Trauma-informed care is super trendy to talk about in health care right now, but what does it actually mean & how do we implement it into practice?
This conversation with Dr. Adam Matichak emphasizes the importance of creating a safe & welcoming environment, through trauma-informed care, for patients to be seen, heard, & understood.
Dr. Matichak challenges us to be intentional & fully present during sessions to build trust & repair relationships with patients (yes, even if you didn’t break it in the first place).
Consider this episode your trauma-informed care crash course, plus how to actually implement this approach into your daily patient care.
Listen NOW.
Trauma-informed care considers the impact of a patient’s past trauma on their physical & emotional well-being
Trauma-informed care is an approach to providing care that acknowledges and addresses the impact of trauma on individuals’ lives. It recognizes that many people have experienced various forms of trauma, such as physical, emotional, or psychological abuse, neglect, violence, or significant life challenges (hello cancer diagnosis?).
Trauma-informed care emphasizes the importance of creating environments that are supportive, empowering, and conducive to healing, while also acknowledging the complexities and challenges that individuals may face as they navigate their trauma recovery journey.
Understanding the complexity of emotions and the external stressors that cancer patients face is essential in providing holistic care. Trauma-informed care is essential in oncology physical therapy as it recognizes the whole person and addresses the emotional and psychological impact of a cancer diagnosis.
Trauma-informed care starts from the very first interaction
The foundation of trauma-informed care in oncology physical therapy begins with the very first interaction between the patient and the therapist. Understanding that many individuals undergoing cancer treatment have experienced various forms of trauma, whether directly related to their illness or from other life events, underscores the importance of setting the right tone from the outset.
Creating a safe & welcoming environment is crucial to building trust & establishing a therapeutic alliance with your patient. This environment should convey empathy, understanding, and non-judgment, allowing patients to feel comfortable sharing their experiences and emotions.
By taking the time to understand each patient’s unique needs and preferences, clinicians can establish a strong foundation of trust that encourages patients to disclose their feelings and experiences openly. This may involve discussing past traumas, fears and anxieties related to cancer treatment, or any other concerns the patient may have. Through compassionate listening and validation of their experiences, clinicians can help patients feel heard, understood, and empowered to actively participate in their own care.
Incorporating these principles of trauma-informed care into oncology physical therapy not only enhances the therapeutic relationship between clinicians and patients but also contributes to improved treatment outcomes and overall well-being. By prioritizing the holistic needs of patients and recognizing the impact of trauma on their health journey, clinicians can provide more compassionate and effective care that addresses both the physical and emotional aspects of cancer treatment.
Trauma-informed care requires YOU to self-reflect
Implementing trauma-informed care isn’t just about adopting a set of practices; it’s a journey of personal growth and self-reflection for clinicians.
To truly become better trauma-informed practitioners, we must first turn the spotlight inward and examine our own attitudes, biases, and experiences. This process of self-reflection isn’t always easy; it requires humility, vulnerability, and a willingness to confront discomfort.
Yet, it’s through this introspection that we gain valuable insights into how our own perspectives and actions may impact the care we provide to patients who have experienced trauma.
Trauma-informed care isn’t a destination; it’s a continual journey of learning and growth. Through ongoing self-reflection, we can refine our skills, deepen our understanding, and evolve as practitioners. Each encounter with a patient presents an opportunity for self-discovery and improvement, as we strive to become more attuned to the needs and experiences of those we serve.
In embracing the practice of self-reflection, clinicians can not only enhance their ability to provide trauma-informed care but also foster personal and professional development that enriches their practice and enriches the lives of their patients.
By committing to this journey of self-discovery, we honor the trust placed in us by those who seek our care and reaffirm our dedication to promoting healing, resilience, and hope in the face of trauma.
For more on trauma-informed care, check out these resources:
- Trauma-Informed Approaches in the Context of Cancer Care in Canada and the United States: A Scoping Review
- Trauma-Informed Care Provides Person-Centered Support for Patients During Deep Distress
- Insights into the Psychology of Trauma Should Inform the Practice of Oncology
- https://www.vitaltalk.org/
See Dr. Adam Matichak speak at The Cancer Rehab Community Conference
Save your seat today at The Cancer Rehab Community – grab your ticket here!
About Dr. Adam Matichak, PT
I grew up in the San Francisco Bay Area. I have always been an athlete playing baseball and basketball though my childhood and eventually football in high school and junior college, now I am an avid golfer. Football injuries made me decide to pursue a degree in Athletic Training, which eventually led me to physical therapy.
Follow Dr. Adam Matichak PT on X
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Transcript
Elise – @TheOncoPT (00:00.385)
which I do think this is going to be a chat episode more than like some of the more structured interviews, but I think this is very much an appropriate format for this. Hey, Anko PT and welcome to this episode of the Anko PT podcast. You know him, you love him, and he’s back here on the podcast today to talk about a really, really cool topic. And I hesitate to even say topic because it almost gives this…
Adam (00:04.407)
Yeah.
Elise – @TheOncoPT (00:26.937)
concept of like, oh, it’s a special area and we’re going to just dip a little bit in it. And then we’re going to move on with the rest of our lives and the rest of our practice. When in fact, this needs to be something that we layer into and on top of and all throughout the day to day patient care that we do as OncoPTs And so I’m so excited to welcome back Dr. Adam Matichek to the OncoPT podcast. Adam, welcome back.
Adam (00:51.81)
Glad to be back. Going for the three-peat. Ha ha ha.
