Connecting with your patient population in the industrial setting

By: Susan Taah, ATC, LAT, CEIS

One of my first industrial athletic training injuries wasn’t anything too gory or complex. A steel belt cutter showed up at the on-site clinic with his supervisor who explained that he had reported an injury. I went ahead and let him get settled in then asked him what had happened.

The sentences that came out of his mouth next might as well have been Greek.

I politely let him finish speaking, then asked him to repeat himself. Between his heavy South Arkansan accent, and the terms he was throwing at me, I was still lost.

“Sorry, tell me one more time,” I asked sheepishly as I tried to jot something on the blank page of my pocket notebook. As the flustered employee repeated himself for the third time, I managed to understand that he had sustained an injury to his right thigh the day before while doing something I had no clue about and when he woke up this morning something happened with his stove and it hasn’t gotten better during today’s shift. I turned to his supervisor who was present and asked, “What’s the part about the stove?” The supervisor explained that he had said, “stoved up,” which meant he woke up stiff and sore.

Talk about a culture shock. I had him point out to me the point of his discomfort and we went through a complete lower leg evaluation where I determined that we were dealing with a low-grade medial quad strain. I spent the next 5 minutes using the diagrams and models in my office to explain to him as best I could the nature of his injury. I showed him what would hurt and what would feel better as he nodded along in agreement. Then I walked through my plan with him, taped him up, gave him a dose of Ibuprofen, told him I’d be by to check on him and off he went back out to the floor to keep working.

As I wrote up my visit notes, I wondered what on earth I had gotten myself into. I had an extreme level of distance between myself and my patient population.

So, I grabbed my mobile kit, threw on my PPE and headed out to my patient’s workstation on the factory floor. As I approached him, I took note of his workstation and how he was moving. He reported that he felt a bit better over the past 45 minutes and the tape was not bothering him. I asked if he could show me how he injured himself.

Not only did I learn about the task he injured himself doing, I spent the next 2 hours learning all about steel belt cutting and what his job entailed. I watched him cut at least 600 yards of belts while we talked, learned common faults and jams, damaged belts, and more. He also explained that the machine belt station across from us had an issue with the wheel break that slowed down his productivity.

I showed him some modifications he could make while he was healing to avoid unnecessary strain on his leg. His injury resolved 2-3 weeks later and he never had any other injuries besides small cuts for the rest of the years I worked there, but his face would light up any time I’d come around to catch up with him.

For a lot of athletic trainers, building relationships with traditional athletes comes easy because many of us were (or are) athletes ourselves. We draw upon our own experiences of brutal practices, a disappointing loss, parental expectations, game day jitters, and more to meet our athletes where they are with empathy and support. But how many of us have worked in oil fields or driven tractor trailers? As new opportunities grow for athletic trainers, it is critical that we are able to transfer our soft skills to all athletes to ensure we are delivering the highest level of care possible. If you ever felt like your time with your industrial team wasn’t as “natural” as with traditional teams that you have had experience with, don’t worry, that’s totally normal unless you were a carpenter before becoming an athletic trainer (yes, I do know a carpenter turned industrial athletic trainer).

There are two main factors to help you gauge where you are with an employee in your care and what you can do to build a better bond.

Trust: Trust is a HUGE factor in all of healthcare, no more so than in athletic training where there is a window in which most of our skills are best applied and our patients can choose not to bring their injury until that window has passed and they need a doctor to operate, prescribe medications, or order additional diagnostics. Carpal tunnel, lateral epicondylitis, plantar fasciitis, etc., these syndromes usually present with warning signs first and the course can be reversed with education. If your patient population doesn’t trust you, they’ll wait until it’s until it’s so bad that seeing a doctor is their only recourse.

So how do you build trust with a 52-year-old who has been building tires since he was 18?

An easy way is to take interest in what they do for a living. How much would football players trust an athletic trainer who didn’t know any of the positions or how to score a touchdown? You should learn everything about your industrial setting and the jobs that exist there because patients don’t bring up issues to people who won’t know what they’re talking about.

Once you have the basics, ask questions. A 52-year-old will gladly explain to you the job he’s been doing for 34 years. You will know how it operated when he started compared to how it operates now, and why the new way totally sucks. I can tell you which powder compounds in my facility needed oil because without it, they would cover a mixer operator from head to toe in dust. I know which machines would jam and why, which rubber stocks were total garbage to work with, and more. When you see an employee doing something you’ve never seen before, stop and ask if you can watch. That’s how you get to see a laser eye installed, or a forklift repaired.

Ask questions about them; children, spouses, parents, hobbies, and side hustles. If you can do so without interrupting their tasks, spending time standing or sitting with with your patient population will build trust you can’t get any other way. If they are hesitant to talk about themselves, tell them about yourself. My employees knew a lot about my own work life, my travel adventures and my volunteer work.

Health literacy: The first domain of athletic training calls on us to prevent injuries among our patient population and promote health and wellness. Tools like annual physicals make knowledge of health status easier for traditional athletes but in the industrial setting it is not uncommon to encounter an employee who hasn’t seen a healthcare provider in over a decade. Not only are many of these employees unaware of healthy norms and their own numbers, but they also don’t understand the need to know and may carry an overall distrust of the healthcare system.

