6 Things You Do That Your Clients Hate

6 thing you do that your clients hateIt’s funny, over the years you start to accumulate several thoughts on a subject that one can only do through experience.  The old saying “if only I knew then what I knew now” is certainly true.  I often laugh at some of the things I did and say to my clients when I was less experienced.  We were having this discussion with our students at Champion the other day, and I consider this a normal part of your career advancement.

In addition to reflecting on your own personal practice, I think there is also a lot to learn about from your clients when they tell you their past experiences with other professionals.

I tend to see a lot of clients that have tried other health care and fitness professionals and for whatever reason find themselves with me after not achieved the results that they wanted.  In my experience, this is often due to a few reasons:

  1. They didn’t listen
  2. They didn’t connect
  3. They didn’t put in the time


Notice how none of these things are “clinical” in nature.  Sure, I see my fair share of clients that were not diagnosed well or treated properly, but in all reality, I’m not perfect either.  But I listen, connect, and put in the time.  This allows my the luxury of being able to call an audible with my clients when I feel we may have started down the wrong path.  They trust me.  If they didn’t trust me, they’d move on to the next clinician.

How about these two comments I received recently from clients about their past experiences with other professionals.

  • “All my therapist did was tell me what I was doing wrong.  I know what I am doing wrong, that’s why I went to therapy.”
  • “I left my last therapist and always felt bad about myself.  They made me feel bad about myself.”


For the young clinicians (and I guess the more experienced one’s too!), I want to share some of the things I have picked up over the years that clients hate.  Remember, you need to connect in order to do you best with your clients.  Learn from my mistakes and errors and avoid these 6 things you do that your clients hate!


Stare at Your Device

I can’t think of a worse way to start off your experience with a healthcare professional than having them stare at their computer and typing while asking you a series of questions.  Not a great way to connect and help your client feel like your are compassionate about them, rather than just trying to finish your “task” of their evaluation.  I still take notes briefly when pencil and paper and do my documentation afterwards.  Sure, it takes more time out of my day, but it’s the right thing to do.

This also goes for staring at your phone their whole session.  You could be responding to a highly urgent and work-related email, but realize your clients will just assume your are posting pics of your kittens on Facebook.  Excuse yourself and respond to an urgent message if you must, but don’t do it right in front of your client.  This looks like they are not important to you at the moment.  Otherwise, keep your phone in your pocket.

I’m not sure if the Apple Watch is going to help us here or hurt us, we’ll see!

Your client needs to feel like they are the most important person in the world to you during their session.


Don’t Listen to Them

Your first interaction with someone is really important for several reasons.  Obviously you need to determine where to start with your client, but it’s also the most critical interaction to development a connection.

This starts with letting them talk.  You want to hear their story.  Some will want to get right to the point, while others will want to elaborate.  Let this happen.  Don’t interrupt if you can, and let them lead the discussion.

As I get more experience, the subjective portion of my exam could really only last 30 seconds for me to have enough information to start looking at the client.  However, I have learned that a big part of connecting with your clients is listening to your client.  You need to provide the platform for them to share what they want with you.


Force Feed What You Want Instead of What They Want

It’s not about you.  Starting with this simple concept is a great start.

As an example, perhaps a client comes to you and says “kinesiology tape really makes me feel better.”  How do you think they’ll respond when you say, “Your shoulder pain is coming from signals in your brain, kinesiology tape won’t help that and doesn’t really do anything.”  Ummm, probably poorly.

You said that kinesiology tape “doesn’t do anything” and they said it “really helps.”  That sounds like conflict, not connecting, to me.

In all honesty, we don’t know as much as we think we do about the human body.  I have no problem providing a treatment, such as kinesiology tape, if there will be no harm, no long term consequence, and there is no definitive research saying it is ineffective.  Obviously, if scientific evidence is available to completely say something is ineffective that changes the topic.

Don’t get me wrong, I will do what I want to do with that client, but may also try some kinesiology tape as well.  Perhaps that makes my treatments even more effective.

Another great example in the fitness world is the focus on movement and corrective exercises.  I think this is great, but don’t lose focus.  If someone comes to you for fat loss and all you talk about is how poor they move and how you want to fix their asymmetrical 1 on the FMS straight leg raise, you are forcing what you want on the client, and not focusing on what they want.  They don’t give care at all about what their straight leg raise looks like.

Again, I think you should work on that movement pattern.  But that can’t be the focus of the program.  It has to meet their goals first.  Sure, we sneak our goals into our programs too, but be careful here.


