For some time, I believed that being a physiotherapist meant diagnosing a problem, generating a set of ‘SMART’ goals and prescribing the right combination of advice and exercises I expected patients to follow diligently. I considered myself to be the expert in the room with my role being to fix my patients’ problems. I was quickly disappointed. Like many physios, I often faced the frustration of patients not engaging in their rehab—despite clear explanations, what I considered to be thoughtful well-designed programmes, and my best efforts to educate them. I noticed some would make great progress, while others struggled to stay motivated or simply didn’t follow the advice they were given. I flitted between wanting to rescue my patients to feeling frustrated with what I perceived to be a lack of will or excuses getting in the way of their progress.
I was fortunate enough to attend a 2-day health coaching course which opened my eyes to the power of adopting a coaching approach within in my clinical practice. Rather than simply instructing patients, I started becoming more curious, asking more meaningful questions:
1) What matters most to you?
2) What would success look like for you?
3) What would that give you?
By flexing my approach and making subtle shifts away from a directive style of communicating to engaging in more of a collaborative conversation with patients, I noticed my practice began to transform. Instead of feeling like I had to push patients toward recovery, I was supporting them to pull themselves forward.
Why coaching skills are can be a game changer for physiotherapists:
1) Personalisation supports motivation – Patients don’t always connect exercise programmes and advice to their personal goals i.e. the things that matter most to them in their life. Coaching skills help us get under the bonnet and uncover their deeper ‘why’. “Do these exercises to strengthen your knee” is okay. But “tell me what you want to be able to do of as a result of treating your knee?” invites more depth into the conversation. “I want to be able run around with my grandchildren while they’re still young” – their rehab suddenly takes on some meaning.
2) Greater accountability and adherence – When patients take ownership of their recovery, concordance tends to follow. Instead of giving a one-size-fits-all program, we can work with patients to co-create solutions that fit their lifestyle, preferences and priorities – the key word being ‘their’. For example, rather than just prescribing three sets of an exercise to be completed daily and ending the conversation, we could ask “Where do you see yourself fitting this into your day?” “what might you need to consider?” “what will support you to keep going with this?” Small shifts like this can make a big difference in follow-through.
3) Reduced pressure on the physiotherapist – Many of us feel responsible for “fixing” patients, but adopting a coaching mindset can help us to reframe our role. We can become facilitators of change, not just experts delivering information. This shift has helped me feel far less frustrated and burnt out. I’m no longer battling resistance, I roll with it—I work with patients, not ‘on’ them. And if patients are not ready to change yet, that’s okay too.
4) Stronger therapeutic relationships and better outcomes – Patients feel heard and valued when we take time to listen rather than just instruct. Most of us think we are really good at listening – I know I did. But studies indicate our patients think we are only about half as good at listening as we think we are. As Dr Rangan Chatterji says “people don’t care how much you know until they know how much you care”. By deepening our listening skills and having more coaching based conversations, we build much deeper trust and rapport with our patients – this in turn leads to higher satisfaction and better outcomes. Instead of a transactional interaction (“Here’s your program, see you in four weeks”), it becomes a collaborative process that empowers patients to regain a sense of control and take more ownership of their recovery.
Physiotherapy is fundamentally about movement, but true progress starts with the mindset. We all want to see patients be able to shift their mindset and take more responsibility for their health, but maybe the starting place is looking at our own. Coaching isn’t for every conversation, and it isn’t a magic cure – If only behaviour change was that easy! But by adopting a coaching mindset and integrating coaching skills into our practice, we are much more likely to see improvements in patient engagement, clinical and patient reported outcomes, and greater professional fulfilment.
If you’re a physiotherapist struggling to get patients to engage in their rehab, a practical health coaching skills course could be the missing piece—helping you bridge the gap between knowledge and action. How ready are you to take the next step toward more engaged patients and a more rewarding practice?