Practitioner Seed #1 – Listen to your Patient!

As you mature as a clinician, you can form a fairly accurate diagnosis from the subjective alone.

However……..

When you graduate, it seems as though you must rote learn the subjective interview questions!

Yet you are still none the wiser on what is actually happening with the person in front of you.

Your pattern recognition system is like a 1980’s typewriter!

 

When you are starting out, focusing on the questions you MUST ask detracts from your ability to listen.

Its hard to listen when you’re speaking!

So, to counteract this, Let your initial question be open -ended.

For example:

“What brings you here today”, or “Tell me your story”.

When a patient has the opportunity to pour everything out, they will give you the most important parts of their injury experience.

Your ability to sit and listen attentively is paramount.

Non-verbal gestures are a key ingredient to effectively building rapport. Maintaining eye contact, an open posture & nodding to indicate that you understand their situation, will all be very useful.

To this day, I find myself writing notes as the patient is talking – Sure its a hard habit to kick! But giving your patient the first 5min of the consult whereby you offer your full undevoted attention, will set the scene for a strong early connection.

But what if the patient in front of you is quite reserved? Not willing to give up information easily. They are a closed book & you get one word answers if that!

This type of patient is very common, holding a belief system that you are the ‘fixer’ and they are there to get ‘fixed’.

They hold full confidence that you will be able to weave magic and fix their problems, when they turn up at your clinic!

In this instance, you might have to probe a little:

How does your injury affect (Insert life activity)? What do you think is happening with (insert injury)?

Motivational interviewing is a technique that would be appropriate to use here.

Motivational Interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change.

This method involves leading the uncertain patient toward forming their own conclusion.

It requires the following qualities:

• Affirming the patients opinion/ position.
• Summarising & reflecting on the key points raised.
• Compassion toward the patients situation.
• Collaboration & empowerment in forming a management plan.

This technique can be time consuming, and might mean that the entire 40 min initial consultation is enveloped by conversation.

It’s important to understand your time restrictions, and ensure that you provide some ‘patient perceived value’ in your consultation – whether that be a burst of manual therapy & some exercises, that improves symptoms and increases patient buy in.

There are many times that patients have presented having seen an external clinician and report that,

All the clinician did was talk at me!

Therefore it’s critical to find that balance in the early stages – The best way to do this is to LISTEN to your patient to decipher their expectations from the session.

What do you hope to achieve from today’s session?

Should be a common subjective closing questions in your tool belt if they haven’t already  given you this!

 

Technology is a beautiful thing!

Let your practice management software list your subjective assessment out for you in a template.

Go back to this at the end of the subjective, when the “well is dry” from your patient volunteering information.

You can ensure that you haven’t missed any of the important questions regarding red flags.

Good luck with perfecting your subjective history taking!

 

Reference

• https://www.physio-pedia.com/Motivational_Interviewing
• Rollnick S, Miller WR. What is Motivational interviewing? Behavioural and Cognitive Psychotherapy. 1995 Oct;23(04):325.