A big portion of athletic training is being able to educate your patient population about WHY their wellness matters. Once you do that, you will be able to capture their attention when they are unwell. Due to the diversity of the industrial population, you should have a good understanding of general medical conditions in your toolbox. Be able to educate your population about hypertension, diabetes, gout, and other common comorbidities. Get comfortable recognizing common dermatologic conditions and seasonal illnesses. You should also be up to date on the signs and symptoms of cancers, autoimmune disorders, and other serious illnesses. Encourage your employees to have a good relationship with their primary care physician and get an annual checkup. Discuss with your employees the medications they are taking and the need for them to know the names and dosages of those medications.

Now that we’ve discussed these two factors, let’s discuss how we can use them to adjust our practice.

Picture these factors on a graph with trust as the Y axis, and health literacy as the X axis.

In Quadrant I we have employees with positive trust and positive health literacy. They bring issues your way & trust in your opinion, experience, and advice. They believe that you know who they are and that you care about their wellbeing. You don’t have much work to do with these employees except to maintain consistency, and seek them out even if they don’t have any medical complaints.

Quadrant II employees have positive trust, but negative health literacy. You have a good personal relationship with these individuals and they may even send other employees to you for help with health concerns, but they don’t take their own health seriously. With these employees you can draw on their personal lives to explain to them why their health matters. Do they have parents who depend on them? Kids they want to play with or have a catch with? A spouse who likes active beach vacations. Even things like fishing or hunting can be affected by illness or injury. Don’t threaten the trust you have established with these employees for a chance to say, “I told you so,” but capitalize on opportunities to educate them on health by proxy.

Quadrant III employees have negative trust and negative health literacy. These are the hardest employees to impact. They don’t trust you, don’t care what you have to say, and probably don’t even know what you do. It may seem best to just leave these individuals alone, but your best chance at moving these employees along the graph is to treat them just like everyone else. Say hello, ask how they are, ask about their work or family history. You may get grunts in response or a snide remark about how you don’t have a real job. Take it all in stride & remember every morsel of information you get from these individuals. Nothing will mean more to them than when you are asking about their daughter’s softball team when they sustain an injury 3 months later. Drop off any health education you do with them. Ask if they have any questions or if they understand the current information. If they say no and throw it in the trash, you still did your job. Bottom line, never ignore or be short with this side of your patient population. Your consistency and bright attitude will be a game-changer for them.

Quadrant IV employees have high health literacy and low trust. They likely don’t know what athletic trainers are, but they know that they don’t care much for them. When they bring an injury to you, they may have already have their own diagnosis about going on with them. They find it difficult to take your opinion at face value and may ask to just go straight to the doctor. These are my favorite employees to work with. Encourage them to see the positive impact you make on their peers and to talk with these employees when they have the chance. Always stay informed because these employees will test your knowledge against what they know. Trust your expertise, but be respectful about their perspective. Share interesting cases that you’ve been a part of with them. They will be surprised at the depth of your education and will begin to trust your skills. Lastly, when these employees need you in a medical capacity, always show up and show out. Positive experiences with you will slide these employees into Quadrant I with ease.

If your facility has or had an emergency response unit made of employee volunteers, those individuals are likely to be in category Quadrant IV. Sometimes they see us as competition even though our jobs are completely different. Collaborate with your emergency response team every chance you get. Share your healthcare knowledge with them and invite them to share their knowledge of the machines with you.

After I understood these concepts and how to adjust my approach to fit my employees, I always had a way to help, even if it was just as an accountability partner.

One January, I had a knock on my door. An industrial vehicle operator I waved to every day popped his head in asked if I had a moment. He explained to me that his doctor had told him he had hypertension and prescribed some medication. He had never taken medication before and knew his blood pressure was high because he had gained some weight over the years. He told me that he was sure he could get back down to normal without ever needing the medication and asked if I had any weight loss tips.

I explained to him the need for him to take the medication his doctor had prescribed. I gave him a handout on the long term effects of chronic hypertension and why getting that number down was the primary concern. Next, we created a game plan for him to lose weight and made a schedule for weekly blood pressure checks. For 8 months, we met every week to see how he was doing and review his progress. On the day we concluded his program his blood pressure was 108/66. We decided it was time for him to call up his doctor and make a plan to discontinue his hypertension meds. In less than a year, he was free from hypertension and had lost 56 pounds because he trusted his athletic trainer enough to ask a question. These are the moments we are rewarded with when we build trust and educate in every population that we meet.

Soft skills can seem overwhelming at first, but they are quite simple. This does not mean you should work to get every employee in your 400-person facility in Quadrant I, there’s only so much time in the day. But it does mean that you have a way to troubleshoot your relationships with your patient populations. When you’re not having the effect you want, look at trust and health literacy for the answer to 90% of your problems. It’s a winning formula that has led me to amazing and wonderful relationships with blue-collar workers from all ages, backgrounds, genders, and more.

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