PVA deep dive Part 2: How to structure your first three pelvic health consults: To make sure patients come back
In Part 1, we looked at why patient visit average (PVA) is a clinical signal, not just a business number - and why front-loading patients with information in session one quietly erodes the perceived value that keeps them coming back. So what should those early sessions actually look like?
Session one: gathering information, not handing it over
Session one is about gathering information, not giving it. It should be the session where you get everything you need to understand the patient - their history, their goals, their context - and, if it fits, move into assessment. That qualifier matters: it has to align with what the patient wants, so always ask them directly what they’re hoping to get out of treatment rather than assuming you know.
If you do move into assessment, your subjective needs to do real work first - enough to be confident the exam is safe, enough to confirm it’s the exam the patient actually wants, and enough to rule out red flags (a post-void residual check or a urine dipstick, depending on presentation).
If a pelvic floor exercise program comes out of the session, the patient needs to practice it in full, in the room, before they leave - then sit back down and talk through adherence properly. The biggest reasons pelvic floor exercises don’t happen come down to a mix of motivation and the barriers patients run into once they’re back in their own lives. Map those out with them, work out a realistic time of day, and be upfront that there’s a real chance they won’t keep it up perfectly - that’s normal, and it’s exactly why they need to come back and talk about it rather than quietly drop off.
So, in full: session one is subjective assessment, some objective assessment if appropriate, and at most one to two clear, achievable takeaways. Nothing else stacked on top.
Session two: putting it all together
Session two isn’t a new assessment - it’s where you bring together everything from session one and hand it back to the patient as a coherent picture. This is where a clinical reasoning model earns its place, particularly a pelvic health clinical reasoning model: how many aspects of their presentation are in play, what further assessment might be needed, and what the realistic treatment pathways look like. This session sets the scene for everything that follows, so the patient understands the shape of their own care rather than receiving instructions one visit at a time.
Sessions three and four: build, don’t dump
Sessions three and four are where you build on that foundation - continuing the pelvic floor program and introducing the next piece the patient can act on. This is often the point where something like bowel issues gets properly addressed for the first time, once you actually understand why it’s happening, rather than being reached for as a quick fix in session one.
In Part 3, we’ll look at why three or four sessions isn’t actually enough to see this through - and what to do with that insight if it’s showing up in your own PVA.