EP174: "Delivering BAD News To Athletes"

[00:00:05] Are you a motivated healthcare or fitness professional? Are you looking to work with more athletes, become a sports specialist, or even get a job in a sports setting so you can finally enjoy the career that you've always dreamed of? If so, you're in the right place. My name is Chris Garcia, physical therapist, business owner, entrepreneur, and residency training sports specialist. I've been fortunate to work in professional sports and travel around the world working with elite athletes throughout my career, and I've learned a lot of lessons along the way.

[00:00:30] I created this podcast to share my experiences and give you everything you need to know to help you become a sports expert. Welcome to the Sports BT Academy.

[00:00:42] All right, all right, all right. Let's call this either how to deliver bad news or delivering bad news properly, effectively. Let's try that. All right, so delivering bad news, let's do thumbnail.

[00:01:15] Bad news. So put some of the image here, like bad news. Good, we'll start with that.

[00:01:28] Worked with a patient and they were, here we go. Have you ever worked with a patient and you had to deliver bad news, maybe surgery results, or that they're going to need surgery, and you didn't know how to do it, and you're trying to figure out, is there a better way to manage this?

[00:01:55] That's what I'm covering inside this episode. Hi, everyone. Welcome back to the podcast. Welcome all new listeners and welcome those who have my content in the past.

[00:02:04] Today's episode is all about delivering bad news. It's a concept that we all have to be able to master, be able to do it effectively.

[00:02:11] But before I go on to that, what is the latest and greatest in my life? I'll tell you what.

[00:02:15] So about a year ago, I had mentioned to you that my son, Zach, had told me one day that he didn't want to kiss me in front of his friends.

[00:02:22] He's eight years old. He's a little too mature for my liking.

[00:02:27] But at the age of eight, seven years old, he told me in front of his friends, he didn't want me to give him a kiss.

[00:02:33] Well, the other night, he was looking at the ceiling. I was getting him ready for bed.

[00:02:39] And he's looking at the ceiling and he starts crying. And I said, Zach, what's going on?

[00:02:44] And he's like, you know, you guys are really rough on me. You discipline me more than my siblings.

[00:02:50] And he's the oldest out of everyone. I said, I totally understand.

[00:02:53] And we were talking about leadership and how he's going to be a leader.

[00:02:56] That's just the assignment he has in life now. And he started crying more.

[00:03:00] And I said, you know, what else are you crying about? What else are you frustrated about besides us being hard on you?

[00:03:04] He said, Dad, I'm also frustrated that you kissed me at school.

[00:03:09] And I was like, this is still lingering. This was a year ago. It was manifesting in his head.

[00:03:14] So today, officially, I hugged and kissed him at my doorstep and I did not do it into school.

[00:03:20] And that was the hardest thing. And I think it's his perception of being around his peers.

[00:03:24] So I get that he's growing. My daughter, Alex, she just gave herself bangs.

[00:03:30] She didn't cut her hair, but she wanted to give herself bangs because her friends are now influencing her.

[00:03:35] She's like right at that ripe age.

[00:03:37] My son, Jacob, he is a yeller and a screamer because he has to do that in order to get what he needs.

[00:03:42] He's the youngest. So he likes to scream.

[00:03:45] So we're in a screaming phase right now and hitting and biting and scratching.

[00:03:48] So that's all what's going on inside my household while I navigate patient cases and navigating my business.

[00:03:57] So it's been fun and it's been amazing.

[00:03:59] If you haven't heard my last episodes, my hearing has been still off.

[00:04:03] I still can't hear out of his left ear. It's slowly getting better.

[00:04:06] And I'm taking finally some decongestants.

[00:04:09] So other than that, life is fantastic.

[00:04:11] Let's get on to this episode.

[00:04:13] Why am I talking about tough conversations, bad news?

[00:04:16] Well, it's part of what we do on a daily basis.

[00:04:20] We have to give bad news because all we do is help people.

