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Not Seeing Progress? Here are 6 Questions to Ask. 

BRAIN FUEL 1/10/2021

We’ve all been in this situation. You look at your schedule and it's the client you just can’t seem to move the needle with. You’ve both tip toed the conversation hoping they would turn the corner.  Today, they come to you and say, “I just feel like I am not making any progress”. In this moment, where does your mind go?

“I’m failing this person”  

“I am not smart enough”

This is a pain point. This discomfort can lead to you throwing away your plan and changing course, referring out when not necessarily appropriate, or blaming lack of progress on the client to protect your ego. All of these stunt growth and limit our ability to solve the problem. Rather than letting emotion take the wheel,  we need a prefabricated plan. A template to use this pain as a stimulus for better problem solving and accelerate clinical growth. 

We need an internal audit protocol. ⁠⠀

Here are the hierarchical questions I ask to audit my process. ⁠⠀⁠⠀

1. What factors may be interfering? ⁠⠀

  • What is the probability that we are limited by a physiological process that we cannot influence? ⁠⠀
  • Is the “rate limiting step” time dependent? (i.e healing process) ⁠⠀
  • Is there a precedent for typical recovery time? Are we still within that window? ⁠⠀
  • Are there certain behaviors/occurrences outside of our plan that need to be modified if able?⠀

2. Is the plan we set out being executed appropriately?⁠⠀

  • Is the client adherent to the plan?⁠⠀
  • Is the way they are performing the plan doing what it is intended to do? ⁠⠀

3. Is the dosage correct? ⁠⠀

  •  Is there a chance we are over or under dosing?⁠⠀

4. Is the stimulus we are applying doing what we intended it to do?

  • What key performance indicators have changed? Which have not? ⁠⠀
  • Is there another way to apply this stimulus that may be more effective? ⁠⠀

5. Is the stimulus we are applying the appropriate stimulus⁠⠀

  • Based on new information is the initial plan still appropriate? ⁠⠀

6. Is the management of this issue within my scope of practice or circle of competence? ⁠⠀

  •  Do I know of someone with more experience managing these types of issues⁠⠀

Creating a protocol to lead us through discomfort can help to set the path to growth. We must be consciously aware of the shortcomings of our emotional and reactive initial response and pre-emptively create strategies to manage this. Get comfortable sitting in uncertainty and pain, it is fertilizer. ⁠⠀

⁠What is your process? What questions do you ask yourself? 

- Dr. Anthony Iannarino, Rehab 2 Perform

physical therapy, CEU, Sports Rehab

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