Tell Them Everything That is Wrong with Them and Nothing That is Right

I think we all get carried away sometimes with finding “deficits” during our assessments and evaluations.  That is normal.  But we need to be careful with how we present this to our clients.

Some people will focus too much on the little things, while others will seem just feel bad about themselves.

Every client should leave your facility feeling better, more optimistic, and in a good mood.  You want to be one of the best parts of your clients’ days.

I’ve actually talked about this in the past in an article on The Dale Carnegie Approach to Assessments.


Talk Over Their Head

As you can see, communication and people skills are pretty valuable in our professions.  Another area that I often see as being an issues is not bringing the discussion to your client’s level.

Just like you should be trying to match your clients’ energy levels, I also try to bring my discussion to their level as well.

Students and young clinicians are often guilty of this for a few of reasons:

  1. They are used to talked scientifically to justify what they are doing to their professors
  2. They haven’t accumulated that database of analogies we all use on our heads
  3. Unfortunately, they are a little too egotistical and trying to impress the person with how much they know

Confusing someone and talking over their head is not going to impress someone.  Some people like to hear all the detailed scientific things, while others just shut you out.  You need to feel this out and adjust.  However, your ability to convey your points and messages in a manner that connects with each person will impress them.

I use several different tools to accomplish this based on how I feel the conversation is going, but my go-to methods are:

  1. Using pictures and videos during my evaluation
  2. Using analogies to compare a complicated point to one they understand.  Car analogies work well!  Things like, “it’s like driving with your wheels out of alignment, eventually your tires are going to wear down unevenly.”
  3. Using a whiteboard to express thoughts.  This doesn’t always just mean drawing a picture.  I also often write and make lists.  Some people are more visual learners.  You can usually tell when they whip out their phone to take a pic of the whiteboard when you are done!

They key is to give them the science but don’t stop there, back it up with something they can understand.


Criticize Their Other Healthcare Professionals and Past Experience

I’m surprised at how common this point is in our professions.  I have many clients that have commented on how other professionals they have worked with in the past just criticize everyone else they have and had worked with in the past.  Like a personal training putting down their physical therapist or their physical therapist putting down their chiropractor, as a couple of examples.  Realize that your client has probably built up a lot of trust and respect over the years for the other people they are working with, which have not currently built up.

Not only does this make the person feel bad about their past choices (see above), but it’s also very transparent that you are just slamming someone else to try to make yourself look good.

I have a general rule of thumb that I developed over the years after seeing many “prestigious” people commit this error – Don’t make others look bad to make yourself look better.  It may work in the short term, but always catches up to you.

Yes, you are a genius when you have the power of hindsight.  Everything is clearer in retrospect.  Be respectful of their other people your client is seeing and has seen, you aren’t always right.


In reality, I probably could have listed another dozen, but these are a great start.  Avoid these 6 things that you do that your clients hate and focus on connecting, listening, and putting in the time to maximize your own effectiveness in helping people achieve their goals.




Collaboration Between Physical Therapists and Personal Trainers

As a physical therapist, I’ll be one of the first people to admit that I truly feel that I have become a better therapist by learning from and collaborating with many great personal trainers and strength coaches.  I say that because I fear that there are some physical therapists that do not feel this way.  Maybe it is ego, or stubbornness, or maybe even a perceived turf war, but I’m not sure why every therapist doesn’t feel the way I do.

We are all technically in the same field.  Sure, I perform physical therapy and you perform personal training.  That is our respective “products” that we provide.  However, we both provide the same “commodity” to the general public – we help people attain optimal health and function.

In the broad spectrum of care, I see it as helping people “feel better, move better, and perform better.”  While I think both physical therapists and personal trainers can help people achieve all three of those goals, there is no doubt in my mind that collaborating will surely provide the best service to our clients.

And isn’t that what it is all really about?  Helping our clients?


How to Maximize Collaboration Between Physical Therapists and Personal Trainers

physical therapist personal trainer collaborationI am totally excited to announce that I have teamed up with Jon Goodman to coauthor an article on how to maximize collaboration between physical therapists and personal trainers.  Jon has authored a couple of great books (I recommend all therapists read his book Ignite the Fire to enhance our own skills) and is the creator of The Personal Trainer Development Center (PTDC), which has quickly become a go-to resource on the web.

Jon and I jumped on Skype about a month ago with no agenda and just started chatting.  One of the things we discussed was the concept of this article.  We took the approach of the two of us writing our own pieces from our own perspective and then putting together.

