In weather, a red flag warning is a signal to residents, firefighters and others that conditions have changed and there is a dangerous risk of fires that could quickly get out of hand. Winds are high and humidity is low, creating the perfect recipe for a wildfire.

In medicine, red flags are a signal to clinicians that a patient's condition has changed and there is a risk of a health issue that could get out of hand. The patient has symptoms and unusual occurrences, ingredients of a potential health crisis.

Sometimes, red flag signals are easy to recognize, but not always. That's when the clinician's observation and listening skills become medical tools. Seeing a wince or listening for an off-hand remark or question can be as important as lab results or vital signs.

When Fred came to Floyd Physical Therapy & Rehab following joint replacement surgery, he was assigned to physical therapist Clay McCollum. The two had worked together before, after a previous surgery. When they reconnected, it was a little like two old friends getting together again. With trust already established, it was easy for Fred to talk about his life, his aches and his pains.

One day, about five weeks into his therapy, Fred asked Clay for some time to talk about some pain he had been having. The pain got worse in the evening, and it couldn't be explained away by diet or activity. His symptoms were not related to his surgeries or the exercises Clay had given him to do.

Pain that gets worse in the evening and is unrelated to a current medical status is a red flag, and Clay knew he needed to act.

Clay did his best to reassure Fred, telling him that, while his symptoms could point to something simple and easily addressed, he should see his doctor. Fred didn't follow through.

The next time he came for therapy, Fred's pain had intensified, and he had developed nausea. He had not seen his doctor, but he was concerned enough to again ask Clay about them. This time, Clay was more insistent, telling Fred he had to see his doctor. Recognizing that he might require more incentive, Clay pulled out a little-used weapon to drive home his point: He told his patient that he would be forced to tell his wife about his symptoms if he didn't go see his doctor.

Fred made the appointment, and the news was not good. He has late-stage cancer, and he is seeking treatment.

Clay listened to his patient. He developed a relationship built on trust. He used his best judgment, and he took action. While it is true that the relationships he forms with his patients give Clay the permission to speak into their lives, it also is true that people tend not to speak if they know they are not being heard.

A therapist's toolkit is broad. It covers everything from free weights and elastic bands to high-tech devices that measure gait and balance, but none of those tools is as important as a listening ear, a respectful relationship, a willingness to speak up and an understanding of human nature.​