Elise – @TheOncoPT (00:56.677)
I need to kind of have like a mental leaderboard of like who has been on the podcast the most. It’s I think you’re approaching like you’re definitely going to be up there before too long. So if you don’t already follow Adam on Twitter now X Adam is easily one of the most prolific
Adam (01:05.43)
Hahaha
Elise – @TheOncoPT (01:18.493)
And not just the JJ Watt tweet that has been going out lately. I’m curious, you know, we can chat off air about what that means exactly, because I’m curious, but you have such a capacity and such a command on how to have these really engaging, thought provoking discussions on a platform where characters are very limited. And one of the things that I’ve seen you talk about a lot, and which is what really kind of stemmed this conversation today is trauma informed care.
Adam (01:22.446)
Hehehehehe
Elise – @TheOncoPT (01:47.221)
And I’m really excited to talk about it today, because I’m not gonna lie, y’all, I don’t have a good grasp on what this means and what all it encompasses. And so when I saw Adam talking about this, I was like, obviously I need to have him on the podcast to talk about this, instead of me trying to figure it out on my own. So Adam, can we dive into what the heck is trauma-informed care and kind of why is it relevant to us and our work as OncoPTs?
Adam (02:13.622)
Yeah, so trauma informed care is kind of taking into account all of the patients past trauma, any kind of history that they’ve been through. And it is such a big umbrella term because trauma comes in all kinds of shapes, sizes, colors. Like we can have patients that have physical trauma, like they’ve been in a car accident, we can have patients that have, you know, psychological or emotional trauma from
a childhood experience or domestic violence, we can have patients that are survivors of sexual trauma. So it’s very like all encompassing. And I think it’s one of those things that I think as PT’s it’s something that we are kind of ingrained with. Like the first time that I heard the term trauma informed care was like, okay. Like
this is kind of how I already practice, but now I have a term or a label to put on it. And it allows us to kind of dig a little bit deeper into it of how do we take this kind of giant umbrella term and actually apply it to our clinical practice. And so I think one of the best ways that I use it is I use, you know, kind of this.
what things has this patient been through that has had an impact on their life? How is it kind of manifesting in front of us? And how can I use that to kind of lead conversations so that I am being respectful, kind of providing a safe outlet for them? I think that’s one of the really neat things about us as PTs is that we spend a lot of face-to-face time with our patients. We get to know them really well.
And we use this to develop good rapport to create this therapeutic alliance between us and our patients. And they feel really open with us sometimes, and that can lead to them being very vulnerable and sharing things with us that maybe they don’t feel comfortable sharing with other healthcare providers. And so being able to have those conversations.
Adam (04:33.77)
and use that information that we get from that to either come up with a plan to help them or to be able to refer to somebody that’s better suited to help them get through something. It’s going to make us better practitioners. It’s going to improve our relationship with our patients and it just kind of we build that bond. We build trust and it leads to better outcomes. You know all sorts of good things come from it.
as Rebecca Griffith would say, all sorts of nice sparkly things come from it.
Elise – @TheOncoPT (05:08.161)
I love that. And that’s so Rebecca too.
Adam (05:10.635)
I’m out.
Elise – @TheOncoPT (05:14.341)
So Adam, I’m going to turn it actually to like a, I’m going to put you on the spot with this question. How have you seen a trauma-informed approach lead to a better therapeutic alliance in your own clinical practice?
Adam (05:31.914)
Yeah, so when we are able to actually like take this and apply it, like I said, we dig a little bit deeper into what’s going on with our patients. So a very specific example, I had a patient a few months ago, almost a year ago, somewhere in there. It all just blends together. But.
Elise – @TheOncoPT (05:52.229)
Mm-hmm. Great.
Adam (05:54.646)
We had a patient that was readmitted to the hospital and their diagnosis is one of my least favorite things that our oncology doctors do is failure to thrive. What does that even mean? They’re just not doing well, right? There’s no specific thing that brought them in. It’s kind of a cluster of symptoms. And so this patient had a syncope episode at home. They had not been eating well, you know.
Elise – @TheOncoPT (06:06.297)
Mm.
Adam (06:24.45)
They just weren’t functioning well. They weren’t very active. And so they’re readmitted and the patient… And so we get to this point where it’s like, all right, what’s been going on? And they start talking about, well, I just haven’t had the energy to do anything lately. We know that fatigue is already kind of a big thing with our patient population.
but then we dig a little bit deeper, right? And it’s like, okay, well, how long has this been going on? It’s like, oh, this has been going on for, you know, four to six weeks, but they’re just now coming in because, you know, we’ve taken a bigger turn. And it’s like, all right, like, what happened a month ago that this all started? And so she tells me that she got a call from her oncologist that they were changing one of her medications.
nothing about her disease, nothing about, you know, things aren’t going well. There’s just a new formulation. So they changed one of her meds. The last time they changed one of her meds, she did not do well. She got really sick. It just wasn’t working for her. And she ended up back in the hospital. And not only did she end up back in the hospital, she ended up in the ICU.
And so when we start to unpack all of these layers, so she is now kind of reliving that prior trauma. And it’s, so, you know, we can, like I said, we use that information to kind of make referrals. So.
She hasn’t been sleeping well. You know, what can we do to, you know, encourage her to get better sleep when she’s in the hospital? You know, we get a mattress topper for her bed so that she’s more comfortable. We were able to make sure that she was in a private room so we didn’t have a roommate keeping her up all night.