I think it is a must read for all physical therapists, personal trainers, and strength coaches.  Hope you enjoy:

–> Click here to read the article over at <–




Choosing a Social Media Platform to Get More Clients

Today’s guest post, written by Charlotte Bohnett and Erica Cohen, reviews the many social media platforms that are available to help promote your practice and get more clients.   With the many social media options available, there are a few factors to consider when designing your online presence.  This is a great start for many, hope it helps you get up and running – we need a stronger online presence and sharing of knowledge!


Choosing a Social Media Platform to Get More Clients

social media more clientsUnless you’ve been living under quite the rock for the past decade, you may have heard the words “social media” from time to time—okay, you’ve probably been bombarded by at least one example of social media in almost every conversation you’ve had, every commercial you’ve seen, or any time you check your email. You probably have an account or three. But here’s something else you may have noticed among the constant stream of Google+, Facebook, Twitter, LinkedIn, Foursquare, Pinterest, and Instagram plugs: social media is no longer just a platform for, well, being social. It’s also a way for companies to connect with current and potential consumers—which in your case means patients, clients, and referral sources for you.  (Photo by Khalid Albaih)

Let’s start off with the basics. Social media is a conversation platform first and foremost, so it’s probably not the best idea to go from 0 to 60 in less than a minute and create a profile for your business on every platform that exists. In fact, one of the most damaging things you can do is create a profile and then abandon it—and your followers. It can communicate all sorts of negative things to prospects about your company, your brand, and your business. Instead, choose the right social media platform for your business and your audience, and then focus on making it represent you the right way.

So, with so much information out there—much of it advertising—how do you pick the right social media platform for your practice?


How to Pick the Right Social Media Platform for You

First, consider your goals. Are you hoping to educate current patients and clients; entice potential consumers; engage referral sources; or simply stay up to date on the latest industry news? Based on your goals, you can then figure out whom you want to reach. In other words, who is your target audience? Then, go where they go. Ultimately, you’ll want to get involved on the sites that best allow you to achieve your goals and reach your audience. Here’s a breakdown of some of the most popular:


Everybody and their grandmother are on Facebook. Although it’s may have lost its hip, cool factor, it’s an ideal place for businesses to connect with current and potential patients as well as demonstrate a level of relevancy. And, because everyone else is on Facebook, you should probably be, too. Here, focus on providing valuable educational information about your industry and your specialization. Your posts should be more than sales pitches—make sure you’re offering your readers content with value. And, it’s all about reciprocity. Participate in the conversation; get involved. Friend and like.

Here are some great Facebook pages to like and share with your audience:



140 characters has become the slickest form of online communication—short, informational bursts of copy followed by a descriptive hashtag and maybe a supporting photo or link. If nothing else, Twitter is a great way to force brevity in your writing. Most people online have way short attention spans (squirrel) so being forced to fit your comment in 140 characters will ensure you only write the things that absolutely matter. Additionally, Twitter is a fantastic way to generate instant conversation and gain valuable insight into just about any industry or topic you wish from experts. For PTs, we recommend hopping into #SolvePT on Tuesday nights to get started. Watch for a while, and then when you’re comfortable, jump right in with your thoughts. Here, you’ll meet some of the heavy hitters in the physical therapy Twitterverse and maybe take notes as to how they generate interest in the profession and their services.  Here are some great hashtags to keep an eye on:



The world’s largest professional network has more than 161 million members. Here, you’ll do less interacting with patients and clients and more with your peers. It’s a great way to connect with fellow therapists and referring physicians. And for any savvy patients who go searching for you online, they’ll find a robust resume of your accomplishments. You can also join groups within LinkedIn to discuss topics that interest you.

Check out some of the great groups that you can join:



It’s a virtual pinboard that allows you to tell your story and inspire through compelling photos or images grouped into specific, searchable categories. Here, you can build pinboards—and research others’ boards—for treatment ideas, infographics, best practices, and happy thoughts.

Give these pinners a follow to get started:


Blogger or WordPress

These two very easy and intuitive platforms make it easy to create your own blog, which is a great way to promote your expertise and provide excellent, valuable content to patients, clients, peers, and referrers. Just note: your blog is public—just as all social media posts are—so you obviously can’t share individual patient data or recommendations.



Similar to Facebook in that they both share the concept of profiles, Google+ also offers hangouts and circles and is fully integrated with your Google (Gmail) account. Most importantly, however, Google+ is a Google product, so a detailed Google+ profile can help increase your practice’s visibility and ranking in search.



Now Get Started!

