super confident in what they were saying, and like talking at me, like, Oh, it's definitely that's and, you know, to your point earlier, where you're you said, you know, we don't exactly know what tissue causes which and that, I mean, those are the providers that I'd be more hesitant to see myself. And so Dave, to kind of summarize what we've been talking about, what are some things that you think are some key takeaways to wrap things up?

Dave Finkelstein 36:09

Yeah, sure, absolutely. So, just to overall, summarize, make sure that you're spending the time to do the research, really taking the time to dive into anatomy and research to know what you're talking about. And if you don't be honest with the patient, do think to develop trust, really build rapport, warmth, the quality, try those things, like having conversations outside of their diagnosis, and really dive into the who that person is develop empathy. So really analyze yourself and see how can I be better at detecting my emotions and other people's emotions and managing both of those aspects, and really taking time to listen to your patient. So get comfortable with silence, get comfortable, really taking the time to listen to your patient and not jump to conclusions or jump to judgment, but really hear what they're saying. And then doing things like recording yourself taking certain personality tests, or even asking friends and family? How effective of a communicator do you think you are, I think all of those things are really gonna help make our profession better at communicating not just to our patients, but our co workers, our management and, and our loved ones.

Nate Reynolds 37:24

Dave, I think this is those are all great points. There's a lot of continuing education to improve your clinical skills. But there's not much on trying to improve your soft skills. And so I think this brings that come to the forefront that you know, there's a side of PT that's kind of more like an art where you really need to work on it. And it's not things that you learned in PT school. So Dave, if anyone wants to reach out to you, what would be a good way for them to contact you?

Dave Finkelstein 37:51

I am mediocre at social media, but I am on my Instagram my handles at Dave Fink DPT. My email is if that is too long for you, then I'm sure you can add my last name to the note so that way people can see how it's spelt.

Nate Reynolds 38:15

Yeah, Dave, I think you're someone that is well experienced. And you've been all throughout the country practicing and so I hope that this kind of reaches a lot of people because I think you have a lot of insight that people can learn from.

Dave Finkelstein 38:29

Yeah, thanks so much for having me on Nate. You know, I really value your, your clinical expertise, your friendship, and your how much stock you put into horoscopes.

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