Advocating For A Mindset Shift
Estimated Reading Time: 5 minutes
As I am writing this, I am about halfway through my final clinical internship. If there is one thing that I have learned from all 3 of my rotations, it is that patients have a set of expectations before we even walk into their rooms.
Patients have a preconceived notion of what they want from us, of what is going on with them, of how they should be feeling and moving, and even what treatment should look like. And if one or all of those things don't meet or exceed their expectations, then disappointment is bound to be felt.
I think it is safe to say that there is a direct correlation between someone's happiness and how close reality is to their expectations. Honestly, sometimes it seems that happiness is more contingent on how much reality exceeds expectations, than just meets expectations. As health care providers, this mind-set can make things challenging. But it's not just the patients who experience this; as a student I have expectations, too—expectations for my performance, expectations for a patient's progress, and expectations of their impressions of me as a future clinician. This can lead to feelings of disappointment, frustration, and anxiousness.
I recently read Daniel Kahneman's Thinking, Fast and Slow in which he discusses the important fact that most events and outcomes in life are due to luck. Regardless of how well-thought-out our decision is, there are numerous other factors working behind the scenes that contribute to the conclusion. However, we tend to believe that we have a lot more control than we actually do. I'm not saying that a patient's success in therapy is contingent on luck. But I am saying that there are more factors at play than what they do in therapy. It is important for the patient and therapist to understand this.
Annie Duke explains in her book Thinking in Bets: Making Smarter Decisions When You Don't Have All the Facts that the way our life turns is influenced by 2 things: luck and skill.
For example, a patient may have performed below baseline for functional mobility in the hospital because of their lack of willingness to participate in therapy (skill), the staff having a demanding caseload with not a lot of time for mobility training (bad luck), or numerous other reasons. On a more positive note, a patient maintaining their functional mobility status could be due to regular therapy sessions and the patient performing their exercises in between sessions (skill), or a quick resolve of their current condition due to a healthy and effective immune system (luck). With both skill and luck working at the same time, outcomes can be hard to predict, making expectations hard to meet.
I'm not advocating that we explain to each of our patient's that most of what happens in life is based on either good or bad luck. What I am saying is that it can be a powerful tool and worthwhile if we take the time to explain that there are only certain things that are in our control, and one of the most important is what we choose to do in the present moment.
I am making 2 distinct points in this post that I believe directly tie to our patients' and our own emotional well-being.
The first is that we have expectations and beliefs about how something should be and when reality doesn't meet those expectations, we are usually disappointed.
The second is that we don't have as much control over events that happen in our lives that we would like to believe; most outcomes, regardless of our decision, are based from good and bad luck. This might come off as if the solution is to have low expectations and not bother trying because everything happens by chance anyway. However, that is not what I'm saying. Instead I am advocating for a mind-set shift.
To be aware and focus on what you are doing in the present, while also trying to ignore what has happened the day before or what might possibly happen in the future. This is the essence of mindfulness, and I believe that it can help to decrease frustrations and feelings of low self-efficacy in a therapy setting.
I recently read an article that said, "What screws us up most in life is the picture in our head of how it is supposed to be." Talk about letting expectations dictate our welfare.
Going back to my second point, with so much of life being out of our control, the picture we believe our life should be is bound to be different from reality. We are setting ourselves up for disappointment.
A number of my patients have expressed frustration during therapy because of the difference between how they think they should be moving and how they actually are moving. The picture in their minds of how they should be is based from memories of how they were prior to the situation that landed them in front of me.
Mindfulness and putting energy and attention on the present moment, help to steer the mind away from this picture of how we think something should be.
I think our patients will greatly benefit from gentle reminders that what matters is what they are doing in the moment and how that's contributing to the bigger picture—that life is fluid and our situations are not permanent. What we have control over is what we are doing in the present and that should be our focus. By living in the moment, we can reduce the power expectations have over us, and as their therapist, it can greatly impact our patient's outcomes.
Megan Mitchell, SPT, is a third-year student at the University of Maryland, Physical Therapy and Rehabilitation Science. You can connect with Megan on Twitter at @MegMitchellSPT.