Start Helping: The Art of the Clinical Consultation

Liverpool manager Juergen Klopp, Thiago Alcantara, and head physio Lee Nobes during the warm-up before the match REUTERS/Lee Smith

Clinicians enter the medical industry with a deep desire to help. Often, their personalities are shaped by a deep empathy. If they can enhance their ability to express empathy, they can create positive patient experiences and improve outcomes⁽¹⁾. The act of caring is scattered through humanity and takes shape in many forms—for example, teachers, veterinarians, and social workers. However, sometimes this desire to improve the lives of others is misdirected into an energy to fix, rather than help, truly help. The reasons for this are plentiful and far beyond the scope of this article. Often, the reasons are supported by personal stories that persuade someone to want to help others. But what happens when clinicians get it wrong? What happens to the therapeutic relationship? Poor communication between practitioners and patients can result in misunderstandings that negatively impact outcomes⁽²⁾. When the clinician assumes the role of expert and the patient becomes subservient to their care, the relationship breaks down, frustration grows (in both parties), and the patient’s health suffers.

To improve the therapeutic relationship, it is essential to take a moment for personal reflection. When a clinician’s ego is confronted to understand the true meaning of helping. To unearth the wide-eyed student who enters medical training with a deep desire to make the world a better place. This reflection begins with understanding how help manifests. Firstly, clinicians must understand that there are five ways of helping⁽³⁾. 
-    Abdicating
-    Instructing
-    Mentoring
-    Advising
-    Coaching

“Stronger therapeutic relationships lead to improved clinical outcomes.”

Each one has its place in helping, and each has its implications for the therapeutic relationship (see table 1). As clinicians undergo medical training, there is a gradual shift towards the expert who uses instruction to help their patients. This moves them further from fostering true, healthy relationship-building techniques. The expert-student relationship is helpful and necessary in certain contexts. However, when the therapeutic relationship breaks down, treatment adherence and compliance are negatively affected⁽⁴⁾. The art of helping relies on understanding which method to use at which point. Although complex, the implementation is theoretically easier because it starts with listening. Listening to understand the athlete, not listening to respond with what they already know. Questions are the foundation for healthy relationships, and listening is the skill required to foster meaningful questions^(5,6). Clinicians need to step aside and understand that the athlete is the only person who understands their health intuitively⁽⁶⁾. That intuition is a powerful tool for creating meaningful interventions in achieving a healthy and fulfilled life.

Table 1: Five ways of helping in clinical practice⁽³⁾

Self-Determination Theory

Athletes returning to sport after injury may experience concerns related to their sense of competence, autonomy, and relatedness⁽⁷⁾. Self-determination theory examines the socio-environmental factors that influence an individual’s tendency toward self-motivated behavior, psychological health, and well-being (see figure 1). Once clinicians understand what constitutes intrinsic motivation, they can ensure that each factor is considered within their rehabilitation and communication approach. Importantly, injury impacts autonomy as athletes lose their ability to choose when and how they participate in physical activity. This immediately affects their motivation and, therefore, compliance.