"Yeah, But.."
Patient:
"I've only been here twice and I'm not better yet."
Which phase are they misunderstanding?
A) Phase 1: Figure It Out
B) Phase 2: Load & Test
C) Phase 3: Maintenance + Prevention
D) TTFN
A) Phase 1: Figure It Out
You explain to your client she needs to schedule 1x a week at this phase, but you have no openings for 3 weeks. Patient says: "I'd really rather wait until you have an opening."
Challenge: Provide a response that keeps confidence in the team and prioritizes patient care.
Example Answer:
"I appreciate that, and I'm honored you feel that way. The truth is that my biggest priority is getting you the care you need when you need it. Our team consists of excellent pelvic health clinicians, and I'd much rather have you start making progress with her now than spend the next several weeks waiting for me while your symptoms continue. We collaborate closely as a team, and if there's ever anything complex, we're discussing cases together."
Patient:
"I'm a 4 out of 10."
What could you ask next?
"A 4 is a great starting point. Tell me why you're a 4 and not a 1. What symptoms, activities, or parts of your day feel better than when we first started working together?"
Patient says: "My husband thinks this is a waste of money and doesn't understand why I need pelvic floor PT."
Give a script that validates the concern, explores the barrier, and keeps the patient on the journey.
"That sounds really difficult. It's hard when the people around us don't fully understand what we're experiencing. Tell me a little more about his concerns so we can figure out how to navigate this together."
*The Skeptic*
Patient says:
"I've seen three pelvic floor therapists already."
"Nobody can tell me what's wrong."
"I don't want to waste more money."
Challenge: Give me a response.
"I can completely understand why you'd feel that way. It sounds like you've put a lot of time, effort, and money into trying to solve this and haven't gotten the answers you were hoping for. Before we talk about where to go next, I'd love to hear more about what you've tried and what felt like was missing from those experiences."
"That's fair. If I were in your shoes, I'd probably be skeptical too. Rather than assuming anything, let's take a step back and look at your story together. My goal today isn't to convince you of anything—it's to understand what you've already been through and see if there are any pieces that may have been overlooked."
"Honestly, I don't blame you. Three therapists is a lot. Before we decide what the plan should be, let's figure out whether we're looking at an orthopedic driver, a pelvic health driver, a nervous system driver, or some combination of those. If we can identify the driver, then we can decide whether it makes sense to continue investing your time and money."
Patient: "I'm feeling good, so I think I'm done."
How would you respond to this, keeping in mind the phase 1, 2, or 3?
Phase 1: "Alright Mike, let's go through each symptom and see where we are starting. On a scale of 0-10, with 10 being your ideal, where are you with leaking, urgency, and constipation?"
Purpose: Establish baseline and identify priorities.
Phase 2: "Awesome, Mike. Let's revisit those same symptoms. How would you rate them today? Last time you were a 3/10 for urgency and now you're a 9/10. That's great progress. Now let's see how those improvements hold up when we challenge the system."
Purpose: Measure progress and prepare for load testing.
Phase 3: "Fantastic work, Mike. Let's review those same symptoms one more time and compare them to where you started. Then we'll establish today's strength, mobility, and endurance measures as your new baseline moving forward to check in with at least every 6 months."
Purpose: Confirm maintenance status and establish future reference points.
Patient:
"Nobody has been able to help me."
Challenge:
Provide a response that validates their experience without promising results.
Example Answers:
"I can understand why you'd feel discouraged. It sounds like you've put a lot of time, effort, and hope into trying to solve this without getting the answers or results you were looking for. Before we talk about where to go next, I'd love to understand more about what's been tried and what felt like was missing."
"That's completely understandable. Most people don't find us on their first attempt, they often find us after they've already been through multiple providers, treatments, or diagnoses. My goal today isn't to promise that I have all the answers. My goal is to understand your story, identify any potential drivers that may have been overlooked, and create a clear plan for where to go from here."
"That's a fair question. Rather than telling you why it will be different, I'd rather spend some time understanding what's already been done and what you've experienced. Then we can decide together whether there's a different direction worth exploring."
Patient says:
"Eh, things are maybe a little better."
"About the same, honestly."
Challenge: What do you say next?
"That's fair. Let's put some numbers to it. When you first came in, where would you have rated your urgency on a scale of 0-10, with 10 being exactly where you want to be? And where would you rate it today?"
Patient says: "I work 60 hours a week. I don't have time for all these exercises."
Give us a script that maintains your recommendation while making the plan realistic.
"That's absolutely understandable. My goal isn't to give you the perfect program, it's to give you a program you'll actually have the time to do. Let's talk about what feels realistic right now, even if it's only 5 minutes a day we can prioritize how to move your needle forward."
*The Time Cruncher/ Executive*
"Can you just tell me the top 2 things I need to do?"
