As Veteran's Day approaches next week, I think of quite a few veterans I've treated. I remember their stories. War - it seems to be a messy topic with many angles and components that can be discussed. The various topics that can be discussed include strategies, money spent, number of soldiers, technology, winning, losing.... Veterans, when they do share stories, keep it very simple: those living, those that lost their lives and the relationships they made.
I think we can learn something from veterans. Soldiers build strong relationships with each other. As soldiers are performing their duties, lots of history, tradition, science and data are incorporated into what and how they do what they do. When they've shared their memories with me though, their memories revolve around the relationships they made.
Although I am a strong advocate for using outcome measures, data and evidence based practice, I try my hardest to not let my head and data dominate my thoughts, feelings and actions. The services I provide are not about me. Sure, I'm a part of the experience, but to be honest, the services are for the patient. I have to adapt to each patient's particular mental or physical state and his/her immediate concerns or focus.
We work with people. The science of what we do is in how we weave the data into each patient's service. In my opinion, the only way to succeed in using data from outcome measures is to also focus attention on building relationships with our patients. Generally speaking, we probably won't build bonds as strong as those made in the military. We can focus on building a strong relationship with each and every patient.
Data won't tell you that 16 years ago Jane and her husband were in a major car accident. You won't know that at that moment Jane lost her husband... nor will you know that it brings Jane joy to share memories of her husband. By building a relationship, you know that Jane wants to continue to live at home, alone, as independently for as long as possible. Her home is the last thing she has that she shared with her husband.
Data won't tell you that Marie's knee gave way and buckled under her when she was 16. It also won't tell you that this type of incident was a common occurrence. Data also doesn't indicate that for the last 45 years, Marie has been very, very guarded with all activities that involve walking or climbing. She may now have a new knee, but she doesn't see that she will have a "normal" life with regard to knee function.
The stories are true... the names are fictitious.
I am hesitantly concerned about the future. Now, more than ever, quality is a huge focus. Quality is actually being measured and incentivized in some payment models. My hope is that rehabilitation professionals keep an even balance in their perspective. For the majority of patients, successful outcomes are dependent upon belief and/or behavioral changes. A foundation of trust is required in order for patients to change and maintain their level of motivation. Building relationships with patients is highly important. As quality becomes front and center in both payment models and clinic processes, we can't forget about the personal aspect of what we do. We still need to value building relationships. One of my most favorite qualitative studies ever focuses on what it is about expert clinicians that make them different than average performing clinicians. Expert clinicians focus on developing "rapport with just about everybody." Data and rapport go hand in hand in achieving positive outcomes.
Today I spent some time getting ready for Veteran's Day. I've only treated retired military personnel. The only reason I even know is because I try to get to know my patients and know enough of a story about each so that I may remember them. I've been honored to be chosen to work with and to hear some stories from soldiers (men and women). This year saddens me. This is the first year that 3 of the veterans I have treated passed away. If you are a veteran reading this, I'd like to extend a big thank you for your service and sacrifice. Although I have been told various stories about many different situations, you and I both know that I really don't have a true comprehension about what it is like to serve this country. I do appreciate what you have given - thank you.
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