The Order of Establishing Attributes 

During the initial appointment, I believe that there is an order of factors which must be established. The primary factor is one of safety and security. The person must feel safe, secure and unthreatened in your appointment. This is established by all of the strategies mentioned thus far through your manner behaviour and pre-appointment strategies.

 

Once in the appointment the next thing to establish is that of your own competency. The goal will be to have you characterised by 2 primary factors, safety and competency. Once these 2 factors are established then you can seek to humanise yourself, generate a sense of friendship, become more personal (if appropriate). But competency must be established before you begin to present more personal or casual side of you.

 

Safety to manage the person flight of fight system during the session and make it a functional session.

 

Competency must be established prior to any further factors because that is how you want the person to characterise you in their mind in the primacy. If you wish the person to respect your opinion and for you to have influence over their decisions, then you must be characterised as a professional healthcare worker who is also nice and friendly. You mustn’t be characterised as a friend who is also a healthcare worker.

 

You can also begin to seed what sort of clinician patient dynamic arrangement will be most productive. But you must first establish your competency. You cannot be seen as somebody who is friendly first and a clinician second. When you give guidance, it must be given with the weight of that competency with backing from your profession. You may have experienced a friend asking you for advice on what they should do with their physical problem and you as a physio will tell them what they need to do. You then watch them totally disregard your advice only to then pay to receive the same advice from someone of the same profession and then watch them dutifully follow it. Of course, tied up in this is the fact that things we receive for free often have no value. But the point still remains that your friend will see you primarily as a friend, but also as a clinician.

 

When I first started as a physiotherapist there was a movement to empower patients. One of the strategies for this was guidance to young physios to ask the patient what they thought was wrong, and what they thought should be done. When I began working I did as I was told and followed this direction only to find many patients strongly rejected this, and immediately questioned my competency. I learned of the complexity of asking a question like this. To whom can it be asked, when during the conversation and the importance of the exact words used to ask.

 

Expand upon factors that different people need for different levels of influence. Some people need to pay, some people need a institution, some people value things outside of the institution.

 

You can play with these different areas but only once you have established yourself as competent.