E683 | The Two Most Important Elements Of A Great Initial Eval

In this podcast episode, Dr. Danny explores the common mistakes that physical therapists often make during initial evaluations with new patients. He shares insights gained from coaching sessions with PT entrepreneurs on how to structure the first visit for maximum effectiveness.

Dr. Danny reveals that in the past, he used to focus on providing short-term pain relief during the initial visit by performing various manual therapy techniques and tests. However, he soon realized that this approach was misguided. Instead, the primary goal of the initial visit should be to provide long-term clarity and understanding to the patient.

To achieve this clarity, Dr. Danny emphasizes the importance of conducting a thorough subjective and objective examination, rather than relying heavily on hands-on work. By understanding the root cause of the patient's issue and going beyond the presenting symptom, the PT can address the patient's true concerns and fears. For example, if a patient presents with knee pain, the PT would dig deeper to learn that it is impacting their ability to play basketball with their kids, which is an important bonding activity. This understanding not only helps the PT create a tailored treatment plan but also provides powerful motivation for the patient to commit to the plan.

During the initial evaluation, Dr. Danny advises PTs to spend minimal time on education and instead focus on providing just a few exercises to avoid overwhelming the patient. The main aim of the first visit is to provide clarity through understanding, rather than seeking short-term fixes or proving skills.

Furthermore, Dr. Danny highlights the importance of sending a detailed follow-up email to the patient. The email should summarize what was found during the evaluation, explain its significance, and outline the next steps in a way that even a non-medical spouse could understand. This follow-up email reinforces the clarity provided during the initial visit and helps justify the patient's decision to invest in treatment. It reduces confusion and potential buyers remorse.

By focusing on providing clarity and understanding, the initial evaluation experience can be transformed. Patients will feel truly understood and committed to the treatment plan, resulting in improved outcomes and increased referrals. Dr. Danny emphasizes the importance of listening deeply to patients and addressing their true motivations and fears, as this is key to achieving success in physical therapy.

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Podcast Transcript

Danny: 

This is the summary email. This is what we're sending them. This is, and then this is next steps. Okay. At the next visit, here's what we're going to do. This is what we can expect over the next few weeks. This is what we can expect over the next few months. Our goal for you is going to be slowly get you back into activities that you want to do at this point, and then full activities unrestricted at this point. And, let us know if you have any questions.

Hey, are you a physical therapist looking to leverage your skill set in a way that helps you create time and financial freedom for yourself and your family? If so, you're in the right spot. My name is Danny Matei, and over the last 15 years, I've done pretty much everything you can in the profession.

I've been a staff PT, I've been an active duty military officer physical therapist. I've started my own cash practice. I've sold that cash practice. And today my company physical therapy business helped over a thousand clinicians start growing scale their own cash practices. So if this sounds like something you want to do, listen up because I'm here to help you.

What's going on? Doc Danny here with the PT entrepreneur podcast. And today. I want to dig into some very tactical, very specific things that I see as mistakes that people are making on their very first visit at the initial evaluation. So this comes from a conversation that I had recently on a call with our rain making clinical rainmaker.

Coaching clients. So this is a program that we have that is a six month mentorship to help you Start and grow a cash based practice, to where by the end of it you're able to go full time within your practice so people are just starting or they're like side hustling and they're trying to go full time.

This is the stage that they're in the, in, in these businesses when we're coaching them and working with them. So I'd had a call the other day that I did with the clinical rainmaker clients. And one of the things we got into was how should you structure your first visit? And I can tell you, here's what I used to do.

And many of you may be doing the same thing. I would literally like do. Manual therapy technique I could possibly think of, test, retest, all kinds of stuff so that I could prove to them that I could make a symptomatic change in their pain. And I felt that if I could do that, then they would be bought in on whatever I said that they needed to do, including buy a package, right?

The. So this is something I stopped doing and I stopped doing this because what I realized and what we teach people now is these little test retest techniques or whatever, like these can be great from an assessment standpoint, but you're not there to try to prove that you can manipulate their pain in the short term.

To help them understand what's going on, what's the root cause of the problem that exists and to get clear on why it's important for them to solve it. And what is actually going on and what it's going to take to get the outcome that they want. So if you can think of one word, one thing that you want to make sure that you're thinking about, that you are focused on in an initial evaluation, it is clarity.