Adam (08:22.97)
She said that she hasn’t been eating well. Great, let’s get dietary in here, kind of make some recommendations to get you eating better. She was in the hospital for six days. She did extremely well because we were able to make those connections and make those referrals and kind of clean some things up. And she walked out of there and she so far has been doing great ever since. We have not seen her back in the hospital again. So like I said, we.
kind of unpack prior trauma and how is that, you know, kind of the same, how do we avoid re-traumatizing somebody that’s going through this for a second time? So, right, we think about our patients that have relapsed disease or, you know, have, like this patient, had a really rough hospitalization in the past and now they’re readmitted to the same hospital on the same unit.
Elise – @TheOncoPT (09:03.197)
Yeah.
Adam (09:20.394)
the same nurses, the same doctors, like just flashbacks, right? Like the last time that I was in this place, things did not go well. Um, and so we need to be able to kind of have those conversations and kind of. Slowly pull that information out of people. And we use this, you know, kind of roadmap of trauma informed care to connect the dots.
Elise – @TheOncoPT (09:27.554)
Yeah.
Elise – @TheOncoPT (09:51.113)
One of the things that I’m really hearing you speak about, Adam, is, you know, we can’t leave things at face value. So when you get an answer, you know, when you’re speaking with your patient and you’re interviewing them or you’re talking with them, you know, I think this kind of requires us to step outside of ourselves and put down the computer and the documentation and the email and all the other things.
show up fully present for our patients. And that is easier said than done. So like, please understand dear listener, I’m with you, right? I’m with you. But I think this requires us to be much more intentional in our sessions with our patients so we can show up fully and hear what they’re saying or trying to say or maybe what they’re not saying.
Adam (10:48.63)
Yeah, exactly. I think when we think about patients that are kind of in the healthcare system, right? They can be traumatized by the system itself. Like they may blame, you know, and fully understandable patients may blame a doctor for a diagnosis that they get. They just, they need something to be upset about. And so,
Patients wanna feel seen, they wanna feel heard, they wanna feel understood, they wanna feel safe. And so when we think about kind of creating that safe space, so I’m a big guy, you know, I’m over six feet tall, I’m as wide as the patient’s doorway when I go into their room to talk to them. If I just hover at the end of their bed and cast them in shadow, while they’re laying there not feeling well,
like they’re not gonna feel super comfortable with this big dude just standing over them firing questions at them. So, right, like pull up a chair, kind of get down to their level. I’m a loud person, so moderating my tone, you know.
We think about like create a safe, comfortable, welcoming environment for this patient to be able to kind of talk and share things that, like I said, they may not have told another provider.
Adam (12:23.97)
Kind of getting back to what you were saying before, like.
this.
Adam (12:34.091)
Just lost my train of thought. Give me a second. What were you, what was the original question? We were…
Elise – @TheOncoPT (12:36.965)
That’s okay. It’ll come back.
Elise – @TheOncoPT (12:42.741)
You know, I don’t even know that I had a question, Adam. It was more of, I think it requires us to show up intentionally and fully for patients by removing a lot of the, I don’t even want to call them distractions because unfortunately they are such a necessity of like the day in and day out of treating patients in physical therapy. But like it, yeah, there’s anyways.
Adam (12:51.842)
Thank you.
Adam (13:06.998)
Yes.
Elise – @TheOncoPT (13:11.489)
That’s the short of it.
Adam (13:11.882)
Yeah, so yeah, so right, like not standing there at the computer documenting as you’re asking them questions, right? And that’s a great way for a patient to not feel like, you know, they’re being valued as a person, right? If they’re just like this little bucket of information that we need to slowly pour into the computer.
And it makes patients feel like every interaction that they have with a healthcare provider is the same. It’s the same, like it’s the same set of questions in the same order every time I come in here. And that kind of creates a lot of distrust. And like you said, it creates a lot of resentment.
And if we’re not being open with our patients, our patients are not going to be open with us. And that’s what we need to do to build that relationship so that they feel comfortable talking to us.
Elise – @TheOncoPT (14:22.245)
I’m thinking through some different kind of patient interactions over the years. And I really appreciate what you said about, you know, sometimes the system itself traumatizes our patients. I mean, cancer alone. Cancer takes so much control out of that person’s life. I mean, even thinking down to, you know, when you are diagnosed with cancer, right? Insert cancer diagnosis here.
Adam (14:36.576)
Right.
Elise – @TheOncoPT (14:51.969)
Like there is a plan because we know that, you know, through research we have determined that this regimen of these agents are most effective for this specific type of cancer. And there’s a reason for that. And I understand that there’s a reasons for that. But a lot of times I think there are missed opportunities where we can start to put.
control back in the hands of our patients. And I think in kind of a roundabout way, I really do think trauma-informed care is a method in which that we can do that to kind of put our patients back in the driver’s seat. And I really, really like what you pulled out there, Adam, about not treating our patients as a bucket of information that we just need to like siphon our…
important tidbits out of before we move on to the next part of, you know, like, oh, today we’re going to do this, and this exercise and this treatment or whatever. Like how many, you know, and I, you know, again, we have a flow, right? There are, there’s information we need to, you know, understand from our patients from the last time that we saw them, et cetera. But like, again, can we be more intentional about that? Can we be more, hmm, ooh, so many thoughts, so many thoughts.
