The ingredient therapists lack when discussing patient care with the surgeons

Saba Kamal, OTR, CHT.

What traits define a successful therapist in outpatient care? The essential elements that allows the therapist to be successful at their job includes knowledge of the anatomy, the injury, the pathology, the procedure performed and its precautions, and the ability to foresee the prognosis or its pitfalls based on the personality being treated.  

Complicated cases require therapists to extra vigilant and have the ability to collaborate with surgeons for a successful outcome.

Unfortunately, therapists often find it difficult to articulate their message in person or on the phone. Given the surgeon’s track record with written notes, critical information may never make its way to the surgeon at the detriment of patient care.

Based off my experiences, therapists hesitate to speak their minds to surgeons. And I wonder Why?

Is it because we are seemingly functioning at two different levels? Surgeons may disregard therapists’ knowledge or therapists may not find surgeons approachable. Competent therapists who lack confidence may unintentionally cause surgeons to interpret their reluctance as insecurity, and influence the surgeon to devalue the therapist’s opinions. 

Could this be the reason surgeons fail to seek the therapist’s input when designing new surgeries and protocols? To earn the view from the top, therapists must put in the work —it is the therapist’s responsibility to sharpen their skillset to open the lines of communication with surgeons to provide the best care to patients. Therapists’ inability to communicate to surgeons is not only a matter of substandard care but it may even be unethical for preventing patients from receiving the best care attainable.

So how can therapists get to a place of successful collaboration with surgeons?  What would it take to climb that ladder, albeit daunting at first, and approach surgeons?

There are two necessary ingredients: One-part Competence and One-part Confidence. 

Competence is defined as the ability to do something proficiently and with the expertise it demands.  Without the core knowledge of basic skills, therapists cannot develop the skill and latter ingredient, Confidence. However, when therapists possess competence, they will also gain confidence to take the first step and voice their opinion. This starts a positive cycle that will continue to build upon competence while boosting confidence.  

Some therapists have competence but have not learned the skills to effectively express their opinions. When a message is received incorrectly, it may ultimately be detrimental to the population being treated as it may disrupt power dynamics between therapists and surgeons. Conversely, therapists who are overly confident and challenge surgeons without the requisite experience may harm the reputation of other therapists in the field.

Competence is required to build confidence, and both need the right fire – communication to express their opinion to enhance the outcome of the patient being treated.

One useful tool for therapists is to acknowledge that the surgeon is still in a superior decision-making role, and to remember it’s the surgeons’ job as a leader to listen and promote open dialogue. At the same time, it is the therapists’ job to educate themselves, see the big picture, and discuss the surgeons’ concerns at their level. The buck ultimately stops with the surgeon; thus, he has the final say. The therapists can climb that ladder one step at a time communicating their competence with confidence and building on it to reach to the apex.

Unequivocally, surgeons respect therapists who prove competency through repeated successful results. Once this dynamic is established, surgeons can and do rely on therapists’ skills for treating difficult cases.

While generally the relationship between therapists and surgeons are improving, we need more therapists to have a seat at the table, design the rehab for their latest techniques and surgeries.

This could be fostered while therapists are still in school, such as implementing a required rotation with physicians and surgeons in a clinic. Therapy students need to develop the skills necessary to discuss cases with surgeons and articulate in an intelligent and meaningful way.  In addition, surgeons would start to acknowledge the therapists as part of the team.

This will promote the free flow of information and prepare the next generation of therapist to build the bridges that will ensure the therapist a seat at the table.

I welcome any thoughts and comments that will help us improve our patient care from both sides. Looking forward to hearing from you all.