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5 Tough Conversations Every Physical Therapist Has at Some Point

Highly successful PTs hone their social skills and learn how to navigate difficult conversations.

Melissa Hughes
5 min read
July 27, 2021
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There’s nothing more satisfying than treating a patient, helping them achieve their functional goals, and getting them back to the activities and lifestyle they love most. That’s what draws so many physical therapists to this profession, after all. And yet, working with a variety of people isn’t always a breeze; it comes with its own set of trials and challenges—like conflict resolution, for instance. 

So, what types of conflict resolution scenarios do rehab therapists face—and how should they approach them? Let’s run through some of the most common ones. 

1. Addressing a Patient's Lack of HEP Compliance 

It’s important for patients to attend their therapy appointments—but it’s equally as important for patients to adhere to their home exercise program. HEP adherence is integral for keeping outcomes on track and helping patients get back to the lives they love—faster. Knowing that, only 35% of patients adhere to their HEP, which means that conversations about HEP compliance are a big part of a PT’s job. 

How to Approach the Conversation

When talking with patients about HEP compliance, it’s important to keep your cool. It can be frustrating to watch patients struggle when you know how much their HEP could help them—but it’s important to remember that they may have legitimate reasons for deprioritizing their home exercise routine. So, try to contextualize patients’ HEPs in a way that aligns with their personal functional goals. Maybe they don’t want to dedicate 15 minutes a day to exercising—but they may be willing to dedicate 15 minutes a day toward becoming strong enough to hold an infant family member.  

Specifically, try approaching the conversation using these tips from Ryan Klepps, PT:  

  • Share how the home exercise program impacts your patients’ functional goals.
  • Provide structure. 
  • Give patients permission to make their HEP work for them
  • Get patients tracking their progress. 
  • Focus on the goals.
  • Make yourself available.

2. Setting Boundaries with Patients Who Make Inappropriate Comments

Over the course of working with hundreds of patients, PTs are bound to run across some folks who like to push the envelope—and not in a good way. Some patients may make comments or snap judgements based on internal biases, creating an interaction and/or conversation that is difficult to navigate. While most (if not all) patient-facing professionals hope these conversations are few and far inbetween, it’s still beneficial to know how to maneuver this figurative minefield without triggering an explosion. 

How to Approach the Conversation

First, evaluate (and be sure you understand) your clinic’s policies. Are you allowed to turn away patients who exhibit problematic behaviors, or are you expected to transfer a patient to a coworker’s care if you don’t feel comfortable treating them? Are there certain behaviors that are never acceptable in the clinic, and are they explicitly stated anywhere? Knowing your clinic’s policies—and whether you have backup from management—can help you navigate these conversations. 

Beyond that, it’s all about setting boundaries and maintaining them. Let patients know exactly what actions or conversations are off limits and communicate consequences if they continue to pursue those actions or conversations. If a patient says or does something inappropriate, know that it’s perfectly acceptable to say, “Excuse me. What you just said or did is not acceptable. If it happens again, you will be asked to leave.” If your clinic allows you to sever relationships with patients, you may also be able to swap out the last part of that phrase with “we will no longer treat you at this organization.” 

3. Calling out a Fellow Therapist for Unprofessional Behavior

Calling out a coworker for unprofessional behavior is as tough as it gets. Whether the therapist is spreading misinformation, making patients uncomfortable, or engaging in conversations (or behaviors) that shouldn’t be present in a professional setting, it’s difficult to head this off at the pass. 

How to Approach the Conversation

In many cases, this type of conversation should fall to someone who works in management—not to a fellow physical therapist. The trick here is to be able to recognize if your professional peer needs a gentle nudge in the right direction or firm guidance from a manager or human resources rep. Consider your relationship with this peer, and honestly ask yourself if they would be open to having this type of conversation with you at all. If not, rope in the appropriate parties and leave the tough talk to those who are better equipped to handle the situation. 

4. Reinforcing the Value of Care to Patients Who Don't See Results Right Away 

Physical therapy has a branding problem. It’s not as well understood as it should be. As such, patients don’t always know what to expect from a PT’s care—including how long it can take to notice significant improvements in mobility. These are the patients who become frustrated with their treatment and—more often than not—self-discharge before completing their full course of care. While it can be difficult to help patients see the value of the care they’re receiving, it’s absolutely critical for retaining patients and turning them into PT advocates. 

How to Approach the Conversation

The trick here is to start these conversations early. Set expectations with patients and engage them in their care; show them how far they’ve come—either by sharing their outcomes data with them, or by reminding them how far they’ve come since they began care. Additionally, consider engaging patients in their care by giving them mini goals they can meet as they work toward their full functional goal. Perhaps they want to ultimately be able to lift 50 pounds without pain. By celebrating milestones as they begin to be able to lift five pounds (or 10 or 20 or 40), patients are more in tune with their progress and will be more willing to continue their care journey. 

Looking to eliminate the dropout problem in your practice once and for all? We’ve got you covered.

5. Negotiating for a Salary Increase

Negotiating for a salary increase can be a really tough conversation for some people. It can be stressful to feel like you’re rocking the boat—and to push for more tangible recognition. That said, this skill is incredibly important for any professional to have. 

How to Approach the Conversation

When approaching these types of conversations, remember that preparation is key. Start by getting a handle on your local market value. Find data about PT salaries in your city and state. If your salary falls below that benchmark, use that data to advocate for yourself and the value of your time. Beyond that, collect information that measurably demonstrates your value to the clinic. For instance, if you always meet your productivity requirements, that’s a great place to start—but so is your patient return rate (i.e., how often your patients return for care when they experience another musculoskeletal injury). 

Make a note of all of the non-measurable work that you perform as well. If you give other therapists treatment advice or contribute to administrative projects, bring it up when negotiating a higher salary. That work is all valuable to the clinic—and you deserve to be compensated for it.

Because rehab therapists work so closely with so many different people, social skills are extremely (and arguably equally) as important as clinical skills. Hopefully this advice helps you navigate some of the more hairy situations you may encounter as a physical therapist. 


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