#PTonICE Daily Show – Wednesday, September 13th, 2023 – Radically candid patient care

In today’s episode of the PT on ICE Daily Show, Modern Management of the Older Adult lead faculty Jeff Musgrave discusses the book “Radical Candor” by Kim Scott as a valuable resource for improving patient care and leadership skills. Jeff highlights the book’s teachings on radical candor, including its definition, common pitfalls, and practical application in patient care. Jeff emphasizes the significance of caring personally for patients and challenging them directly. Caring personally entails demonstrating genuine concern for the patient’s life and goals, while challenging directly involves establishing and upholding standards and expectations that contribute to the patient’s success. Jeff believes that this book is relevant to patient care and can assist clinicians in becoming better leaders for their patients.

Take a listen to learn how to better serve this population of patients & athletes.

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00:00 INTRO

What’s up, everybody? Welcome back to the PT on Ice Daily Show. Before we jump into today’s episode, let’s chat about Jane, our show sponsor. Jane makes the Daily Show possible and is the practice management software that so many folks here at ICE utilize. The team at Jane knows how important it is for your patients to get the care they need. And with this in mind, they’ve made it really easy and convenient for patients to book online. One tip that has worked well for a lot of practices is to make the booking button on your website prominent so patients can’t miss it. Once clicked, they get redirected to a beautifully branded online booking site. And from there, the entire booking process only takes around two minutes. After booking an appointment, patients get access to a secure portal where they can conveniently manage their appointments and payment details, add themselves to a wait list, opt in to text and email reminders, and fill out their intake form. If you all are curious to learn more about online booking with Jane, head over to jane.app.physicaltherapy.com. Book their one-on-one demo with a member of their team. And if you’re ready to get started, make sure to use the code IcePT1MO. When you sign up is that gives you a one month grace period that gets applied to your new account. Thanks everybody. Enjoy today’s show.


Welcome to the PT on Ice Daily Show. My name is Dr. Jeff Musgrave. I’m one of the faculty with the Institute of Clinical Excellence in the Geriatrics Division. We call modern management of the older adult. Super excited to talk to you about a book that I recently read called Radical Candor, written by Kim Scott. This is a great leadership book, but it has some direct correlation to ways that you can improve your patient care, okay? So super excited to talk about radically candid patient care with you this morning. But before we get into that, just a couple things going on in the MMOA division. If you’re looking to continue on to get your MMOA cert, Our next cohort of Essential Foundations is going to be on October 4th. If you’ve already had Essential Foundations, you’re looking to get into Advanced Concepts, you’re going to want to hop in the cohort October 10th, and if you want to see us on the road, there’s still some spots in Oklahoma City for this weekend.


So, this book, Radical Candor by Kim Scott, what does it have to teach us? The things we’re going to cover is what is radical candor. We’re going to talk about some of the ways we sometimes miss a mark. This is going to hit home for me because one of these downfalls is something that I have succumbed to time over time and have been working to improve. And then how to apply this well in patient care and some things to consider. So, what is being radically candid? What does that mean? So, Kim Scott defines this in the book as two factors. Two factors to being radically candid. You’ve got to care personally. You’ve got to care personally. I think oftentimes, if you’re listening to this podcast, you’re someone who cares personally, because you’re trying to get better. You’re trying to level up. The second piece of this, where I think oftentimes we miss a mark as clinicians, is to challenge directly. to challenge directly. And for me personally, this was something really difficult to learn is how to challenge our patients directly to hold the line. We’ve got to hold the standard. We’ve got to say, this is what it takes. and we’re going to hold the line until we get there. Or we’re gonna make referrals to other people, we’re gonna bring in whatever parts of the medical team it takes to get you to this standard, because this is what it takes to reach your actual meaningful goal, the thing that you really want to do. So that’s what radical candor is. You’ve got to care personally and challenge directly. Some of the ways we see this go wrong, the first bucket is the one I fell into over and over and over again, and that was ruinous empathy. So ruinous empathy is defined as you care personally, but you don’t challenge directly. You care about your patients, they know you care about them, but you don’t challenge them directly. They may give you a really bad rep or any effort and you just say, that’s so great, that’s amazing, that’s exactly what I wanted. And you know in your heart of hearts, that wasn’t it. You didn’t hit the mark. That’s not anything like what I told you to do, and we did not coach them up. We want to be really effective coaches, really effective coaches, set people up for success, and we challenge them directly. We give some room for them to struggle. So ruinous empathy is the first bucket if you miss being radically candid. That is, you care personally, but you don’t challenge directly. We’re congratulating every attempt, whether it’s actually a progression or not. Now that being said, I will tell you one of the factors that we use, one of the principles we use when we’re working with older adults is we do intentionally underdose. We do make things a little bit easier so we can hit success. So we make the challenge a little bit easier so that we can get some successful reps early on, and that is important. But over time, we ramp up that challenge pretty quickly because we don’t have time to waste, particularly with older adults. If we’re not getting them strong, we’re going to see them decline very quickly.


