“Did you fall on your elbows?” The nurse practitioner asked me as she did a quick visual scan of my appearance at my employee occupational health visit.

Did she mean any harm by saying this? No, of course not. Does it make me feel a little awkward? Yes, definitely.

“No, it’s actually from a rare disease I have,” I explained back.

Her pause and stare made it clear she didn’t know how to respond after.

“Oh, okay, well then I can mark you down as having something congenital. But you’re still doing really well in this screen.”

Well that’s a relief, because for a moment there it seemed maybe the appearance of my odd-looking elbows could have made the functional health screen head in a different direction. Or maybe not. But what am I to think now?

As both a physical therapist and a human who has a rare disease, I experience both sides of this awkward situation. Ya know, when you say something that you didn’t mean to be harmful but maybe it came off that way…

How could we have worded this better: “Did you fall on your elbows?” –? To some this may make the conversation get ugly – “Well why did you point that out?” Or others, it may make them feel embarrassed and not want to confide or give you all of their health information.

First off – is it even important in this functional occupational health screen? It wasn’t noticed until after I already performed an upper body gross screen with manual muscle testing – all with flying colors. It wasn’t until after as we were chatting some more that this was noticed. Do we need more training in these functional screens? More education? It’s possible.

Maybe she felt really comfortable with me, I always think I’m fairly easy to get along with and talk to. Maybe she thought I left out an injury on my form. Maybe she was just curious.

I’m not sure – but again, the muscle strength was already there AND the (minimal) decreases in my range of motion were not noticed until I pointed them out.

You see, with a rare disease, deformity, illness – anything that isn’t super common, the patient generally has to do more of the explaining to the practitioner. I pointed out that I did not fall on my elbows, but since I have Nail Patella Syndrome, I did indeed have large radial heads which also limit full elbow extension and forearm supination. Again, was this noticed during the upper body screen? Nope. It never has been. Or if it has been, nobody has ever said anything.

So where is that fine line? How do you politely and appropriately ask someone about something that seems peculiar/abnormal without offending them and without asking about more than you need to know.

I don’t have answers here, this is more just a reminder to watch what you say and process what you are saying to patients before you do. Luckily for me, I am not offended easily and am open to conversation, but I can’t say the same for all the others with rare genetic deformities.

And with that being said, of course there are clinicians and people in general out there who are still not as mindful of these things. Those who think that one way is the only way and that in order to perform at your optimal level – you must be “perfect” – with that “perfect” range of motion, “perfect” form. Newsflash y’all – everyone and every body is different. Our bodies are made to perform the best they can with what we have.

Yes, certain improper forms may predispose people to injuries, especially when awkward repetitive actions or techniques are performed. But in your “abnormal” person with a deformity – how do you treat that? You make sure they are functional, right? Help them improve themselves to the best of their ability.

Someone asking me if I fell on my elbows does not upset me now, but as a child – whether it was people asking about my elbows, accusing me of being anorexic, making fun of my thumbnails, or heck – even pointing out my giant calf muscles (I know, who gets embarrassed about that..but I was a kid) – these things can hurt. And they can linger through life.

I’m not saying that I’m perfect with this. I know I still have patients where I try not to offend them but then something comes out and I realize I said it the wrong way. Just thinking of different ways to ask questions, getting to a patient’s eye level, speaking with the proper tone of voice, and showing caring gestures and welcoming body language can help – and I can’t stress the importance of it enough. Building relationships between patients and clinicians is a huge part and foundation in helping everyone thrive in this crazy healthcare world we have now.

Be compassionate, think before you speak. Don’t end that relationship before it even gets started. And hey, do yourself a favor and keep educating yourself, keep practicing, and don’t forget to forgive yourself if you make a mistake. 😉

If you’re interested in any other PT thoughts that I have, be sure to check out a few of my other blogs: The Generalist PT, Becoming an Acute Care PT, tips with Productivity in Acute Care, and the Struggles of being a Small PT. Or if you want to learn a little more about the rare disease I have – check out NPS and Knee Pain and NPS and Pregnancy.

And of course, be sure to join in with the GlobalPTConnect fun on Instagram to join PTs sharing their days around the world! Or just check out my time visiting an Outpatient Japanese Clinic and a Singapore Physical Therapy School. 😉

Until next time,

Jen