Adam (16:13.762)
So when we think about the way that we are all taught how to do a subjective interview when we’re in PT school, it’s the same information, and it almost feels like we’re all reading off the same script. So, it’s like, I’ve got my clipboard, I have my 12 questions, I need you to answer these 12 questions so we can move on to the next thing. And so, when we interview a patient that way,
Elise – @TheOncoPT (16:36.866)
Mmm.
Adam (16:41.558)
and we don’t give them space to process what we’re asking them. And we get patients that ramble and there is so much emphasis put on productivity and our time management and our efficiency as a therapist that when patients start to ramble, our instinct is to cut them off. Like, all right, like that’s not important right now.
And so, right, like we get these patients that come in and, you know, maybe they were diagnosed initially in the early 2000s, right? Or God forbid, like the late 90s. And like, and they like, when they start sharing this information.
Like they go back to like when I originally found out I had cancer and it’s like our immediate instinct is like, whoa, like that’s so long ago. It is not relevant to what I am asking you about right now but it’s very relevant to how they ended up where they are right now. Because cancer, a cancer diagnosis itself is a trauma. It is life changing.
Elise – @TheOncoPT (17:44.775)
Yeah.
Adam (17:54.27)
you know, it can take away a large chunk of a patient’s personal identity, whether that is not being able to do an activity that they used to enjoy, whether that is not being able to go back to their job because their job was too stressful or too physically demanding, or, you know, I’ve had patients from…
every possible walk of life. Like I had a patient that was a long haul truck driver and he transported all kinds of like hazardous waste and stuff like that. And his doc was like, yeah, you’re not doing that again. And so we start kind of unpack, like I said, we unpack all of these layers to, you know, how a patient got to us and…
Like it’s a lot and it can be heavy. Like we get our AYA patients that it’s like, they can’t have a family, like they can’t like start a family in the traditional way because of a diagnosis. Like that’s a huge impact on somebody’s life. And if we don’t know how to have those difficult conversations and be tactful and respectful and.
you know, like I said, create that space, create that trust. Like those conversations are not gonna be helpful. They can actually be harmful in some ways. And I think something that you and I have talked about before, like when you break that trust with a patient, whether it is something you say or just a…
Elise – @TheOncoPT (19:30.651)
Oof.
Adam (19:35.538)
random interaction during a session or an eval. It’s really hard to rebuild that trust. And you think about, like, if you are a PT, especially if you are an outpatient PT in an urban or suburban area, it’s like they can go find another PT.
Elise – @TheOncoPT (19:43.545)
Yeah.
Adam (20:00.062)
If you are the only PT that works with cancer patients in a small community hospital, you need to find a way to repair that relationship or you’re not gonna have great outcomes, that patient’s not gonna enjoy working with you. You’re not gonna enjoy working with that patient because it’s gonna be very tenuous every time you step into that room. So it’s really hard when we say something or do something to be able to walk it back.
Elise – @TheOncoPT (20:04.033)
Yeah.
Adam (20:29.666)
And so we need to come from a place where we can have those conversations and we don’t do a great job of teaching students or new grads how to have those conversations. And we need, like that’s an area that I think every PT program can do better.
Elise – @TheOncoPT (20:49.606)
Yeah, 100%. And I don’t want to give us outpatient, urban or suburban PT’s a pass on this, okay? So yes to all the things that Adam said, but just because you’re in a larger institution or a larger city where there are.
other physical therapists, we cannot have this attitude of like, they’ll find another. They may not find another one. They may have had that such a negative experience. They don’t want to come back to PT. And this is something that I hear a lot, unfortunately, in my area is like, I don’t know, maybe it’s the area or just the population. But I hear, you know, I tried physical therapy once it didn’t work. It’s like, well.
And that is a totally valid experience that you had, unfortunately. Um, you know, do I wish they could have found another PT? A hundred percent. I wish PT had worked for them, but it could only take one time. It could take one time, one interaction that for, you know, us as the PT, it’s just one patient on our schedule. It’s just one session on our schedule. That is, and I can’t remember who said this, Adam, maybe you remember who this is. But like you and I.
see patients with cancer all day, every day. We’ve seen a lot of diagnoses, we’ve seen a lot of treatments, all the things. This is our patient’s likely first experience with cancer. This is hopefully their only experience with cancer. I don’t, you know, and I think that’s something that sometimes we forget of like, oh, I put on my expert hat and I’ve seen it before. Like, you know, and we want to exude.
confidence and competence to our patients. I’m not saying don’t, but sometimes we put on that expert hat and we kind of forget there’s a person who has been diagnosed with the worst diagnosis they could probably ever experience. They have to go through these horrific treatments and are probably going to live with side effects and impairments for the rest of their life, whatever that ends up looking like. Like…
Elise – @TheOncoPT (22:58.237)
This is so much bigger than a 45 to 60 minute session that we’re trying to get in with this patient and build four units or whatever we’re trying to do here. It’s so much bigger than that.
Adam (23:10.998)
So I want to pick up on something that you just said, right? Like, this is a patient with X diagnosis. That is not a, our patients are not a diagnosis. Patients are people. They have feelings, they have emotions. Emotions are complex. They’re like, talk about like soft skills. Like emotions are, you know, they’re ugly. They can…
Elise – @TheOncoPT (23:25.242)
Mm-hmm.
