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The Trap
THE MOST COMMON MISTAKE
Explaining the diagnosis overly accurately instead of explaining it usefully.
This is the default failure, and it is a failure of highly trained people like us. The better your anatomy and physiology knowledge, the worse you are at this, because you have more true things available to say.
Watch how it goes. The patient asks what is wrong. You tell them. You name the tissue, you describe the mechanism, you mention the imaging findings, you reference the structures involved, and you are accurate the entire time. You might draw something. You feel like you did a thorough job, and you did, by the standard you were trained on.
Then the patient goes home and tells their spouse one sentence about what you said.
That sentence is the only thing that survives.
Everything else you said is gone within a day. What remains is a compressed, emotionally weighted summary, and the patient built it themselves out of whatever words in your explanation felt most important. Usually the scariest ones. Degeneration. Tear. Instability. Bone on bone.
Why This Happens:
Accuracy and usefulness are different targets, and we only get graded on one. Every exam you have ever taken rewarded completeness and precision. No exam ever asked you to say the true thing in the form a frightened person can carry. So you optimize for the thing you were measured on.
You are explaining to the wrong version of the patient. The person in front of you is not processing at baseline. They are in some mix of pain, worry, and the specific anxiety of waiting to hear what is wrong with them. Comprehension in that state is not what it is in a classroom, and nobody tells you to adjust for it.
Findings feel like answers, so we lead with them. Imaging and special tests are satisfying to report. They sound like substance. But a finding is not an explanation, and a list of findings is actively worse than one clear mechanism, because the patient has to pick which one matters and they will pick wrong.
We talk about the tissue instead of the person's actual question. The patient did not ask what structure is involved. They asked three questions they may never say out loud. Is this serious? Will it get better? What am I allowed to do? Answer those and you can skip half the anatomy. Skip those and no amount of anatomy helps.
Nobody ever watched you do it and gave you feedback. You were observed doing special tests, needling, manual work, and documentation. Your plan conversation has probably never been observed by anyone. A skill nobody critiques does not improve by itself.
The Cost:
One sentence can produced months of avoidance, measurable deconditioning, a new complaint in a different region, and a patient who now believes their body is fragile. That belief is going to make our job harder for the next 3-6 months, and it is the hardest part of their presentation to treat. Their tissue is most likely fine. Their model of their body is the problem.
Multiply that across a caseload.
The patient who stops the loading program at week two because it hurt a little and nobody told them that was expected. The patient who never books visit three because they understood visit two as the end. The patient who takes your rehab plan, rests instead, and concludes six weeks later that rehab does not work.
None of those show up in your chart as a communication failure. They show up as non-adherence, no-show, or poor outcome. The cause is invisible, which is exactly why it never gets fixed.
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The Practice
The Performance Doctor:
WHEN MORE EXPLANATION IS THE WRONG ANSWER
I need to put a limit on this before it becomes a hammer.
There are patients for whom more education makes things worse. The patient who has already read everything, already knows the terminology, and is deeply anxious does not need another mechanism. They need fewer inputs, not more. For them the intervention is often to reduce the number of things they are monitoring in their own body.
There are patients whose barrier is real and material. If someone works two jobs and cannot get to a gym, your explanation was never the problem, and re-explaining is a way of avoiding the harder work of redesigning the program around their actual week.
And there is a version of this skill that curdles into salesmanship. If you find yourself crafting language to get compliance with a plan the patient has reasonably declined, you have left clinical communication and entered persuasion. The goal is an informed patient who chooses the plan. Not a patient who agreed because you were good at talking.
Explanation is a tool. It is not the answer to everything, and knowing when to stop talking is part of using it well.
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The line between framing and withholding. Everything in this issue is about choosing which true thing to say and how to say it. That is legitimate clinical communication. It becomes something else when the framing starts omitting information the patient needs in order to decide.
The test I use is whether the patient would feel misled if they later saw their own imaging report. If I describe findings as normal age-related changes and they later read the word "degenerative" and feel I hid something, I did not reframe, I obscured. The honest move is to name the term they will encounter and explain it. "Your report will say degenerative disc disease. Here is what that actually means, and here is why it does not change what we are doing." That is reframing with the door open.
In health and strength,
Dr. Thomas Kauffman, DC, CDNP, CSCS, USAW
The Clinical Coach™ a SmartCARE Education™ publication
The Clinical Coach™ is a clinical education publication produced by SmartCARE Education™. Content is for educational purposes and CE credit. Always exercise independent clinical judgment with individual patients.
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