Cultivating a Culture: Empowerment
I recently read a quote that spoke to me, it stated "durability is more important than ability." When I saw this I immediately began to think what makes something/someone durable? Naturally I looked it up. Webster's dictionary defines durability as the ablility to exist for a long time without significant deterioration in quality or value. But what are the characteristics? I couldn't proceed with my thought process (of course I did actually write down my key characteristics) because to reach the point of being considered durable means a patient has developed certain traits that are beyond the therapeutic environment. When contemplating, "how we successfully move a patient to this endpoint?", I identified the therapeutic CULTURE as fundamental. Why? Well, what is a culture in biology because we are dealing with human biology, after all. Webster tells us it is an act or process of cultivating living material in prepared nutrient media. In other words your culture will effectively dictate your patients outcomes. Patients are a clinician's living material and the culture can be one of two types: passive-dependency or abetting and empowering. A clinician's choice dictates a patient's durability outside 4 walls of a clinic. A passive culture cannot sustain life, or in Rehab terms it cannot sustain long term outcomes. It creates dependency. This can be in regards to a clinic, practitioner, or even a specific technique. It is this characteristic that is so dangerous of the passive culture. Dependency leads to higher rates of reoccurrence as well as longer courses of treatment. Why? In my opinion it is due to a the lack of accountability stemming from the lack of responsibility given to a patient. Often this precedent is established day 1. Ever heard the phrase, you can only make a first impression once. Obviously no body wants create a culture that doesn't sustain outcomes, so how does it end up happening? Many clinicians don't value the n = 1 principle. They pick their favorite means of therapeutic intervention and run with it regardless of their patient's needs. They fall into the all or nothing principle in regards to their treatments. They are either all exercise or all manual. Very few clinicians respect the need for both because its' hard to integrate them both into a single session and control their stress. It forces clinicians to understand that manual therapy can be effective at both physical and psychological healing as well as proper exercise prescription can yield long lasting adaptations within the human system. Patients need a nutrient media that helps them grow in their understanding as well as provides a unique therapeutic approach to be successful. When does a clinician start being this nutrient media? Day 1. It starts at the initial evaluation where we lay the foundation that can be built upon. The stronger the foundation you lay the more durability potential that exists. So how can a culture effect this foundation? It starts with a sense of empowerment. This is defined as the process of becoming stronger and more confident, especially in controlling one's life and claiming one's rights. This actively engages the patient in their own care and they become invested in themselves. How do we do this? My thoughts: 1. Ask them a question: Are you ready to heal? Now this may seem silly because of course they are going to say yes without hesitation. But I want to know if they are truly ready to be pain-free because they may be using their pain as a crutch (or excuse) to get through each day. The pain experience is one with boundaries. In this instance pain can be acting as a stabilizing feature of their system. Without pain a person may experience vulnerability. Being vulnerable is
uncomfortable and in today's society we strive to avoid the uncomfortable at all costs. In turn, pain becomes an excuse or scapegoat, rather than a gift that protects us (more on this here). This is a critical first step in the healing process. Healing cannot occur if we don't let go of our pain and become vulnerable. Optimal learning also occurs in this state. Thus, their pain is preventing them from recognizing that they are more than they believe. This makes the clinicians role invaluable, especially in the next steps because they help a patient realize and accept they have substantial potential beyond their belief! 2. Create an understanding. Knowledge is the liberator. Often patients present after seeing their MD or receiving their medical reports stating they have degeneration, bulging disc, a tear, or some other fear provoking diagnosis. This immediately heightens their stress-response as well as creates a sense of hopelessness. Educating a patient on their condition not only gives hope, but immediately roots them in their own care. Don't under estimate their capacity for understanding they want to know what's going on whether it be anatomical, physiological, or a movement pattern dysfunction. The goal is to fill in the patient's gaps that exist. 3. Establish a unique plan. This is where most empowerment 'plans' start, but the 2 steps prior are essential to ensure an effective plan is integrated. This should include: educational material (facilitates step 2), exercises, objective goals, as well as any form of manual restorative techniques. Each of these hold different benefits and although your patient will more and likely just accept your advise without question, you need to provide an explanation so they know what they are trying to achieve with each element. Again knowledge is liberating!
Dependency leads to higher rates of reoccurrence as well as longer courses of treatment.
4. Utilize accountability. When steps 1-3 are met it allows for step 4 to be implemented. Accountability removes the excuses for the patient and allows us to move ahead in a steady and progressive manner and if their is stagnation it allows for identification of where things are falling short. Thus we can readily address them and continue working on their long term durability. Thus, empowerment sets the foundation for long term success of a patient because it gives them the tools they need to manage themselves. Empowerment is essential in cultivating a culture suitable to develop patient durability!
