Patients First


Creating a client-centric care practice.

By Susan Nowell, PT, DPT
“Nobody cares how much you know until they know how much you care.”
—Theodore Roosevelt

Any smart business person knows that solid customer service lies at the heart of a company’s ongoing success. I recently went to a business conference attended by a diverse group of small business owners seeking feedback and marketing development strategies. The expertise among the group ranged from the tech-savvy software engineer specialized in building social media platforms to the real estate agent focused on how to stand out in the competitive San Francisco market. The resounding message for the various business problems being discussed: Your client needs to know that you care.

This was amazing to hear, especially coming from a highly intellectual group of business people when so much of the customer service that we receive in our own lives has become so watered down. Think about it. How often do you end up waiting for unapologetic customer service? I can think of a few instances from just this past week.

On the heels of this business conference, I was thumbing through the sports section of the New York Times and found myself pulled into some fine print on baseball. That never happens. Baseball is not my sport. What drew me in was the humanistic aspect of this article. The Mets’ pitching coach, Dan Warthen, a 62-year-old former professional pitcher, faces the greatest professional task of his second career: developing one of the best young pitching staffs in baseball.

A torn ulnar collateral ligament thwarted Warthen’s pitching career years ago. Tommy John surgery was then too new a science and too expensive a procedure for Warthen to partake. He now protects his players by teaching “innings limits” and his “Dan Warthen slider,” a pitch that puts less gapping stress on the elbow. He exemplifies the famous quote he uses to describe his coaching style: “Nobody cares how much you know until they know how much you care.”

Across the board, whether in the competitive business of creating apps, selling houses, or training professional athletes, the message for improving the customer experience remains: Your client needs to know that you care. The true challenge lies in effective application.

Health care is a challenging business with respect to customer service. For one, our patients do not always “choose” to become paying customers. A person who is unexpectedly thrust into a trauma or injury situation does not necessarily choose to become a paying customer. Furthermore, in our reimbursement-focused system, patients are not the only entities paying for our services. Every therapist, at one point or another, has probably experienced an abrupt end to treatment sessions due to reimbursement issues. Aborted care does not qualify as positive customer service.

Reimbursement issues, while major, are not the only source of customer service dilution in our field. As therapists in reimbursement-based care, we often act as the middle person in health care delivery. What I mean is that we are relying on efficient and effective communication and service delivery with referring providers, other practitioners, and equipment vendors. Just this last week, I found myself struggling to maintain quality service while feeling caught between poor interdisciplinary communication and ineffective equipment delivery. I had been treating a patient status–post open reduction internal fixation (ORIF) for a distal radius fracture. She had a follow-up appointment with her surgeon and came to therapy verbalizing that the doctor had progressed her weight-bearing status. Meanwhile, the equipment we ordered for this patient had been misplaced in her home facility. As I placed multiple, unanswered calls to her surgeon (for weight-bearing status confirmation) and the durable medical equipment (DME) vendor and facility (to locate equipment), her therapy progress felt stalled. The obvious challenge of documenting progress to third-party payers and maintaining a positive customer service situation remained.

Luckily, the above example was an extraneous case, and I can just as easily think of positive, efficient interactions that I have had with surgeons and vendors. The most effective, quality care-inducing interactions I have had with vendors and other health care providers has always involved the three classic “C’s” of communication. This means that professional communication is clear, concise, and current. If we can expand this communication to a level of doing what is clear, concise, current, and client-centric, we are much closer to quality customer service.

Over the years, I have surveyed different patients and family members on their therapeutic experiences. Here are some of the most common complaints about therapy care I have heard:

  • “Beautiful space with great gear, but impersonal feel.”
  • “Not enough feedback/supervision on exercises.”
  • “Not enough 1:1 time with my physical therapist.”
  • “Not enough explanation about injury and choice of exercises.”
  • “Spent more time with the aide than my therapist.”
  • “Not enough visits/got cut off from therapy.”
  • “Had to wait too long to see my therapist.”
  • “Billing enigmas.”

I am a big believer in listening to complaints as feedback and a way to improve the patient experience. Most of these complaints include an aspect of careless customer service. More often than not, an unhappy patient is not questioning the knowledge of the therapist, but the application of the knowledge. “People don’t care how much you know until they know how much you care.” Turning these complaints and carelessness inside out, we get a list of therapeutic service strategies with clear, concise, current, and client-centric delivery of care:

  • Gain an awareness of the whole persona so you can individualize treatment based on patient’s motivations/passions and progress treatment properly.
  • Engage your patient in the care, encourage patient ownership of care.
  • Encourage communal cheerleading between client and support staff.
  • Create and communicate realistic expectations.
  • Manage resources to minimize waiting periods for start of care.
  • Promote proper use of therapy time; avoid idle “wait” times by utilizing support staff or maximizing therapist/client interactions.
  • Promote clear and efficient division of labor among support staff so client receives appropriate supervision and communication time with therapist directing care.
  • Invest in your client as an individual.
  • Listen as much as you talk.
  • Promote fun; motor-learning is most effective when individuals enjoy the experience.

In summary, the main ingredients of good customer service in therapeutic care involve positive management of the client:therapist interaction through establishing communication, management of expectations through realistic appraisal of outcomes, proper time management, proper resource management, and therapist self-management in maintaining both transparency and accessibility.

Patients who receive focused, individualized care are more likely to refer themselves back to you and/or opt for recurring private pay care. It is not about abandoning your intellect to shower your patient with unicorns and rainbows. It is about using your clinical intellect to find the most appropriate treatment approach and using your emotional intellect to communicate and show that you do indeed care.

Susan Nowell, PT, DPT, is a PPS member and owner of Endurellect. She practices physical therapy in San Francisco. She can be reached at

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