Isn’t This A Problem?

My wife: How did the afternoon go?

Me: One eval and discharge, one cancel at the door, one revisit. I would have hit my productivity target for the week if not for that cancellation.

Her: Why at the door?

She was really emotional and was not appropriate for a PT eval. Poor Jake, I told him he could handle the introductions and move right in to the assessment; he just walked into a buzzsaw that he couldn’t have been prepared for.

What do you mean?

We had seen in her charting that she was struggling to cope with some family issues, but the nurse has to go through a depression screen, so a bunch of emotional stuff usually bubbles to the surface with the admitting nurse that I don’t necessarily see in subsequent visits. I had told him as much and I couldn’t have been more wrong. Of course – and I don’t think it would have mattered anyway – he didn’t help matters either.

What did he do wrong?

I wouldn’t say wrong. Just different. The first thing that he asked was, “How are you.”


So I try not to ask them that. It opens up the potential for a series of questions and ideations that I have no answers for, or control over.

But that is what people do; you are being rude if you don’t.

Listen, I am not saying it is wrong to say it, I am just saying that I don’t. And I don’t think that I come off as rude, either. I hope to come off as caring and purposeful. It isn’t that I don’t care about her family stuff, there is just nothing that I can do about it and (today) it is not pertinent to what I need to do.

What do you mean today?

Today, I am going in to complete an eval with a patient with no complaint of pain and there is no documentation of any difficulties with mobility. The staff at the facility denies any significant changes in her mobility in the last few months. The nurse was probably just covering her ass in making the referral – which is fine, it is not her job to determine if the patient is a safe ambulator – but we were probably just going to evaluate her and discharge her the same day. Now, if she has pain and I hypothesize that her emotions may be linked to…well…that is a whole other discussion. But even if she has pain, to get back to the point, I would still not greet her by saying, “How are you.”

Keith, you are being ridiculous…

No, I’m not. Are you seriously telling me that if I walk into a home, grasp their hand in a warm handshake while introducing myself, tell them how pleased I am to meet them and then move into explaining why I am there and then ask them how they are moving throughout their home…are you telling me you don’t think I can pull that off without coming off as an empathetic and friendly professional? I would argue the opposite…I would argue that I present myself in a way that is a departure from cultural convention without being weird or off-putting. I would argue that this places me in a position of advantage as the patient is likely to see me in a more favorable light. You know, where they smile and think, “He is just different.”

Okay, fine…but there is nothing wrong with people doing it.

I already said that and I don’t disagree.

So…what happened?

Well…he asked how she was doing and she began weeping right away. Poor dude was like a deer in headlights. So I just stepped in and assured her that we did not want to disturb her during this very emotional time and that we would be back at a later date; what we wanted to do could wait. Then, once we were in the car, I made the necessary calls to be certain that a psychiatric skilled nurse got in to eval her right away.

So it ended fine.

Well, yeah, I guess so. He did make one mistake, though.


Yeah, but I know you would do the same.


If you walked up to me and asked me how I was doing and I burst into tears because two of my four children had died this year and the remaining two are arguing over my estate while I am stuck alone in an assisted living facility, what would you say to me?

Probably, “I’m sorry…”

(interupting) Yeah, see?

What is wrong with saying ‘sorry’?

What are you ‘sorry’ for? What did you do?

I didn’t do anything, but I can still feel ‘sorry’ for them.

No, you can’t. To feel ‘sorry’ is to sympathathize. It is to pity someone. Your job as a professional is to empathize. There is a difference and we need to understand that.

But Keith, it is a phrase. It is what people say. It doesn’t mean that I actually pity them.

But you are telling them that you do. Words have meaning, even if we don’t mean for them to.

It’s what everyone says.

I am walking into their home as a professional and empathetic caregiver. I need to do be – and do – better than ‘everyone else’.

Fine. What would you say?

“That must be very difficult.”


I still demonstrate that I am listening, the conversation remains patient centered and the conversation can remain open for to her expand further if she is inclined, while she has a sense that I understand that this must be taking a toll on her.

Keith, this is ridiculous. You cannot expect everyone to stop saying ‘I’m sorry’. Not everyone thinks about what they say.


4 thoughts on “Isn’t This A Problem?

  1. Good post, thanks! I am currently in my 3rd year of PT school and have really enjoyed your 8 Weeks of learning post! Thanks for the great info.

    • Thanks for reading, Jimmy.

      Glad you have found some the information presented here to be useful!

      • So what do you say instead of “how are you?”??

      • “Good afternoon, ma’am. It is good to see you today.”

        (Allow for patient response, followed by reflection)

        “At our last visit, you were experiencing a pulsing ache [using the patient’s own language from the previous visit] in the low back. It was a more on the right than the left, is that right? Okay, so we worked together for a while, and you were moving better when I left on Wednesday and you were planning on following up on your own with the activities that we practiced that day. Were you able to follow through as you had initially thought you might? Have your symptoms changed since that visit? For better or worse? In what way?”

        Of course, it varies per patient, but (for better or worse) this example is representative of how I try to engage my patient’s in a focused conversation regarding their care. I learn, tweak and adjust often…this is where I am at today.

        Thanks for your interest.


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