It's clarity that they feel like a. They know what's going on because most often they don't in the medical community. It's very confusing. And we take this for granted because we do understand, the body better than most people do. Definitely better than the people are coming to see us and our clients.

But what they don't understand is why they have pain. How long is it going to last? What's going to stop them from doing this? All the things that they're worried about and. Your job in that first hour with them, assuming that's how long you have your initial valuation set up for. That's what we did.

Is to have them leave there and be very clear on the A, they know what's going on. B, they know what's going to take to get the outcome that they want. C, why they're putting in this money effort. Time and then also from there, they have a strong enough understanding that they could then go explain this to a partner at home that has no medical understanding that is the intent of the first visit.

So I recommend on a first visit, you do very little hands on work, very little corrective exercise education. And you do an incredibly thorough job with a subjective and an objective, so you can be very clear on what we're dealing with, what they're dealing with, and spend the time trying to figure out why they're here in the first place.

What is bringing them in? Let's say you have somebody that comes in and they have knee pain. And they're trying to get some help with this pain in their knee. If you do not understand the root cause, not necessarily the root cause of their pain, you'll get to that. But the deep reason why they're there.

You're not going to have as good a compliance, and you're definitely not going to have as good of an opportunity to get them to commit to solving the injury through a plan of care. Which we know, if they buy a package of a plan of care, the likelihood of their outcome improving goes up. They're committing.

Right then and there to solving this problem and you have the time to then help them get that outcome So let's say this person comes in. Okay, your knee hurts. All right. Awesome. What's stopping you from doing? I can't really run and jump and like that it's frustrating. Okay. Why is that important to you?

Yeah, I like to play basketball it's something I enjoy doing okay cool are you playing pickup games or like What kind of basketball are we talking about? You're like, okay, yeah, I play pick up occasionally, but more than anything, I'm like, I'm playing with my kids as they get older.

I really like to play basketball with them. They're really into it. And I want to be able to do this for years to come because they are getting older and I want to be able to keep up with them as they get older. And it's really important to me because I get to spend time with them and this is where we talk about their day or whatever.

Okay. Now, all of a sudden you went from knee pain. And if you just leave it at that, you were leaving so much on the freaking table. And if you just go, Oh, basketball's important to you. Okay, cool. Now you got a little further, but if you can talk to this person about the put, putting their fear at ease, that they're there, they're.

Thinking of themself, Oh my gosh, I'm not going to be able to play basketball with my kids. I'm not going to be able to chat with them about their day while we're shooting in the driveway and we're playing a little bit of one on one because my knee hurts so bad that they can't do it. That is the fear that you are.

Dealing with that is the motivation that you're also using to help make sure that they do things They need to do to get the outcome that you want them to get and they want to get So now you get a chance to talk on a far deeper level a far more meaningful level About what's going on and we know that the psychology behind that is going to drive action.

It's going to drive commitments And it's going to it's going to create a lot more clarity for them for why they're doing what they're doing So it's okay, as part of this, I need you to do these exercises a couple times a day, whatever. And for them, if they know, okay, this means if I do these, that means I get to play black basketball with my kids for years to come.

That's very different than if I do these, my knee won't hurt as much. And that may sound like it doesn't make that much of a difference, but it makes a massive difference. So VisitOne is all about thorough, subjective, thorough, objective, deeply understanding why they're there. And showing them through all the things that we can do from an objective standpoint that we understand and we are Teasing out what is going on from a root cause standpoint where we can help them solve this problem For good long term and that is your goal.

Your goal is clarity on the first visit You might give them a couple things to do but don't overwhelm them with a bunch of shit I used to do like every manual therapy technique I could think of and give them like two weeks worth of programming and Then have them come back in two weeks huge mistake overwhelm them Did too much stuff.

They, and for me, I was just like unsure of my skills and what people found value in that I just did everything that I could possibly do to try to prove that I was worth the 175 they were giving me or whatever. Versus not understanding that they were there because they wanted clarity.

They want to know why they were hurt and they want a solution to the problem. And the first visit should really be about providing them that clarity and. And then it's about solving the problem after that. So the second part to this that I would say that we got into, it's really important for you to keep in mind is that you want to reinforce the clarity that was that was gained on the first visit with a very thorough.

Email that you send them afterward. This is your summary email of the visit should be very thorough It should be something to where if like I want you to think if they went home and they had to explain to their spouse What was going on as well as why they just paid you 2, 000 to help them with an injury What their spouses want to know what the heck are you doing?

