13/11/2025
𝐓𝐮𝐫𝐧𝐬 𝐨𝐮𝐭 𝐈 𝐰𝐚𝐬𝐧’𝐭 𝐚𝐬 𝐩𝐚𝐭𝐢𝐞𝐧𝐭 𝐜𝐞𝐧𝐭𝐫𝐞𝐝 𝐚𝐬 𝐈 𝐭𝐡𝐨𝐮𝐠𝐡𝐭…
Even though the answer was obvious, the question always left me a little uncomfortable:
“𝘋𝘰 𝘺𝘰𝘶 𝘵𝘩𝘪𝘯𝘬 𝘐 𝘴𝘩𝘰𝘶𝘭𝘥 𝘩𝘢𝘷𝘦 𝘢 𝘮𝘢𝘴𝘴𝘢𝘨𝘦?”
I used to get this fairly frequently from patients - we have massage therapists in our clinic, and every so often a patient would ask me if they should see one.
And apart from the rare situation where it was contraindicated, I’d generally respond with an enthusiastic yes.
The patient would leave, book in a massage, and generally come back next time telling me how helpful it was.
On the surface, it was a pretty good outcome.
So it took me a while to work out why it always left me feeling a little nervous - not massively worried, just a slight feeling in my gut that things hadn’t quite lined up, and that I’d messed up somehow.
It definitely wasn’t about the massage - we have great therapists here, and I’d seen them help countless people over the years.
Eventually, I realised what was bothering me - it was they had to be the one to ask.
Although it never happened, there was this slight fear in the back of my head that they’d come back with “so why didn’t you recommend it earlier??”
And I knew I didn’t have a good answer.
In truth, the issue was something I thought I’d already overcome.
I wasn’t just being cautious, I was 𝘶𝘯𝘥𝘦𝘳-𝘳𝘦𝘤𝘰𝘮𝘮𝘦𝘯𝘥𝘪𝘯𝘨.
And under-recommending is just another form of that classic ethical practitioner trap - undertreating.
Looking back, I realise I’d always seen the value in what massage therapists do.
We’d had them in the clinic from the early days. I’d refer occasionally, but usually only if things weren’t going to plan… or if the patient brought it up themselves.
I told myself I was being respectful, giving patients space to decide for themselves.
But if I’m honest, that wasn’t the real reason…
… deep down, it was about me - I didn’t want to seem pushy.
It’s exactly the same fear that causes practically all new graduates to undertreat their patients (though it’s something a lot of experienced DC's struggle with too - they just talk about it less).
We overcorrect for the image of the over-treater and end up swinging too far the other way.
In the moment it feels like the right thing to do.
But ironically, it often means that the more we care about being patient-centred, the more hesitant we can become to lead.
Of course, that same fear can also push us in the opposite direction, where we become a little too direct.
I saw that just this week with a mentee of mine:
We were discussing a recent Report of Findings conversation - a patient who’d injured their back and was eager to return to the gym.
Their instinct was to protect them:
“𝘐 𝘥𝘰𝘯’𝘵 𝘸𝘢𝘯𝘵 𝘺𝘰𝘶 𝘭𝘪𝘧𝘵𝘪𝘯𝘨 𝘺𝘦𝘵, 𝘪𝘵 𝘤𝘰𝘶𝘭𝘥 𝘴𝘦𝘵 𝘺𝘰𝘶 𝘣𝘢𝘤𝘬.”
Their tone was caring, even cautious.
But the patient’s response told a different story - they came back with “𝘖𝘩 𝘯𝘰, 𝘐 𝘸𝘰𝘯’𝘵 𝘧𝘪𝘵 𝘵𝘩𝘳𝘰𝘶𝘨𝘩 𝘵𝘩𝘦 𝘥𝘰𝘰𝘳 𝘪𝘯 𝘢 𝘮𝘰𝘯𝘵𝘩’𝘴 𝘵𝘪𝘮𝘦, 𝘐’𝘮 𝘨𝘰𝘪𝘯𝘨 𝘵𝘰 𝘱𝘶𝘵 𝘢𝘭𝘭 𝘵𝘩𝘢𝘵 𝘸𝘦𝘪𝘨𝘩𝘵 𝘣𝘢𝘤𝘬 𝘰𝘯…”
Rather than feel reassured, they started feeling anxious - and that something was being taken away from them.
After the session, we talked about it.
I said, “You don’t have to decide for them. Just offer the options.”
