“Made to order” restaurants are my preferred establishments. Why? Because I’m picky! Please don’t put mustard on my sandwich. I understand the chef probably added mustard to add to the flavor profile, and she is the expert, but I really won’t eat it if there’s mustard. What good is a perfectly balanced sandwich if it is thrown away? We can look at how we treat patients in the same light. As much as I dislike patients telling me what treatments they want (“Can I have ice and stim?”), their perspective matters. And with an increase in diversity in our communities, the challenge grows. If we are unfamiliar with a patient’s culture and perspectives, how are we to provide patient-centered care? One way is to recognize that the Golden Rule has been upgraded to the Platinum Rule! Instead of treating others as I want to be treated, we should treat others as they want to be treated. This poses a very difficult task! We aren’t mind-readers. We can’t expect to get it right every time. Maybe how they want to be treated is perceived as not following the best Western Medical principles. Just like if I’m given a sandwich with mustard, our patients will throw us away if we do not take time to listen and attempt to understand their values, wants, and needs. Remember, providing evidence-based practice includes taking into account patient values and perspectives.
Another aspect to consider is equal versus equitable care. Take for example our athlete playing wheelchair basketball.
When she enters the athletic training facility would you tell her, “Go ahead and grab the pulleys from the top shelf, throw the loop over the top of the door, and begin your active-assistive range of motion warm-up. I’ll be with you in a bit!”? Those instructions may be your standard instructions and you’d be providing equal treatment, but she would have extra barriers to overcome to accomplish the task. Equitable treatment would mean you provide additional assistance to allow the athlete access to her treatment by removing or reducing barriers. “The pulleys are set up for you. Go ahead and begin your warm-up and I’ll be with you in a bit!” This example may be obvious, but it can apply to many circumstances.
Providing patient-centered care and evidence-based practice is a challenge. But as AT’s, we have the advantage! Most of us work in a setting where we can get to know our patients. We should strive to get to know the whole person and what is important to them. Why do they always ask for “ice and stim?” Are they just being needy? Do they like how it feels or are they looking for pain modulation because their belief system doesn’t allow oral medications? Maybe you recommend seeing a physician, but their parents don’t trust the medical system. Maybe they enter your AT clinic needing social support and “ice and stim” is their ticket in the door. The possibilities are endless. We are the medical experts, but they are the experts of their own bodies, and we shouldn’t expect all patients to receive our care in the same way. Patient-centered care is individualized care. Our patients have different skills, abilities, and beliefs; therefore, our treatments must be specific to those characteristics. Take time to listen and learn what is important to them. How can we utilize our skills to match their expectations? We may be the expert, but we don’t always know what is best. Ego has no space when providing patient-centered care.
Athletic trainers are in the service business, within the medical model. Be the medical expert that offers alternate treatment ideas based on patient needs and wants. Variety is the spice of life, but hold the mustard if you’re my AT!
Lynette Carlson, DHSc, ATC
Clinical Education Coordinator
Graduate Athletic Training Program
University of Tennessee at Chattanooga