[00:04:24] But the reality is sometimes we get cases who need x-rays, MRIs,

[00:04:27] and it just comes in and presents really differently or poorly.

[00:04:32] I'll give one example.

[00:04:33] I had a PT I was mentoring.

[00:04:36] It was one of my staff PTs.

[00:04:37] And there was an evaluation of somebody who had woke up with hands going numb,

[00:04:44] see like six, seven referral symptoms, and they couldn't move their neck.

[00:04:49] And they said nothing happened the night before or anything else.

[00:04:52] And they said they just slept wrong and they came in.

[00:04:54] Well, they started going through the case.

[00:04:57] And about 40, 55 minutes in, he asked,

[00:05:02] do you have any imaging results?

[00:05:05] They said no, I haven't had any.

[00:05:07] And he wasn't able to get rid of their symptoms completely.

[00:05:10] He couldn't even get their symptoms down at all.

[00:05:12] And so positioning told him that it was more herniated disc,

[00:05:17] but beyond that because there was no relief and it was constant.

[00:05:21] And now this person was suffering on a daily or hourly basis and it was getting worse.

[00:05:24] So he came to me in the office.

[00:05:26] He said, hey, you know what?

[00:05:27] I'm going to go check with my mentor.

[00:05:28] So he comes back in the office.

[00:05:29] He says, hey, I'm concerned that this is beyond me.

[00:05:32] And I said, you know, I really don't like to send out for imaging unless absolutely necessary.

[00:05:36] I said, did you go through these tests?

[00:05:37] Go through these tests.

[00:05:38] I said, he said, yeah, I went through it all and I can't get any symptom relief.

[00:05:42] No comparable signs.

[00:05:43] And this is worsening.

[00:05:44] And anytime I get around that neck, she seizes up and gets more symptoms.

[00:05:47] I said, what do you want to do?

[00:05:48] He said, you know, let's, I want to send her for an x-ray.

[00:05:51] So no problem.

[00:05:52] Do go ahead and send.

[00:05:53] So he said, you know, I think you should go to the urgent care.

[00:05:56] And, you know, we're a cash pay practice.

[00:05:58] So we were able to see them that morning.

[00:06:00] They sent to urgent care and they ended up getting an MRI within, I think, 72 hours.

[00:06:04] And it looked, and it turned out that this person had a fragment of a bone chip that was pushing

[00:06:09] onto a disc or a nerve and that was sending symptoms down.

[00:06:13] And, you know, I said, what was the hardest part about that after we reflected with, with

[00:06:16] the PT?

[00:06:17] And he said, you know, I didn't know how to tell the person that this is not in my scope.

[00:06:20] It's worse.

[00:06:21] And without getting them scared, I didn't want to tell them, you know, like, oh my gosh,

[00:06:25] they're going to die.

[00:06:26] You're going to need surgery or all these other things.

[00:06:27] But I definitely wanted to warn them.

[00:06:29] This is pretty serious.

[00:06:30] And I don't, I didn't know how to effectively do that.

[00:06:33] So we walked through these things and I want to share, that's just one example, but I

[00:06:36] want to share three steps that I'll take to delivering bad news.

[00:06:40] And I've done it at the employee level.

[00:06:42] I've done that the employer level.

[00:06:43] I've done it with PTs that I mentor.

[00:06:46] I've done it with patients.

[00:06:46] I've done it with athletes.

[00:06:47] At any given time, you have to be able to do this.

[00:06:49] I've done it with pro athletes who can't play or shouldn't play and having to make that

[00:06:53] decision or telling a coach that this is not going to look good and they're up for a

[00:06:56] championship game.

[00:06:57] And these are tough things you have to do.

[00:06:59] And I think the more you navigate, the more efficient, the better you get at them.

[00:07:02] But those first initial ones or when you don't have any guidance, they all seem horrible.

[00:07:06] They seem terrible.