So to circumvent that, to make sure that they can be successful and we can be honest when we’re giving them that feedback, we make sure the challenge is appropriate. And sometimes we’ll make it just a little bit easy at the beginning, but we very quickly ramp up so that we are directly challenging our patients because that is where they’re gonna get better. So maybe you’re not being ruinously empathetic, Maybe you’ve fallen into this other category that Kim references as obnoxious aggression. And that could represent the burned out clinician here. I’ve had periods in my career before I found my passion where I was doing work, too much work, not saying no, and found myself completely overwhelmed with work. where you don’t care personally about this patient, you’ve not connected on a deep level to be empathetic to what their experience has been, but you do challenge directly. So that could look like you being obnoxiously aggressive in your feedback. Like, nope, that’s not it. Nope, nope, nope, nope. Instead of just being quiet, letting those improper reps happen, we like to have people start some of these new movements that we’re teaching in such a way that they’re not gonna get hurt if some ugly reps happen. We can let those ugly reps happen, and then once we see a good one, we’ll be like, yes, that’s it. that can help you circumvent if you tend to be obnoxiously aggressive in your feedback. So that is when you don’t care personally, but you do challenge directly, and there’s a mismatch there. And that can do a lot of damage when we’re trying to build a relationship with our patients so that they trust us. If they don’t think we care about them, then they’re probably not going to come very long, they’re not going to take our instruction well, probably not going to be very beneficial of a therapeutic relationship with that client. So that’s the basics of radical candor and how we can miss a mark by being ruinously empathetic or obnoxiously aggressive. What I want to do now is just lean into what it looks like to truly care personally for our patients. So I truly believe that you cannot give world-class care, you cannot give the best care if you don’t care about your patient. If you don’t know enough about your patient to know how their problem is impacting their life, you just can’t do it. If you don’t know how it’s impacting their life, you’re never gonna dig deep enough to even get a good goal. And if you don’t get a good goal, you don’t really know what movement to work on. To give you an example of this, say someone is having knee pain. You’ve got an older adult coming to you for knee pain, and you just take that at surface level. Okay, I’m just gonna figure out why your knee hurts, and I’m gonna give you exercises for your knee. But maybe you’ve not dug deep enough to find out why the knee hurting, why that even matters. Why does that matter to this patient in their world? What impact is this having? If that knee pain is keeping them from taking care of maybe their favorite pet. We like to talk about Fluffy a lot. A lot of our older adults have pets. And we say, okay, why does it matter that you have to get in the ground, get on the ground to take care of Fluffy? Or maybe they need to kneel down to clean the kitty litter. It’s like, well, I live alone. I have no help whatsoever. And Fluffy is my only emotional connection. Fluffy’s the only person in my world. I’m completely socially isolated, and if I can’t take care of Fluffy, I’m gonna have to get Fluffy away. And my fear is that my only social connection, my only being that I can connect with is going to leave me, just like maybe family members that have passed away.


Man, if we have dug that deep into our patient’s goals to know why it’s important that they get their knee better, First of all, we’re going to set a better goal because their knee may feel good and they may have better manual muscle testing. But if we don’t ever bridge the gap back to them being able to get in the floor or take care of Fluffy, we’ve not really done our job. We’ve not dug deep enough to even get a good goal to care for them. And if they don’t know how important this is, they’re not going to trust us. like they would if we dig deep enough to know that we really genuinely care. And that trust is going to allow us to do the second part very well, which is to challenge them directly. We’ve got to challenge them directly. So what we’ve got to do is set very clear expectations of what success, what it’s going to take to get to success. This client may have been dealing with this problem for decades. And if we tell them, oh yeah, I can get you better, in three weeks, even though we know this problem has been coming on for decades and decades and decades. When the reality may be that we are in more of an acute setting, someone just had a fall, they’re in an acute or subacute setting, and the reality is to get back to getting into and out of the floor or getting their own groceries, it may be a year-long process. And if we just tell them, oh yeah, you know, I’m gonna give you a few exercises to do and if you do those for a week or two, you’re probably gonna be better. That’s not it. That’s not truly challenging directly. That’s being ruinously empathetic.


We care, but we’re not setting realistic expectations. We’re not challenging directly. That patient needs to know this journey is gonna take you a long time, but you can get there. The tools, the resources are out there. I’m gonna get you started on your journey. I’m gonna plant the seeds of the fitness that you actually need. to hit these big goals and I’m going to make a referral to someone who can take care of you. So if you’re in a more acute setting your job is going to be planting some seeds and you’re going to send them to a fitness forward clinician on the next step down the line so they can hit those big goals after you’ve uncovered them. So This may take one referral, maybe you’re an outpatient, it may take several referrals. Maybe their medications are off, maybe they need different shoe wear, maybe they need to go to a podiatrist or an optometrist. If we dig deep enough, we do a really good job on the front end and get this information, we need to set realistic expectations of all the people that may be involved and how long it’s really gonna take. Our older adults know when we’re not shooting them straight. They know. When you hear, I’ve not been active for 40 years, and I’ve got a goal that requires a lot of activity and strength I’ve not had for 40 years, they know immediately if the goal is not realistic, and they’ve already lost trust with you. They may show up and get what they can, but they’re not going to open themselves up to the challenge that they’re really gonna need to reach their goals. So that’s what I’ve got for you team. I think that this book by Kim Scott was very beneficial. It is a leadership book, but is very relevant in our ability to be leaders to our patients. And the two main goals here is we have got to care personally for our patients. It’s got to be clear to them that we actually care about their life, that we’ve dug deep enough on that first visit to find out what their true meaningful goal is. And then our second job is to challenge them directly. We’ve got to set and maintain the standard. We’ve got to set realistic expectations that’s actually going to lead to their success. If you’ve read this book, if you’ve got questions, comments, concerns about what I outlaid out here, I would love to discuss it. Leave me some comments. Otherwise team, have a wonderful Wednesday. We’ll catch you soon.

14:29 OUTRO

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