Ethos, Pathos, Logos and developing a patient centered alliance

I have been talking about patient empowerment for over half of my career. Terms like “Patient Centered Care” and “Therapeutic Alliance” have become more more common place than they were 20 years ago.

But has much changed on a day to day basis in the practice of Physical Therapy(Physiotherapy) or do we just pay lip service to the terms?

On the average day in a busy clinic, with a packed schedule, several new evals, one or two re-evals, several patients turning up late, how do your “motivational interviewing” and relationship building skills fare?

If you have a consistent patient interaction skill set, then even on the busiest day, with all the hiccups that may ensue, you will still be able to give each and every patient the understanding and empathy they deserve.

One simple and consistent method of patient interaction is to practice Ethos, Pathos, Logos. The original concept developed by Aristotle to win people over to his arguments during debate. This was later expanded on by Stephen Covey (of Seven Habits fame).

Ethos, is the root word for Ethics and Covey explains it is the essence of developing a good relationship, simply put it means “gain trust.”

During the initial encounter with a patient everything matters, patients are assessing your clinic, the staff, and you, as much as you are assessing them. It is important they feel safe and listened to. Gaining their trust is key to a good therapeutic alliance. Without trust as a foundation everything else may start to fail.

Pathos, is the root word for empathy, Covey suggests that this implies “seeking to understand”, without judgement, truly listening to another, seeing things from their point of view. The emphasis is on empathetic listening, where one listens not with the intent to prepare to answer, but to understand the patient’s narrative. (This synergies with Ethos, as it is a powerful tool for building trust)

Logos, is the root word for logic, here Covey suggests that after truly listening then one can “seek to be understood” again this synergies with Pathos and Logos, seeking to be understood requires one to utilize the patient’s narrative, to form an individualized assessment and treatment plan, based on shared decision making with the patient. Education is not simply an add on to the end of a treatment session it is part of the fabric of the whole patient encounter. Allowing patients to reflect during the clinical encounter leads to a more patient centered learning experience.

Ethos, Pathos, Logos is a simple framework which can be utilized to make each clinical, encounter meaningful for both the clinician and the patient. 

@retlouping 2020

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