[00:07:06] Well, the problem becomes if you don't feel good about them, you delay them as long as

[00:07:10] possible.

[00:07:10] That becomes a problem.

[00:07:12] And because of that, you're not delivering the highest level of care.

[00:07:15] Why?

[00:07:16] Because of your insecurity.

[00:07:17] And so I want to give you that confidence so you can maximize the patient outcomes,

[00:07:21] maximize that relationship and ensure that you're helping people to the maximum ability.

[00:07:25] So I'm going to tell you my top three tips.

[00:07:27] And some of these are really straightforward, but the reality is it's all about how you

[00:07:32] deliver this.

[00:07:33] I'm going to give you the process to be able to do that.

[00:07:35] All right.

[00:07:36] So anytime that you're delivering bad news, you have to consider what is your job?

[00:07:41] What's your role?

[00:07:42] You're a healthcare provider.

[00:07:44] You're a physical therapist.

[00:07:44] And your job is to help people live a better quality of life, improve their outcomes, do

[00:07:50] diagnostics, provide them information so they can have a better option to choose whatever

[00:07:55] they need necessary to improve their function.

[00:07:58] So if you keep that at the top of your mind, you understand what your role is.

[00:08:02] Now, the question is, once you understand that role and somebody comes to you, a lot of

[00:08:06] physical therapists say, well, that's not my role.

[00:08:08] I'm not here to, I don't interpret an MRI.

[00:08:11] I don't read the x-ray.

[00:08:12] I don't do all those things.

[00:08:13] However, a lot of times patients don't want the full interpretation.

[00:08:17] They don't want the full impression.

[00:08:18] They want your opinion.

[00:08:21] And that's hard because you're like, well, what if I'm wrong?

[00:08:24] What if I tell them the wrong thing?

[00:08:26] That's the greatest fear that you have.

[00:08:28] So I'm going to, I'm going to tell you that your job is to provide as many options as possible.

[00:08:34] So the first thing you have to do, this is fundamental, never lose sight of this.

[00:08:39] You have to lead with empathy, not just sympathy.

[00:08:44] All right.

[00:08:44] So be empathetic for that person.

[00:08:46] Now, here's the problem with empathy.

[00:08:49] Most physical therapists, they try and build a relationship, try and build trust through

[00:08:55] gaining into that patient's heart, right?

[00:08:57] They're like, oh, I'm going to be a good friend of yours.

[00:08:59] Tell me about your family.

[00:09:00] You know, like I'm such a good person.

[00:09:02] You're a good person.

[00:09:03] Why can't we be good people together?

[00:09:04] When in reality, you're a medical provider, your job is to provide options for this person

[00:09:12] so they can make the best decision, not develop a friend.

[00:09:15] There's a very big difference between building a good patient PT relationship and being a provider

[00:09:22] who provides the highest quality, best options, and has a good relationship with the person.

[00:09:29] But the young physical therapist or the person who fears and lacks the security and confidence

[00:09:35] to deliver bad news, what they'll do is they'll rely on good relationships and avoid the whole

[00:09:39] conversation of, well, here's the bad news.

[00:09:42] And they'll just keep delaying that inevitable.

[00:09:44] So the first one is lead with empathy.

[00:09:47] And what you need to do is understand your job is not to get into their heart.

[00:09:51] Your job is to improve their logic so that they can make the best decision for themselves.

[00:09:56] So your job is to connect to their brain, not to their heart.

[00:10:00] Meaning, help them understand your logic when you give your impression, your interpretation,

[00:10:07] your opinion so they can make that best decision for themselves.

[00:10:11] So the first one is to lead with empathy.

[00:10:15] Lead with the brain, not with love.

[00:10:18] And when you're dealing with your partner, you're dealing with your family, sometimes you

[00:10:22] can't deal with logic because they're so emotional.

[00:10:26] You're so connected to the heart.

