Right from the beginning, when studying Osteopathic Medicine I was repeatedly bemused by how some of least capable in the class would manage to perform at the same level in clinical exams as the most gifted. The lazy thinkers who could pull on a coat of charm and guile in practical and clinical exams and manage to portray an air of capability and impressive knowledge without seemingly having the best capability or knowledge as the rest of us saw it (from numerous hours in lectures and class together).
I was brought up to treat most things like a meritocracy: to quietly ply your chosen trade or passion with integrity, focus and a good dose of hard work. Do this, and you can say you are true to yourself and you will be rewarded. I realize of course, that there are many things that don’t work in such a effort-recognized-and-rewarded way but throw in completing a degree majoring in neuropsychology before I started my osteopathy training and you have a bemused someone, genuinely interested in how and why those charmers, the extroverts, the boldest can hold their own with the most genuinely talented and the grafters.
In the many years in clinical practice since those days at college that plot is repeating itself and there is a whole rainbow of flavours in those we see as being the most successful in the fields of osteopathy and physiotherapy. It can’t be just about talent alone.
Attending a conference on back pain a few years back, my take home message was nothing to do with pain, but some insight into my gentle intermittent musings about that rainbow of success . That it is perhaps something to do with the types of confidence we portray as clinicians to our patients, and that confidence is not handcuffed to talent and capability alone. Patients love confidence. They need to know we are going to help them, take on their problem and get them better, that they are safe. This will only happen if they are confident in our confidence and there are two types: subjective and objective. Subjective confidence is that which comes from what is perceived independent of clinical knowledge. It is clean clinic windows, it is polished shoes, a fancy tablet to make electronic notes, a texted appointment reminder. It is an assertive tone, a personable manner, smooth charm, a sofa without stains on it in the waiting area. Objective confidence is really about clinical knowledge, experience and seeing that you “know your stuff”. It comes from the practitioner being able to communicate what they are doing and why, to be able to untangle difficult scenarios and explain them clearly, including a diagnosis and treatment plan, to demystify things that often the patient has been around the houses for years getting more befuddled about.
Here is the thing: both confidence types on their own can build successful, busy clinic practices, and patients get better, but the similarity ends there. The lasting effect of each is very different. Subjective confidence is like a boiled sweet, it gives the immediate delicious sugar rush that you feel confident in your practitioner, has you skipping back to the office after your treatment literally singing the praises of the “seriously amazing” practitioner, that has you wanting more and will make you want to book back in next week, or earlier! The thing is, it doesn’t last. In fact if you don’t book in pronto then the feeling of that confidence wears off quickly so that in 8 months’ time, you will have long since lost the effect and are unlikely to either book back in yourself to see that same practitioner or suggest enthusiastically “you must go there” or “ you must see them” when colleagues or friends around you have crocked their back. Objective confidence, on the other hand, is the chia seed of confidence: the slow release that lasts. You are reassured you are in safe hands, and are soothed that you know what is going on and you have found someone who can help. You may not be as instantly wowed when you meet that practitioner or outwardly be blown away when you head back to the office (and maybe won’t sing a note in appreciation of that) but it lasts. It lasts. In 8 months’ time when you or your colleague have sprung a muscle in the neck, you will chirp in immediately with “ you must go see…!”.
So there you go. Both can build busy, popular practices but in very different ways, and patients will still get better. However, the purveyors of subjective confidence will have to keep peddling hard to source and get new patients in and to book them back in quickly to avoid run off and keep those confidence sugar highs coming. The practitioners giving more objective confidence will naturally get more returning patients and more delayed-onset referrals, and hence steadily grow a clinic more strong and effective. Most importantly, this means better clinical care and completion of that care for patients. So whilst little bit of both is good and will bring instant patient confidence that lasts from the very first point of contact, I know which I prefer to rely on for my patients.
Something to consider then: how much of each type of confidence does your physiotherapist or osteopath rely on when treating patients? As clinicians, we should not be relying on boiled-sweet subjective confidence alone – a treat in moderation – and strive to reach for the chia seeds that are more beneficial to all.
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Bsc(Hons) OstMed MA Cantab DO ND
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