Once you decide which social media platform(s) you’re ready to commit to, get committed. Create your profiles and start speaking with your audience. Just be sure that what you share relates to your goal and is meaningful to your followers. And stick to it. Reciprocity and engagement can take time; make sure you’re dedicated with your efforts.


get more patientsAbout the Authors

Charlotte Bohnett and Erica Cohen are both Senior Writers at WebPT, the leading cloud-based EMR software designed specifically for the rehab community. For follow-up questions or additional information about WebPT, email at





Frontal Plane Stability, Soft Tissue Duration, and Cash Based Practice

This week’s stuff you should read comes from Chris Johnson, Patrick Ward, and Jarod Carter.


Inner Circle Update

This month’s Inner Circle webinar is actually happening later today!  We will be talking about how I integrate science and evidence into exercise selection.  I love topics like this and feel that little tweaks to exercise can you make you look like a rock star.

Inner Circle members can head over to the dashboard to sign up for the webinar.  I’ll get a recording of the video posted ASAP afterward as well.  Click here to learn more and join the program. Update

There were a few new webinars added to this week!  We have a ton more coming too.  Here is what was new this week:

  • Part 2 of Kevin Wilk’s Current Concepts in ACL Rehabilitation covering several concepts of biomechanics, exercise, and neuromuscular training during the intermediate phase of rehabilitation from week 2 to week 10.
  • Peripheral Neuropathies by Dr. Mike Ellerbusch, who I have collaborated with in past EMG studies
  • Surgical Options for Knee Arthritis in Young Athletes by Dr. Lyle Cain.

And also working on a ton more webinars including kinesiology taping, integrating neuroscience, and more strength and fitness webinars.



Frontal Plane Stability Drill

Chris Johnson shows a nice video of a frontal plane stability drill he uses in runners.  I like the thought and emphasis on the stability of the leg on the ground and the core.  Notice how well Chris performs the exercise and doesn’t allow a hip hike o r



Cash Based Practice Advice 

Jarod Carter includes a nice video of his speech to a group of physical therapy students about cash-based practice.  Nice message and Q&A session.



How Long Should We Spend on Soft Tissue

Patrick Ward answers a question he received regarding how much time we should spend on soft tissue.  To summarize, as long as we need to produce the desired effect!  But how many times in a crazy outpatient setting do we get rushed?



How Self-Pay Patients Have Made Me a More Effective Clinician

self-pay patientsToday’s post is a guest article by Jarod Carter, owner of a cash-based physical therapy practice, describing how self-pay patients have made him a more effective clinician.  I think this is a great thought and something we should all work towards.  His thoughts can apply to many different fields as well, especially the fitness and performance specialists with self-pay clients.  Here is the real challenge, though, if you aren’t in a self-pay situation, or you are an employee, how can you use these tips to make yourself more effective?


How Self-Pay Patients Have Made Me a More Effective Clinician

If I have to see a patient with an ankle sprain for more than 4-5 visits, I start to get nervous. Why? Because my patients pay $120 out-of-pocket for each one-hour session, and they expect to get better very quickly with that kind of expense; and the same expectations exist for just about any fairly recent non-surgical injury.

Aside from avoiding the hassles of Medicare and Insurance reimbursement, cash-pay patients can have another positive impact on your practice.  In many ways their presence both requires and leads you to become a better clinician. The ways in which this occurs are numerous, but I will expand on a few of them below.


Self-Pay Patients Are More Motivated

Whether you have an entirely fee-for-service clinic like mine, or just see a few private-pay patients here and there, you will likely notice a distinct difference between them and insurance-utilizing patients. On average, they tend to be more motivated to get better quickly and are more compliant with their home program. When they are paying 3-5 times more than a co-pay for each session, there is an inherent financial motivation to minimize the amount of needed treatments. I could be wrong, but if you were to grow the private-pay portion of your patient population, I imagine you would start to see faster and better outcomes solely for the above reason. Another positive side effect of this is that when the majority of your patients are highly motivated and compliant, it makes your job more enjoyable and rewarding.

[Editor note – I agree with this 100%.  This is also probably a big factor in the recent study that was published reporting that direct-access physical therapy produced better results with fewer visits.  Patients that choose to go to PT are going to be the most motivated.


More Hands On Time Means Better Patient Satisfaction

There are a variety of approaches to treatment and scheduling in the cash-based practices that I know of, but in general they all seem to provide more than average one-on-one time with each patient. There is also less (or no) utilization of techs or PTAs, and often modalities are not used either. In these situations, the added one-on-one time with the PT is another reason why clinical outcomes tend to be better with self-pay patients.