Adam (23:41.494)
manifest in different ways. Like I said, like we may have a patient that you know is just angry about their current set of circumstances and We have a really unique opportunity to make some of those things better But if we’re not like, you know, we keep coming back to this like if we’re not able to engage with them
in a respectful manner and a manner that builds trust, we’re not going to. Our patients have hopes and dreams and things that, especially our younger patients, things that they still wanna accomplish. And for maybe the time being, they feel like cancer is taking that away from them. Our patients are scared, especially when they’re in the hospital. We think about like,
Other things that, you know, kind of trauma brings along with it, stress is a big one. So when patients are stressed, and that can be emotional stress, you know, with my bone marrow patients, like, they’re admitted and like they may be in the hospital with us for a month. If they are a father of two, and
their wife has to stay home and take care of the kids and run the household because they’re in the hospital. So their family’s not visiting that often. We are taking that person out of, you know, kind of their normal routine. If family is very important to them, like that is something that now has been taken away from them. When you think about environmental stress, you know.
when was the last time a patient got any quality sleep when they were in the hospital? There’s monitors beeping, IVs going, nurses are waking up in the middle of the night to take their vitals, the beds are uncomfortable, you know, the hospitals just come with a lot of noise. And so we’re taking this already traumatic experience of being diagnosed with cancer. Like think about our patients that like
Adam (25:57.314)
feel off and like come into the ED and it’s like, oh, like your white count is in the hundreds of thousands. Like you’re being admitted and we’re starting things right now. Like they haven’t even had time to process what’s going on. And now you are taking them out of their normal routine. You’re taking them and sticking them in the hospital, away from their family. It’s a lot.
Adam (26:28.942)
That’s a lot.
Elise – @TheOncoPT (26:30.717)
Let’s add on to that, because one of the things I’m good at is catastrophizing Adam, if you haven’t already figured that out. So you have this father of two who has been admitted to the hospital. We know whether that’s through the emergency circumstances we’re talking about, or like we knew it was coming. Like I say, it was known that this was coming. This person is no longer working, right? Probably not able to go to a job.
Adam (26:35.23)
Hehehehehehe
Elise – @TheOncoPT (26:59.309)
So now there’s a financial level of.
concern and you know stress to am I going to be able to make enough money to pay my normal bills let alone we know the astronomical costs of cancer right like there’s so much more and that’s one of the things so I actually like right before this Adam I interviewed Dr Katie O’Bright who’s very big into primary care PT and her definition of primary care it was almost like you could have slapped
high quality onco PT onto it. And I was like, oh man. And so she really talked about, we’re not just looking at like the body systems of this person, but also, I’m gonna sum it up, the internal and the external environment of this person that they are within themselves, but also that they are in and their community and just all these different factors. And I loved, loved so much of what she said because it really does come down to like,
There’s a whole human who is more than just the sum of their body systems, right? There is a whole human in their life that has now been absolutely just disrupted, upended, and they’re now being thrust, thrusted into this completely traumatizing experience.
maybe they’ve had time to process their diagnosis, maybe they haven’t. You know, I’m working with a patient right now who has a new diagnosis. And, you know, I think this person’s about a month or so out from diagnosis, but still even just talking through things at the initial evaluation. I mean, the tears came and it was very, very apparent of
Elise – @TheOncoPT (28:50.109)
there is still stuff. And I’m not saying we need to wrap it up in a month, we shouldn’t have that taken care of. No, there is a lot that is also needed here to ensure that we’re taking care of this whole person. And so for this patient, the next step is we’re trying to get this person into see the palliative care team so we can address more of those quality of life against some of the.
Adam (28:57.379)
Right.
Adam (29:05.782)
Right.
Elise – @TheOncoPT (29:15.829)
the surrounding environmental things but also internal environment stuff.
Adam (29:20.662)
Yeah. And so, you know, if we want to add another layer to this, when we think about, when we, when we think about trauma informed care, so we take that father of two. And what if his past experience, he lost his father when he was young.
How is that going to affect his mental well-being while he is now battling a life-threatening disease, knowing that he has two small children at home? Like, there is so many possible layers, and this is kind of where the whole concept comes from, right? If we don’t address and acknowledge those things,
that we can’t paint the whole picture. We can’t make those connections. We can’t make the right recommendations for this patient if we haven’t addressed all of the baggage that comes along with it.
Elise – @TheOncoPT (30:30.689)
I’m going to ask you to solve the entire world’s problems in this one question, Adam. So I’m very aware, like this is a very loaded question.
Adam (30:34.574)
I’m sorry.
Elise – @TheOncoPT (30:42.309)
How do we?
uncover some of this. How do we learn about some of this, like what the person has experienced? Or, you know, like what are some of the traumas that they are coming with? You know, one of the things you mentioned, you know, that I’m really grateful you brought up was, you know, like, okay, then add on this person is not just a patient with cancer, is a father of two.
also lost a parent to something previously and is now worried about that. That’s some stuff that I’m just thinking like, if I’m having a wine night with girls, sometimes we talk about this, we get super deep into it, but this is not necessarily something that someone might just come out and be like,
Hello, this is what I’m dealing with and this is why I’m afraid of, you know, all of this, like this, these are some deep layers. How can we start to uncover some of this?
Adam (31:41.523)
Yeah.
Adam (31:48.49)
Yeah. So it starts from our first interaction with that patient, right? It comes from what we had already talked about. Um, you know, that initial eval, I am, I am present with that patient. I am not, you know, standing at the computer, you know, all right, you know, where do you live? What kind of houses do you have stairs to get into your house? Like who’s there with you when you get home? Like, you know, we need to.
it needs to be more of a conversation. It needs to, we build trust and we build, it’s almost like we’re building friendships with our patients, right? And so, we create that relationship with our patient where they feel comfortable sharing some of those kind of dark things with us. And it doesn’t happen overnight. It doesn’t happen.