[00:10:27] But now that they're paying for your service, you are not allowed to leave with love.

[00:10:33] Your job is to provide logical solutions.

[00:10:36] So, for example, what if you were having an issue with your shoulder or neck and you went

[00:10:42] to a surgeon and you're like, I've tried everything.

[00:10:45] I've tried physical therapy.

[00:10:45] I've tried all these other things.

[00:10:47] I've tried every other service under the sun.

[00:10:49] And that person is like, oh, I feel for you.

[00:10:53] And you're like, well, what should I do?

[00:10:54] And they're like, oh, just wait it out.

[00:10:56] Just keep trying, okay?

[00:10:59] Just keep trying.

[00:11:00] It's a very parent approach, right?

[00:11:02] Just lead with love and support people.

[00:11:04] But the reality is you want an answer.

[00:11:06] So your job is to find that answer.

[00:11:08] But most physical therapists don't treat yourself like surgeons.

[00:11:10] You treat yourself like an empathetic healthcare provider, almost like maybe a social worker,

[00:11:16] somebody who's trying to help them and feel good for them and don't worry about everything

[00:11:19] will be okay.

[00:11:20] No, everything is not going to be okay.

[00:11:22] And I have to deliver this message.

[00:11:24] So that's the first one.

[00:11:25] The second one is you have to understand that your job is to be empathetic, but then also

[00:11:33] to lead with logic.

[00:11:35] But the problem is, is that you're reading off a script.

[00:11:38] You're reading off of a sheet.

[00:11:41] So you have to be genuine when you provide this.

[00:11:44] And I think that that's the hard part is that if you listen to my last episodes, there's something

[00:11:48] called a 738-55 rule where when you're trying to help somebody through something, emotion,

[00:11:53] create change, whatever it is, 7% of that total emotion created, that energy created is

[00:11:58] through words, meaning that only 7% of what you convey is actually going to help somebody

[00:12:04] feel better about themselves, feel better about a decision they're about to make.

[00:12:07] 38% is through the tone that you use and 55% is through the body language, meaning 93% is

[00:12:13] nonverbal.

[00:12:14] So if you can't feel for this person, you can't demonstrate that, that listen, I understand

[00:12:20] that you have significant neck pain going down your arm.

[00:12:24] Here's what I would do if I were you.

[00:12:26] Your symptoms aren't going away.

[00:12:27] All my special tests come out negative or positive.

[00:12:30] I can't get you to decrease your pain.

[00:12:32] Those are all traditional signs and symptoms that I can help you in the very near future.

[00:12:36] But because I haven't been able to do that today, you haven't been able to sleep, you

[00:12:40] can't reduce your symptoms, and you can't even function despite taking high-level pain medications,

[00:12:46] I would go to the ER or urgent care now.

[00:12:50] If you don't want to go that route, then I would say I need to see you for the next three

[00:12:55] days, three days straight to see if we can reduce those symptoms.

[00:12:58] If I can't reduce those, then I need you going then.

[00:13:02] So you're either going to go now or in the next three days and see how your symptoms reside

[00:13:06] with pain relief and all these other strategies.

[00:13:08] But I want you to know that I don't think it's life or death, but I do think that this

[00:13:14] is beyond a normal orthopedic problem.

[00:13:17] And what I did there was I shared how I truly feel based on objective data.

[00:13:21] So I hit the logic on these are the three reasons why I need you to go to get MRI now.

[00:13:27] I also have empathy for you and I understand that.

[00:13:30] And if you were a family member, this is what I would do.

[00:13:32] I'm either going to have you go now or in three days.

[00:13:35] Which one resonates or jives with how you want to manage this?

[00:13:39] And if that person just needed to hear, I was thinking about going to the ER.

[00:13:43] Fine.

[00:13:43] Perfect.

[00:13:44] I'm out.

[00:13:44] So versus the empathetic physical therapist who doesn't want to have that hard conversation.