"How quickly can we get results?"
Challenge: Provide a script response.
"Absolutely. My goal is to make this as efficient as possible for you. If we focus on only two things this week, these are the two actions I think will have the biggest impact. As for results, that depends a little on what drivers we find, but my goal during the first few visits is to identify what's contributing to your symptoms and start building momentum as quickly as possible."
"I like how you're thinking. Let's focus on the highest return on investment activities. Rather than giving you ten things to do, I'd rather give you the two things most likely to move the needle and reassess from there."
Patient:
"Yeah, but I don't think stress affects my symptoms."
Your BEST next move is:
A) Explain the nervous system
B) Pull out research articles
C) Ask what they've noticed during stressful periods
D) Tell them they're wrong
C) Ask what they've noticed during stressful periods
Patient:
"I'm terrified I'll make this worse."
Best response:
A) "You won't."
B) "Don't worry."
C) "Sounds like you're worried about causing more damage."
D) "That's irrational."
C: "Sounds like you're worried about causing more damage."
Patient:
nods throughout the entire session, agrees with everything you say, but never asks questions.
Challenge:
What do you say next?
"I've shared a lot of information today. Before we wrap up, I want to make sure we're on the same page. What are your biggest takeaways from today?"
"This all sounds good in theory, but what part of today's plan do you think will be easiest to implement, and what part might be challenging?"
"On a scale of 0-10, how confident do you feel that you'll be able to follow through with this plan over the next week?"
Patient: "I can't afford coming weekly."
You: "____"
Option 1: Front-load then space out
"Would it be more realistic to do the first 3-4 visits weekly so we can establish a strong foundation and gain forward momentum, and then transition to every other week?"
Option 2: Every other week from the start
"If weekly isn't feasible, we can certainly work every other week. We may just be a little more strategic about what we prioritize each visit and what I ask you to work on between sessions."
Goal: Holding your clinical recommendation while remaining able to meet the patient where they are.
*The Chat GPT-er*
Patient says:
"I read online that this is caused by hormones."
"ChatGPT said it could be my pudendal nerve."
Provide a script response.
"Those are definitely possibilities worth considering. One thing I always remind patients is that many different conditions can create very similar symptoms. Let's look at your story, your movement, your nervous system, and your pelvic floor findings together to see what fits and what doesn't."
"I love that you've been researching and trying to understand your body. My job is to take all of those possibilities and figure out which ones are actually relevant for YOU, because what we see online is often only one piece of the puzzle."
"Hormones could absolutely be contributing. The pudendal nerve could also be involved. My question is whether those are the driver, the passenger, or the victim. Let's figure out whether we're dealing with a hormonal driver, orthopedic driver, pelvic floor driver, nervous system driver, or some combination of those before we decide where to focus treatment."
Patient says: "I think I'll just wait until August to get started."
Challenge:
Provide a response that expresses urgency without fear mongering.
Example Answers:
"Of course, that's your decision. My concern is that many of the issues we treat don't tend to improve by waiting, and in some cases they become more difficult to address the longer they've been present. I'd rather see you while this is still a small fire than after it becomes a much bigger one. If getting started sooner is possible, that's what I'd recommend."
"Ultimately it's your choice. I will say that the sooner we can start identifying the drivers of your symptoms, the sooner we can start changing the trajectory. Most people don't call us on the first bad day, they call after months or years of dealing with something. My concern is less about next week and more about where you'll be 3-6 months from now if nothing changes."
Patient:
"I feel broken."
Best reflection:
A) "No you're not."
B) "You shouldn't think like that."
C) "It sounds like you've been carrying this for a long time and are losing trust in your body."
D) "You're fine."
C) "It sounds like you've been carrying this for a long time and are losing trust in your body."
Patient says:
"My urgency is basically gone."
"I think I'm good now."
What would your response be?
Example Answer: "That's fantastic progress. The urgency may have been the fire that brought you in. Now I want to make sure we're checking for any warm coals underneath, things like pressure management, mobility restrictions, pelvic floor coordination, nervous system sensitivity, or strength deficits that could cause the symptoms to come back later. The goal isn't just feeling better today, it's lowering the threshold enough for staying better."
Patient says: "I'd love to do this, but I have a newborn and every time I try to work on myself, the baby needs something."
Give us a script that acknowledges this season of life while keeping momentum.
"That makes a lot of sense and is extremely normal to feel. Right now we're not trying to be perfect, we're trying to make progress with your new lifestyle. Let's talk about what feels realistic in this season and find a few things you can consistently fit into your day."
*The Boundary Pusher*
Patient says: "You don't have to step out while I undress."
Your challenge:
Provide a response that maintains rapport while maintaining professional boundaries.
"I appreciate that, but I step out for every patient so you can have privacy and get comfortable. I'll knock before I come back in."