Physio Blog

Interpretation of our words and understanding

All in the way you say it….
We can all remember that time as a teenager when your mum or dad used the words ‘it’s not what you have said, it is the way you have said it’. A powerful statement. Meant to educate us on the nuances and finer detailing of our communication skills with the people around us.  Maybe we were not equipped with the skills to adapt our way of communicating or maybe we were not ready to hear these home truths. It’s a good statement to use in order to make the point today. Sometimes, with patients we use many words and many phrases. In a single session with a patient you might be talking for up to 20minutes (hopefully with some careful listening taking place alongside this). The words you choose to use are not only important in terms of what you are saying about their ‘tight shoulder muscles’ or ‘restricted hip movement’ but also its the words we choose to use to describe what we think is going on that can have both a very negative or very positive effect on our patients.
A lot of what we are talking about is interpretation of our words and understanding. The immediate example is the patient who hears the word ‘unstable’ in the sentence ‘you have weak core muscles that are leading to instability in your low back and that is what is causing your back pain’. This patient may not hear another word you say as they focus on this one word. It might be that they associate the word unstable with experience from their working environment. They might be a builder and hence ‘unstable’ means unsafe. Make the building more rigid and it is inherently more ‘stable’. This may translate to rigidity in their back in order to prevent this ‘unstable’ reaction. Each person will interpret your words differently depending on their own particular set of experiences and associations.
Another good example is the patient that hears they have ‘osteoarthritis’ of your knee on X-Ray. We as clinicians are aware that the visible signs of wear and tear known as Osteoarthritis on X-Ray do not directly correlate with how much pain or disability the patient will experience but telling someone they have ‘osteoarthritis’ can open a can of worms. The patient may have older relatives that have experienced medical practitioners of old telling them that they have Arthritis and that eventually their pain will worsen and deteriorate. This pre-existing experience can cloud their understanding or intake of the information you may provide to them about Osteoarthritis and its current management.
Our advice for practitioners is this: Stay vigilant to the power your words can have on your patients. Use of the word ‘chronic’ can have a negative meaning as many interpret this is permanent and debilitating rather than use of the word ‘persistent’ as an alternative when discussion ongoing pain with clients. Taking the time to fully explain what you mean and not throw in big or potentially harmful words without full explanation and the time to check the understanding and interpretation your patient has made of what you say. Be careful about which words you choose to use with patients. Give examples of what you mean, avoid the words that can have bigger meaning in their particular lives, depending on what job they do, what their family members may have experienced and what social context imparts on that word.
To our clients, here is our advice for you: Make sure you communicate with your therapist. Be open and honest about any previous experience you may have had around the words that they are using. Be honest with yourself if certain words catch and hold your attention, acknowledge them, verbalise them to your therapist. Even if you do not know why they catch your focus and make your uncomfortable, mention it. Usually this allows your therapist a deeper understanding of you as an individual and allows them to better explains things in relevant terms to your life experience. Be honest and open about words that you do not understand or statements that they may have made in the course of trying to explain things to you. If you do not understand fully then the risk of you mis-interpreting what is being explained is higher and so your recovery may be affected.
Open and honest communication is key to recovery. Poor communication can slow it down. Bad communication can potentially make you worse…..
Leanne Plenge
Bristol Manager
Specialist MSK Physiotherapist 
Physiocomestoyou Ltd
M: +(0) 779 661 8827