Elise – @TheOncoPT (32:28.867)
Yeah!
Adam (32:44.034)
during that first session, but we lay the framework for it by having good conversations, by being more present, by not just kind of sticking to the script and like, this is the information I need from you. But it comes from…
you know, being open with your patients, you know, they’re not gonna share, you know, a lot of their baggage with you if you can’t be vulnerable with them, which is hard to do. It’s hard to do as a new grad. It’s hard to do for someone that’s been in practice for almost a decade.
Adam (33:26.698)
You know, one of the things that I have bonded with my younger patients with is my wife and I have been through the trauma of losing a pregnancy loss. And so, you know, we have those patients that, you know, have either lost a baby through when they have had a start treatment or are not gonna have the ability to.
uh you know have a natural birth um or you know have to do IVF or adopt or you know whatever because of you know certain circumstances with their disease and with everything that they’ve been through treatment wise um and I’ve shared that with patients before um and like you talk about right like the tears start flowing and
you know, that goes both ways. Like there have been times that I’ve broken down in front of patients. There’s been times that, you know, patients have broken down in front of me. Like it’s a two-way street. And if we don’t treat it that way, you know, it’s kind of like, you know, when we’re going through PT school and we get that lesson, right? It’s like, don’t have a patient do something that you wouldn’t do yourself.
So, right, like when you think about an exercise program or when we’re making recommendations for patients to be more active or things like that, like don’t have your patient do something that you don’t feel comfortable doing yourself. And we can’t expect our patients to be vulnerable, especially about like this stuff, like it’s heavy. It’s not easy to talk about a lot of the time, especially
like we’re taking, like think about working in acute care, like they are in such an already uncomfortable environment. And like now we want them to just like open up and be an open book about, you know, every horrible experience that they’ve ever had. And it doesn’t work like that, you know.
Adam (35:40.434)
I’ve had so many great talks with patients when we’re going for a walk around the unit. And it’s just like, what do you wanna talk about today? Like, and it starts as one conversation and kind of morphs into something else. And like the more that we can have that conversation back and forth, right? And not just get hung up on like, oh, like.
I see your stride is a little bit shorter on the left than it is on the right when you’re walking like we need to get out of that mindset a little bit. Right. And like I said, we need to see our patients as people, not as a diagnosis or a list of impairments. They are people. They
Elise – @TheOncoPT (36:35.749)
I’m thinking back to a patient I had. This was probably four years ago. And this was…
a patient. So this was back, God, this was in the first couple of years of my practice. And I can’t remember if it was first year or second year. They was all just a haze. And this was a patient that I had a really great relationship with. And most of the times she would come in and we would, like we would sit, we would girl chat. And that’s like my favorite thing to do. And like, that was, that was 99% of our sessions. But this one time she came in, unfortunately, she was,
metastatic cancer and there was a lot going on. She was a young mom of two kids and I don’t remember how or like what spurned this, but she was extremely frightened about like her children. It wasn’t just a if they have to live some day without her. It was when they have to live without her.
And she came in and I mean, immediately you could just tell like, well, we’re, we’re off right now. And she was crying and we spent, I truly believe like 40 minutes of that session where she was just crying and talking and sharing that information. And the young clinician in me was like, Oh my God, I don’t know how, like my first thought, which
It like, listen, y’all, I’m gonna say it first so you don’t feel so bad about having said this or thought this yourself. My thought first was, I don’t know how I’m going to bill for this session. And it goes back to Adam, what you said previously about like productivity and all this. I literally first thought was like, I don’t know how I’m gonna bill for this. And then quickly, thankfully, I was like, that thought just needs to like, leave. And so we sat.
Elise – @TheOncoPT (38:40.705)
and we held hands and we both cried and we hugged. And that is exactly what the patient needed in that moment. Far more than anything therapeutic exercise or activities that we would have covered in that session. And the reason I bring this up, Adam, is this approach is not really native
or conducive to a lot of the corporate healthcare structure of things, how healthcare is run. And so I want the listener to recognize like, this is challenging, and it’s a challenge to implement.
but it’s the right way to treat another human, especially in the context of healthcare and especially in the context of cancer. And so I wanna, first of all, give the listener like, hey friend, I’ve already had the thought of how am I gonna bill for this, okay? We need to put that aside and we need to show up.
in those hard moments, especially in those hard moments for our patients, because in that session, that is when my patient really opened up to me about some of the things that we’ve been talking about today, and if I had just blasted through or tried to like, okay, that’s enough, that’s enough, you can cry on the UBE next, I would have totally just decimated any.
any level of relationship and therapeutic alliance I had built with that patient. And that is absolutely like, I’m, that was entirely accidental, but I’m really glad that I had that experience where I was like, Oh, that is how healthcare is supposed to work.
Adam (40:33.119)
So I’m going to push back a little bit. That wasn’t accidental. You made that environment safe and welcoming enough that she felt comfortable sharing with you. That was not an accident. That was the work that you put in from the first time that you met this patient to that day.
Elise – @TheOncoPT (40:35.685)
Ooh, yes.