This is what compels the majority of my patients to forgo using insurance and pay up front for my treatments. My focus in the clinic is primarily on Manual Therapy and anything else that the patient can’t reproduce on their own time (I should also note that I don’t see a lot of post-surgical rehab patients, but see plenty that are trying to avoid surgery).

Trust me, you can get a lot done in 60 minutes of individualized treatment, and it’s quite luxurious for you as the Physical Therapist as well. In a normal clinic you may only have time for a few Manual techniques and some Therex before it’s time to move to the next patient. With a full hour available, if the first couple things I try don’t make an immediate and significant difference, I can keep trying new approaches and techniques.

For this reason, it’s rare that a patient leaves my office without having some type of significant improvement in their symptoms/movement. Simply put, if all else is equal in terms of clinical skills, the PT who spends an hour with each patient is going to produce more results per session than the PT who races from one to the next every 15-30 minutes.


Motivation to Improve My Skills

Returning to the first paragraph, one of the biggest motivating factors for me to always improve my skills is the pressure of higher expectations from my patients. Most self-pay patients will be paying out-of-pocket in hopes that fewer total visits will be needed. I’m not saying patients in a traditional PT clinic don’t expect you to do a great job; but I’ve worked in both insurance-based and cash-based settings and I assure you that the expectations are not quite the same.

To live up to this (especially as a fairly young PT), you tend to go beyond just the requisite CEU hours and continually seek out new information to improve your skills. If you’re a subscriber to Mike Reinold’s website and newsletter, you’re already displaying this type of drive to be better.

After all, if self-pay patients can get similar results by going to the insurance-based PT down the road, why in the world would they pay top dollar to see you?


My Patients are My Biggest Referral Source

This pressure to perform does not just stem from patient expectations, but also the nature of how referral sources shift in a cash-based practice. At least in my experience (and the experience of other private-pay PTs I know), a cash practice relies on word-of-mouth to produce new patients much more than it relies on Physicians. The reason why is beyond the scope of this article but is explained in more detail here if you’re interested.

In no way am I saying that every patient doesn’t count in a traditional PT clinic; but when your primary referral source becomes the patients themselves rather than physicians, you tend to go that extra mile for each individual on a more regular basis. If you disagree, please think of the times when you’ve had a referring physician come to you for treatment. Now imagine that every one of your patients was a referring physician. Interesting concept isn’t it?


About the Author

Jarod CarterJarod Carter, PT, DPT, MTC is a private practice owner in Austin, TX.  Jarod has formed a successful cash-based physical therapy practice and now has a website to help others do the same.  Check out his site for more information on cash-based physical therapy.



Start Your Own Private Practice

Starting your own physical therapy private practice seems pretty daunting.   I understand and agree, I have never owned my owner my own clinic, though I have certainly had experience running one.  I thought I would use this week’s stuff you should read article to share some resources that you may find helpful if you are thinking about opening a clinic or if you already own one.

The first two resources are two brand new programs geared towards starting a fitness business.  While the content is specific to the fitness business industry, I must say that the information is priceless to those of us in the rehabilitation field as well.  Many of the concepts behind running a profitable fitness business can be applied to a rehabilitation clinic to an extent.  This is especially true in this day and age when more cash based practices and “post-rehab” programs are going to become more popular.

Counting Reps to Counting Revenue

The Counting Reps to Counting Revenue program by Alwyn and Rachel Cosgrove is an excellent resource.  Alwyn and Rachel run one of the most profitable fitness businesses in the country.  They share how the built this and how you can too.  If you haven’t heard of him, Alwyn is one of the best minds in the fitness business.  But, hurry, this is a one time program that ends tomorrow, Friday 9/2/11, so if you are interested, don’t delay.  Click here for more information.

Fitness Business Blueprint

Pat Rigsby, Mike Robertson, and Eric Cressey teamed up to deliver a “blueprint” of how they started their fitness businesses.  This program is pack with their tips, pearls, custom forms, and probably most importantly – mistakes that they made!  I went through this program myself and enjoyed the content.  A great combo of guys with different backgrounds and skill sets.

A Complete Guide to Cash-Based Physical Therapy

Jarod Carter has started a website with many tips that he has used to build a succesful cash-based physical therapy practice.  He and I have been communicating over the summer and I have enjoyed his content.  Certainly makes you think about the future of PT clinics and insurance reimbursement.

The APTA Private Practice Section

Last but not least, the APTA’s Private Practice Section is a good resource to begin thinking about opening a private practice.  They have many resources for those inspiring to open a clinic or also currently owning a private practice, including their popular “how to manual” on opening a private practice.


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