How Patient Empowerment Begins

There is so much talk about “patient empowerment” in healthcare, but WHY does this matter in pelvic health physiotherapy?

Pelvic health physiotherapy is a private and intimate rehabilitation service that often brings out the most vulnerable sides of patients – physically, mentally, psychologically and emotionally. Patients place their trust in the physiotherapist within a setting where there is often a power differential due to differences in information and skill, as physiotherapists generally have more clinical resources. Furthermore, pelvic health physiotherapy is likely more sensitive than other orthopedic physiotherapy care because the patient’s intimate information is exposed, and the physical examination can involve (with informed consent) digital vaginal and/or rectal examinations.

Patients who have a history of sexual assault might find pelvic exams embarrassing, painful, or even unbearable. While empathy and patient rights-based approaches have helped reduce the power differential between therapists and patients, more strategies are needed to create a genuinely safe and comfortable environment for everyone. Simply using signs/stickers to claim a clinic or pelvic health physiotherapist offers a “safe” space is not enough to ensure true patient empowerment.

So HOW does one create a space for patient empowerment?

First, it is vital that the organization has a coordinated flow from the first contact person at the administrative level, moving through the care journey with the physiotherapist, and to closing the loop either at payment or making future appointments. A safe space requires all staff (non-clinical as well as clinical), to provide a culturally safe environment together. This may mean that a pelvic health physiotherapist reaches out to and collaborates with colleagues and other healthcare professionals to not only ensure pronouns are used accurately, but also sensitive matters or patient preferences are emphasized so that a patient can feel more in control of their care.

On a personal level, the attributes of the pelvic health physiotherapist matter. Hard skills such as manual techniques are easily taught and learned in university. In my opinion, if you have the resources, anyone can become a physiotherapist on paper. However, soft skills such as care, warmth, genuine interest, and active listening are even more essential to patient empowerment. A pelvic health physiotherapist must communicate authentically and effectively through verbal and non-verbal skills to promote confidence and trust in a patient. Patients need to feel heard, understood and comfortable with the emotional support that is provided. But most importantly, the pelvic health physiotherapist needs to be curious about the patient’s narration – the life story – and ask non-judgmental questions to explore and discover what is meaningful in the patient’s life. By giving space to the patient to discover more about themselves, this leads to patient-centered goal setting, shared decision making and patient empowerment. By placing an emotionally supportive detective cap on the physiotherapist’s head, rich qualitative information can be drawn from the patient.

Building a rapport with a patient can happen quite quickly. Developing a relationship that lasts across the health journey requires more time, effort and skill. Firstly, the pelvic health physiotherapist must recognize that empowerment is not something one does to patients. Rather, empowerment begins when the pelvic health physiotherapist acknowledges that patients are in control of their symptoms, and their daily care. It is the shared expertise – the patient being the expert of their own body, and the pelvic health physiotherapist being the clinical expert – with mutual respect, interdependence and emotional responsiveness that bonds a therapeutic relationship. We, as pelvic health physiotherapists, are guests in the patient’s healing journey where we need to clearly, honestly and openly define our role as a guide, a partner, and a support person to them. The goal in pelvic health physiotherapy should be for the patient to have self-efficacy to achieve their immediate functional goals but also to self-manage their condition to live a fulfilled life. Essentially, we could be seen as “leaders,” but we lead from the front, side and behind. We must approach the relationship in different ways at different moments in the health journey like a pendulum swinging back and forth to foster patient empowerment.

Patient empowerment also depends on the degree of autonomy a patient has in the relationship and the healing journey. To maximize autonomous systems, pelvic health physiotherapists must educate the patient about their own body, their current health condition, what is happening to their body, why they feel the symptoms and how their lifestyle affects their body and mind. Education does not simply mean dictation. A pelvic health physiotherapist requires using various educational strategies including visual drawings, technology/app/videos, physical pelvic models, and perhaps reading medical tests and diagnostic results together. Furthermore, pelvic health physiotherapists create opportunities for patients to self-reflect on matters such as what has helped them in the past and what has worsened their symptoms. With self-reflection, education and informed consent to their assessment and treatment, there can be a shift in the patient’s belief system where they can increase their capacity to plan and conduct their path of action. Such methods can increase patient autonomy which leads to a shared decision-making process and patient-centered care.

In my opinion, this last factor is often forgotten or missed in how patient empowerment begins in pelvic health physiotherapy care: creativity. There is much needed attention to the biopsychosocial approach where care is not a checklist style approach focused solely on body regions. We consider the unique person with unique wants, needs and preferences. But the art of pelvic health physiotherapy needs consideration as well. This is not only the art of adapting to changes in patient choices, lifestyles, beliefs, behavioral patterns, but also to choosing a “style of care” that best suits the patient so that they can examine their beliefs about their condition and grow with self-reflection and knowledge sharing.

In conclusion, true patient empowerment in pelvic health physiotherapy is achieved when the focus shifts from merely enhancing a patient’s health status to fostering their ability to think critically and make informed, autonomous decisions about their own lives. Pelvic health physiotherapists exceed expectations when crafting personalized care plans in collaboration with patients, colleagues, and other healthcare professionals. Such an approach not only addresses individual health needs, but also supports patients in their journey of self-reflection and personal growth.

Michiko Caringal (she/her) holds a Master’s of Science in Physical Therapy as well as a Master’s of Health Science in Bioethics from the University of Toronto. She is a Registered Pelvic health Physiotherapist in Vancouver, BC, with over 15 years of experience in clinical, research, education, and leadership roles in rehabilitation, health care and fitness. She is the founder of Happy Down There Physiotherapy, works part-time at the University of British Columbia Bladder Care Centre, as well as CAYA Health Centre, and leads as Educator/Mentor at Trans Care BC. Her personal accounts and professional work have been published in medical journals such as The Journal of Ethics in Mental Health, and she is regularly interviewed for her professional insight in popular magazines and podcasts. In the clinical setting, Michiko believes that combining the clients’ expertise on their own body with her expertise in pelvic health helps to achieve client goals and a better quality of life.

Book an initial appointment with Michiko here!