Elise – @TheOncoPT (41:00.193)
Adam, you always know how to make me feel just so warm and fuzzy on the inside. But again, like I do, I really do like, it is a choice to implement this approach and you have to be intentional in this approach. Like we, you and me friend, you and me.
have to be intentional about implementing this because we owe it, we are morally and ethically responsible to show up in this way for our patients. And you know better and you do better. And this is like, we’re educating you right now, mainly Adam, on how to do better. Now the onus is on you, dear listener, on how do you implement this into your practice every day with every patient.
Adam (41:49.886)
And sometimes we don’t know what to say, or we have a thought, and we don’t know how to verbalize it. And sometimes the best thing that you can do is just stay quiet, just be there for them. Let them vent in whatever way that is whether that patient needs to break down and cry and kind of work through it that way. Or if that patient needs
you know, as long as you feel physically safe, as long as if that patient needs to just be angry about something for, you know, five minutes. And, you know, you might learn a couple of new cuss words that way. But, you know, patients just, they…
Elise – @TheOncoPT (42:34.521)
Nyehehehe
Adam (42:40.854)
they need to have that outlet for their emotions, right? Whatever way they decide to manifest. Like we said at the very beginning, trauma is very complex. Emotions are, you know.
They’re challenging. And if you think about, if you’re going to go way back, as you were in those formative years, when you were a child, if you didn’t learn great coping mechanisms, if you had a very traumatic childhood, it’s going to be even harder to deal with trauma as an adult. We think about.
are pediatric patients. Like this is, talk about like pull you out of your regular routine. You know, I’m not going to play on the playground today because I’m stuck in a hospital that hooked up to chemo. They don’t know how to process that. Like their brain isn’t fully formed yet. Like.
Adam (43:58.646)
Then we get those patients that, like I’ve had a handful of these in my career, where like they were diagnosed as a child and did really well, and now they have a secondary cancer or a relapse as an adult. And it’s like, here we go again, like flipping my entire world upside down.
Adam (44:28.206)
It’s sticky.
Elise – @TheOncoPT (44:42.489)
I have a question for you, Adam. And if you don’t like this question, I can just cut it from the interview, okay? So like, this is entirely you tell me what you wanna do here. But one of the things that I am personally working through is I’m doing my own emotional coping trauma work right now through therapy. And I genuinely have started to understand.
the layers of trauma, and I mentioned this right before we started recording today, but the cumulative effect of trauma and traumas. And so I guess my question that I’m trying to ask is
Elise – @TheOncoPT (45:34.501)
How are you working on you to be able to show up as a better trauma informed clinician implementing trauma informed care?
Adam (45:52.234)
Yeah, this is something that I’ve been doing a lot more work on since I became a parent. Because how I respond to big emotional things in life is imprinting on two small human beings that live in the same house as me and how they are going to grow up to cope with and handle trauma in their life.
Adam (46:22.062)
My parents were not big emotion people. You know, when we had things happen in our family, there was not a whole lot of talk about it. It was, you know, a lot of words. And the help was kind of push that down and move on. My parents were both blue collar, working class, just like…
I can’t let this affect me because I have to get up and go to work in the morning or we’re not going to be able to pay rent this month. So we didn’t wait there was not a whole lot of like let’s talk about our feelings and you know sit around the campfire and you know hash things out. It was so I feel like you know kind of coming into adulthood. I was not great at handling traumatic experiences in whatever form they showed up.
Adam (47:19.846)
And so for me, it’s been kind of working through a lot of just generational issues with my family. Journaling has helped a lot. Being able to take a really complex thought and put it into words. That’s been really helpful for me.
One of the other things that I’ve been struggling with as a clinician lately is when I get those patients that are in their early to mid thirties and they have a couple of kids at home, it’s like, how do I not see myself as that patient? How do I not let that affect me when I’m treating this patient? You know, we talk so much about
you know, trauma informed care from our viewpoint as a clinician dealing with our patients’ trauma and everything that they’ve been through. But how do our own past traumas and things like that impact the decisions that we make, our word choice? And so being more aware of my own baggage and my own biases and…
you know, all of those things that, you know, make us a more well-rounded clinician, that it is not just a set of hands-on skills that we learned how to do really well. It is all of the other stuff. And I think, you know, we…
A point that I like to bring up with students is. Like you don’t learn how to talk to patients that are going through it unless you talk to patients that are going through it. Like this is an experience thing like this is not. I read about it in a book and I’m going to go do it like.
Adam (49:24.542)
If you don’t practice these things day to day, like they are not skills that you’re gonna get better at. Like this is a, I have had a lot of difficult conversations with patients and like you learn, you know, kind of what those responses to those conversations are gonna be and.
Typically the first response when you give a patient bad news is expect a big emotional response. And if you are not in tune enough with your own emotions to be able to handle that response, things are gonna go downhill very quickly. So you need to have some kind of framework to have that conversation and be aware of your own emotions and kind of mind state and where you are.
and kind of have, like I said, that framework to kind of work through it and not get stuck where now like you have either said something, you know, given patient bad news, like, you know, five, six years ago, I had a patient that like, he was a like world-class triathlete. He went through a transplant and had
some of the most horrific Graffers-House disease I think I still at this point in my career have ever seen and was on steroids for such a long time and was just so weak that like walking from his bed to the bathroom was a chore. To like go and talk to that person to like tell them that they’re probably never going to do another triathlon.
like that was that patient’s identity. And you know, we get that like with him, that big emotional response was, you know, F you, I’ll show you right now how much I can do. And it’s like, all right, like take a beat, like, you know, what are your goals? What do you wanna do? What do you, then?