Then we reframed the same idea:
“𝘖𝘧 𝘤𝘰𝘶𝘳𝘴𝘦, 𝘸𝘦 𝘸𝘢𝘯𝘵 𝘵𝘰 𝘨𝘦𝘵 𝘺𝘰𝘶 𝘣𝘢𝘤𝘬 𝘵𝘰 𝘭𝘪𝘧𝘵𝘪𝘯𝘨 𝘈𝘚𝘈𝘗 - 𝘵𝘩𝘰𝘶𝘨𝘩 𝘮𝘺 𝘤𝘰𝘯𝘤𝘦𝘳𝘯 𝘸𝘰𝘶𝘭𝘥 𝘣𝘦 𝘪𝘧 𝘺𝘰𝘶 𝘨𝘰 𝘩𝘦𝘢𝘷𝘺 𝘵𝘰𝘰 𝘴𝘰𝘰𝘯, 𝘪𝘵 𝘮𝘪𝘨𝘩𝘵 𝘧𝘭𝘢𝘳𝘦 𝘶𝘱. 𝘐𝘧 𝘺𝘰𝘶 𝘸𝘦𝘳𝘦 𝘵𝘰 𝘱𝘢𝘶𝘴𝘦 𝘵𝘩𝘢𝘵 𝘧𝘰𝘳 𝘢 𝘣𝘪𝘵, 𝘪𝘴 𝘵𝘩𝘦𝘳𝘦 𝘴𝘰𝘮𝘦 𝘰𝘵𝘩𝘦𝘳 𝘭𝘰𝘸𝘦𝘳 𝘪𝘮𝘱𝘢𝘤𝘵 𝘦𝘹𝘦𝘳𝘤𝘪𝘴𝘦 𝘺𝘰𝘶’𝘥 𝘭𝘪𝘬𝘦 𝘵𝘰 𝘵𝘳𝘺 𝘪𝘯𝘴𝘵𝘦𝘢𝘥?’
The message is the same, but the tone is completely different.
It shifts the conversation from control to collaboration - you’re presenting choices, not convincing them to do what you want.
Which is exactly how I’d gotten past my old habit of under-referring.
When I finally recognised the issue made a conscious shift.
Not to start “selling” massage, but to start mentioning it - openly, neutrally, and early on.
These days, I’ll probably recommend massage to 20–30% of patients at some point in their care.
Of course, not all of them take it up - and that’s totally fine.
My goal isn’t to get them to book - it’s simply to make sure they know it’s available and could help.
I’ll usually phrase it like this:
“𝘋𝘰𝘸𝘯 𝘵𝘩𝘦 𝘭𝘪𝘯𝘦, 𝘰𝘯𝘦 𝘵𝘩𝘪𝘯𝘨 𝘐 𝘵𝘩𝘪𝘯𝘬 𝘤𝘰𝘶𝘭𝘥 𝘳𝘦𝘢𝘭𝘭𝘺 𝘴𝘶𝘱𝘱𝘰𝘳𝘵 𝘸𝘩𝘢𝘵 𝘸𝘦’𝘳𝘦 𝘥𝘰𝘪𝘯𝘨 𝘩𝘦𝘳𝘦 𝘢𝘯𝘥 𝘩𝘦𝘭𝘱 𝘺𝘰𝘶 𝘨𝘦𝘵 𝘵𝘩𝘦 𝘣𝘦𝘴𝘵 𝘳𝘦𝘴𝘶𝘭𝘵𝘴 𝘪𝘴 𝘴𝘰𝘮𝘦 𝘮𝘢𝘴𝘴𝘢𝘨𝘦 𝘴𝘦𝘴𝘴𝘪𝘰𝘯𝘴. 𝘋𝘰 𝘺𝘰𝘶 𝘩𝘢𝘷𝘦 𝘢𝘯𝘺 𝘵𝘩𝘰𝘶𝘨𝘩𝘵𝘴 𝘰𝘯 𝘵𝘩𝘢𝘵?”
If they’re open to it, great - we can either book them in, or plan to incorporate it a few weeks down the line.
If they’re not sure, I just respond, “𝘕𝘰 𝘱𝘳𝘰𝘣𝘭𝘦𝘮. 𝘐𝘵’𝘴 𝘢𝘯 𝘰𝘱𝘵𝘪𝘰𝘯 𝘰𝘯 𝘵𝘩𝘦 𝘵𝘢𝘣𝘭𝘦, 𝘢𝘯𝘥 𝘸𝘦 𝘤𝘢𝘯 𝘳𝘦𝘷𝘪𝘴𝘪𝘵 𝘪𝘵 𝘭𝘢𝘵𝘦𝘳 𝘪𝘧 𝘺𝘰𝘶’𝘥 𝘭𝘪𝘬𝘦.”
It’s a happy middle ground, and also gives them time to think about it without feeling they need to decide right away.
Not directive, not detached — just clear.
It’s the same principle I shared with my associate: our job isn’t to hand out permission, or take things away from patients.
It’s more about helping them “map out the terrain”, so they can choose their own route with confidence.
And that, I think, is where collaboration often gets misunderstood.
Being patient-centred obviously doesn’t mean being pushy - but neither does it mean stepping back and abdicating responsibility.
It means showing up fully, sharing what you know, offering the options… and making sure the patient doesn’t have to do the detective work themselves.
Then once they’ve made the choice that’s right for them, giving them the best possible version of that choice.
That feeling in my gut all those years ago was guilt, in a way - the kind that comes when you realise you’ve held something back that could have helped.
In hindsight, the only reason I hadn’t mentioned it was that I was more worried about how it might look than whether it was in the patient’s best interest.
Not out of neglect, but out of fear - fear of being misunderstood.
Once I named it, it stopped being uncomfortable and started being useful.
Because if it shows up again in a new situation, I know it’s a signal:
There’s probably an option I haven’t put on the table yet.
So if a patient ever asks you for something you already believed could help, don’t feel bad - get curious.
What stopped you from offering it first?
P.S. In case you missed it in Tuesday’s email, I’ll be taking the next few weeks off whilst my daughter recovers from her surgery.
I’ll be scheduling some of my most popular emails over the past few years to go out during that time though, so you won’t be missing out ;)