[00:13:50] You're very, you know, it would be a great idea if you did.

[00:13:53] Yeah, I understand.

[00:13:54] Let's just wait it out for a little bit.

[00:13:56] Yeah.

[00:13:57] I don't think it's too serious, but in reality, you're fearing for your life right now because

[00:14:02] you're like, this is not normal, but you don't have the confidence to have that.

[00:14:06] And the reality is you take yourself out of the equation.

[00:14:09] What is your job and what are you supposed to execute right now?

[00:14:12] You're supposed to execute.

[00:14:13] What is the best possible option so that this person gets the best outcome today?

[00:14:18] You have to remove yourself from the equation.

[00:14:20] The problem is, is that you hold your insecurities, your challenges in the way of what is this patient

[00:14:26] need and want?

[00:14:29] That's a problem that most people have.

[00:14:31] They cannot remove themselves from the equation because they fear judgment.

[00:14:35] They fear being wrong.

[00:14:36] And that's the problem that you have.

[00:14:39] And the irony of this whole situation is, let me guess, you got into this profession because

[00:14:43] you wanted to help people.

[00:14:45] You had this in high school.

[00:14:46] Your parents one day had this.

[00:14:48] They helped your kid walk better, whatever it is.

[00:14:51] All of you have some reason how an empathetic person helps you or your family to get there.

[00:14:58] Well, the reality is it wasn't the empathy that got them there.

[00:15:02] It was everything leading up to it with empathy, with being genuine to help somebody make that best decision.

[00:15:10] That's the challenge that you currently have.

[00:15:13] Now, all right.

[00:15:14] So we're going to say, we're going to be empathetic.

[00:15:17] Yes.

[00:15:18] However, within the empathy, you're going to hit the logic, not the emotion.

[00:15:21] You have to be logical about this thing.

[00:15:24] Okay.

[00:15:24] Number two, you have to, you have to be genuine about this whole thing.

[00:15:29] The last part is, do you have the approach and the logic to take them to that next step?

[00:15:38] So for you, your main job is to create action out of all these things.

[00:15:44] Most people have the empathy.

[00:15:47] I 100% agree with that.

[00:15:49] You try and get into their heart, but no action is created because you don't want to have that conversation.

[00:15:55] You don't want to tell them that it's the MRI that, you know, it looks like a herniated disc.

[00:16:01] It looks like you're going to need surgery.

[00:16:02] It's the ACL, right?

[00:16:04] The dreaded ACL.

[00:16:05] You test it.

[00:16:06] Oh man, this is my favorite, right?

[00:16:08] It's a physical therapist who finally sees their first ACL that's torn, that hasn't been seen by a surgeon.

[00:16:15] And they go and test it.

[00:16:17] Their eyebrows go up and they're like,

[00:16:19] And what you just did right there is you didn't do your job.

[00:16:24] Your job was to maintain your emotion in a stable state.

[00:16:28] Your job was to provide a logical sequence of events that needs to help them create action.

[00:16:33] And what you did was you created emotion through your tone, your body language of fear.

[00:16:39] What is your job?

[00:16:41] To guide patients towards a specific direction of better clinical outcomes or better direction.

[00:16:46] The problem is you lead with love.

[00:16:49] You get connected to them.

[00:16:51] No action is created.

[00:16:52] So you know what?

[00:16:53] They're like, you're a good human, but you're not taking me in the direction I need.

[00:16:57] So they self-discharge.

[00:16:58] They go find someone else.

[00:16:59] So the problem is, is that you were okay with that.

[00:17:02] If you're an it network or an out of network or a cash pay, whatever it is,

[00:17:07] whenever an insurance provides a certain amount of visits, they come to see you.

[00:17:12] They will love you only for how many visits that the insurance provides.

[00:17:16] Your question here is whenever there's a tough conversation, you need to have it as soon as possible.

[00:17:22] Why?