Adam (51:49.73)
You know, if we have that patient that’s in that position and their goal is still, I am gonna go back and do another triathlon, great. I think that’s a great big goal. How do we get there? What are next steps? What are small goals that we can accomplish that are gonna lead up to this big one? Because then patients get frustrated if we’re not making progress or if they plateau or if they have a setback medically, physically.
whatever it is. And if we can’t adjust and we can’t understand how their emotions and like I said, that past trauma is affecting their decision-making process and how they’re seeing things moving forward. Like it makes those conversations even harder to have.
Elise – @TheOncoPT (52:51.801)
Someone is listening to this right now, Adam. They’re like, I understand that I have to have the conversation before I can get better. Because again, I really like that you called just to the front of everyone’s minds of this is not something that you can learn from a textbook and then be able to practice perfectly the first time.
What advice or encouragement do you have for the listener who is like, I’m on board, but I’m really uncomfortable with the idea of having uncomfortable conversations. Like I want to rush the process so I can just get better. I want to just be better at having these and initiating these conversations.
Adam (53:39.382)
So two things. The first one is, you know, seek out good mentors for these things. Like, you know, when I was a student on our bone marrow transplant unit, like one of our PTs was great at having these conversations. They had been in clinical practice for years and they were really good at it. And like, not only did they bring me in when they had these conversations with patients, but then like,
they let me lead one, but they were there as a safety net. Like if I misspoke or if I got stuck, they were there to step in. So there is really no replacement for a good mentor that has been doing this for a long time. Because we just talked about it is so much experience and the more conversations you have, the better you’re gonna get at it. So start with…
your patients that, you know, kind of are in a good kind of stable place. And that’s where you can like patients that you have that good rapport with, you know, we can start kind of tiptoeing into those things a little bit, but it’s not something where, you know, a patient that you just met or
Elise – @TheOncoPT (54:59.322)
Ha ha.
Adam (54:59.37)
patient that is, you know, kind of really in the thick of it, we’re going to go, you know, what else have you been through in your life that is affecting how you’re feeling today? Like, that’s not how we approach the situation. One, one excellent resource is a website called vital talk.org.
So they have courses that are actually like instructor led courses that you can take and they kind of work through some of this framework type stuff with you so that you can be better at having these conversations. They also have a bunch of free resources for like managing like different conversations and they kind of have a couple of different like.
like acronyms and things like that, but like give you this like step-by-step framework, kind of what to say, how to say it, kind of give you an idea of how to set conversations up. So that’s a great resource.
Elise – @TheOncoPT (56:06.249)
Yeah, I’ll definitely include that in the show notes also. So that way y’all can go and look at that. I definitely need to get plugged into that resource as well. Adam, one of the best resources that I’ve personally found so far on starting this work and becoming curious and then diving further in has actually been you. Where can people follow you and connect with you on social media?
Adam (56:36.85)
Twitter is the best place. I like you talked about like Having these conversations with patients is really the only way that you’re gonna get better at it. So Just a random Twitter poll that the thanks cancer handle put up about like hey like since you were diagnosed Have you been more active less active? you know what has changed in your life like
I hijacked that post and like, just talk to people. Like I said, you don’t get better at it unless you’re talking to people that are going through it. And so I commented on that post, like, hey, like I’m a cancer PT, indulge me. Like what has been your biggest barrier? If you like, if your answer to this question is that I have been less active, what’s been your biggest barrier to being active while you’re going through treatment?
And it got a ton of engagement. People were, you know, putting in like, Oh, like I’ve had a horrendous neuropathy and, or like the fatigue that I’ve been having since this round of chemo has been brutal. And it’s like, it gives me a chance to reach out to people, right? That like, these are people that are going through it. I don’t know if they are seeing a PT or not, but I can give them my clinical input on what they’re going through.
Like social media can be such a wasteland sometimes, but it is also just, it’s a great way to connect with people that you may never have before. So take advantage of it.
Elise – @TheOncoPT (58:06.613)
Ha ha!
Elise – @TheOncoPT (58:12.321)
Yeah. Agreed.
I think Twitter is also how you and I got connected for the first time. So like as much as I agree with the wasteland also what a great opportunity to connect with people. And that’s what I really, really love about it. So thank you for sharing that Adam. Again I will link Adam’s Twitter in the show notes as well so that way you can give them a follow. And like I said y’all talk about a masterclass of using a platform that a lot of people are on with a kit like a very strict and defined character limit.
but still being able to reach across.
and connect with people and learn, especially from that patient perspective, I saw that thread and that was like genius of what a better way to get inside our patients’ heads and what they’re experiencing than to talk with them directly that capacity. And I think that’s so, so cool. So definitely give Adam a follow. I will also let the world know. Adam is also presenting at the Cancer Rehab Community Conference again this year
blessed that he decided to come back and talk about it. And we’re actually going to talk a little more about this kind of stuff. So you definitely don’t want to miss out. He was a dynamic, wonderful speaker at our last conference. And we’re so excited that he’s back. Um, you can register now at the oncopt.com slash conference. Adam, this was a really, really wonderful conversation. And I’m really glad that you spent your afternoon with me and shared this information, cause this is, this is one of those.
Elise – @TheOncoPT (59:50.293)
Again, like soft skills that we don’t learn in school. And you can’t learn from a textbook. You really have to learn when you’re actually working with the humans in front of you. And I think you’re a great guide to help facilitate this transformation for all of us listening. So thank you.
Adam (01:00:09.578)
Absolutely. Always a pleasure to be on a chat with you.