Why did you decide to do that? And if you can send them an email that clarifies to their spouse in such a, meaningful, simple, effective way of what's going on, what is not happening, Hey, good news. This is not going to require any further imaging, surgery, orthopedic consults, none of this stuff where you're going to have to spend any more time, energy, money going down.

This rabbit hole. You're in the right place. Here's what we found today. Here's why this is important. And here's what we need to address in order for you to be able to get back to a not having knee pain, but B being able to do, change of direction, movements, jumping, landing, and not have knee pain.

So you can continue to play basketball with your kids. This is the summary email. This is what we're sending them. This is, and then. This is next steps. Okay. At the next visit, here's what we're going to do. This is what we can expect over the next few weeks. This is what we can expect over the next few months.

Our goal for you is going to be slowly get you back into activities that you want to do at this point and then full activities unrestricted at this point. And let us know if you have any questions. And this is something that you need to send afterward so that they can then reinforce this at home with their family or they can reinforce it to themselves because they might forget, what the hell did I just do?

Why did I give that person all this money? It, did I make a mistake? Buyer's remorse is a real thing. And if you can justify everything that they did in the office, either to their spouse or to themselves, when they get home, the likelihood that person is going to feel really good about their interaction with you, they're going to feel really good about their decision to invest in themselves to solve a problem.

Long term it's going to be exponentially better. And if you can get these two things your customer experience alone is going to skyrocket because. If there is lack of clarity, think, just think about how many problems that causes in your life or in society in general, when people see things differently than each other, they don't understand, why somebody is doing something or what the reason is behind it.

And they just assume whatever they think is happening. And that doesn't necessarily mean that is accurate. So for us to be able to provide clarity for them, it eliminates a lot of the communication breakdown that leads to so much frustration and people feeling maybe they've gotten taken advantage of or do the wrong thing or whatever it might be.

This increases your customer experience dramatically, and it will frankly increase the number of people they send your way because if you treat them this way, and just think about any medical experience that you've ever had. Very rarely do you leave there feeling like completely sure that you know exactly what's going on and what the next steps are.

More often than not. Your provider is late to see you. They're rushed. They are like not clear. They're using too much medical verbiage that you don't understand. You leave, you're not sure why you're taking these pills or whatever they give you, or you're doing these next things that they say you need to do.

You have no idea. And because you have no idea, you don't, you do not feel comfortable. You do not feel compelled to then move on to the next things. 'cause clarity is why people make decisions and that is lacking. In a significant way in healthcare in general, you have the time. Now, if you set up these cash based clinics to where you have time with people, that's a luxury for us.

And you, you need to use that as. Primarily for clarity and education on the first visit that will make more of a difference than any sort of manual technique you can possibly do for somebody. And you're setting the stage for solving a longterm problem with a thorough process and not a quick fix where somebody is coming to see you so you can do a quick hands on thing.

They feel better and it comes back in a couple of weeks because then they don't think you actually did a very good job. That is what you don't want to turn into. So that's the keys to focus on. Number one, focus on clarity, be very thorough with your subjective in particular, take your time, have a conversation with them, listen to them.

For God's sakes. No one listens to people in healthcare. If you just listen to them, it's going to make a huge difference. And I'll tell you, I'll tell you a great, just barometer for whether you're doing this right or not. If you have people get emotional in your office, talking about why they're there and what they've gone through.

And most people are frustrated and they never get a chance to express that. No one listens to them. And if that happens to you, if your clients start to get a bit emotional, sometimes legitimately break down talking about, their injuries and what their fears are, that is a great. Sign that you are listening to them, that you are actually helping them solve a problem and that they are understanding why they're there as well.

That, that means a lot. If you're doing that, you're on the right track. I'm not saying you're going to get that all the time, but I'm telling you got to go deeper than just, Oh, your knee hurts. Cool. We work knee pain all the time. No, it's got to be more than that. And then clarify to them why they're there, what you're working on and then what the next steps are so that you can future paste that for them and their.

Partner so that they understand that the investment they're making in themselves, they're doing for a reason with someone that is. Intentionally working towards helping them get back to a goal that's important to them. And if you can do that, you'll have no buyer's remorse, you'll have way more referrals, and you're going to get a lot better outcomes for the people you're seeing.

So it's a win. Focus on those two things. Clarity, and then follow up with a thorough email that explains everything to the level that their spouse, who is not a healthcare provider, would understand.

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