[00:17:22] Because if you have prepaid visits or preauthorized visits, you might need them on the back end,

[00:17:27] whether that's surgery or anything else.

[00:17:29] So when you have this hard conversation or this, you know, being genuine and having these,

[00:17:34] these conversations, the bearer of bad news, you do have to understand that people need these,

[00:17:41] this logical approach and then in a timely fashion.

[00:17:44] So number one, be empathetic.

[00:17:47] Number two, be genuine.

[00:17:49] Number three, be logical.

[00:17:50] And then number four is be genuine, excuse me, is to have a timely response on this.

[00:17:55] And the problem with that is that if you're empathetic, you're not genuine and you're not

[00:18:01] providing a logical approach, that patient suffers.

[00:18:04] And then if you don't do it in a timely fashion, they're missing out on how much they can actually

[00:18:09] get better faster.

[00:18:10] And I can tell you, anytime that you avoid that conversation and you're like, gosh,

[00:18:14] I think it's an ACL tear.

[00:18:16] I think it's an ACL tear.

[00:18:17] And then you're like, oh, but don't worry about it.

[00:18:20] We're just going to test some things out and we'll get your balance better and all those things.

[00:18:24] But the problem is, is that if you don't do this quickly, you're going to be in a position

[00:18:28] where that patient now is suffering for longer.

[00:18:30] They now have to wait till they have surgery and you're in a worse off position and they now,

[00:18:35] you now lose their trust.

[00:18:36] So if you're trying to figure out how to gain a patient's trust, trying to build that relationship,

[00:18:42] get the maximum results.

[00:18:44] Don't wait on this.

[00:18:45] Be genuine.

[00:18:46] Don't be a robot.

[00:18:47] Because we talked about this on previous episodes that you're that analytic.

[00:18:50] You love to analyze situations.

[00:18:52] The problem is, is so does that person.

[00:18:54] But your job is not to analyze and take this, take your sweet time.

[00:18:57] Your job is to analyze as much as you possibly can.

[00:19:01] Summarize it in that visit.

[00:19:02] Provide timely feedback.

[00:19:03] Be genuine.

[00:19:04] Be logical.

[00:19:05] And then that is what creates success.

[00:19:06] And so if you delay that, you're not doing your job right from the get-go.

[00:19:11] So stop doing that and put yourself in a better position.

[00:19:14] That is how you deliver the bad news.

[00:19:16] I've done this thousands of times.

[00:19:18] I love doing it because it's a genuine approach.

[00:19:20] And all you're trying to do is get this person who has a problem, who's going to hire you to

[00:19:24] get to that next step.

[00:19:25] So if you are stuck and you absolutely need help with how to deliver bad news, when do you

[00:19:30] do it?

[00:19:31] How do you do it?

[00:19:31] If an athlete's in a specific situation, if this scenario, and I've never seen it, never

[00:19:36] done it before, and you're looking for more guidance, sign up for my SportsPT Kickstarter.

[00:19:41] It's an online eight-week online mentorship program where we run you through acute injury

[00:19:47] management, strength and conditioning, programming, all of the above to help you get to the next

[00:19:51] level.

[00:19:51] And in between all that, you're going to have to have situations where you have bad news

[00:19:56] to deliver and you have to be able to do that effectively.

[00:19:58] And if you're lost and you're trying to wonder like, well, how do I get this information?

[00:20:02] How do I consolidate it?

[00:20:03] What do I do for this scenario?

[00:20:04] It's going to be perfect for you to take that next step in your career.

[00:20:07] So there you have it.

[00:20:08] If I don't see you inside the course, I will see you guys on the next episode.

[00:20:11] Take care.

[00:20:17] Bye.

[00:20:18] Thanks for tuning into the SportsPT Academy podcast.

[00:20:21] It means the absolute world to me.

[00:20:23] If you enjoy my content, subscribe to the podcast so you know exactly when new episodes

[00:20:26] come out.

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