I recently put out a message on our Facebook and Twitter pages asking what things followers of this blog would like to see or hear more of? One of the responses was about subjective questions or objective tests that I preferred. That got me thinking about some of the things we tend to say to our patients, with or without realizing it. So, I’ll list out some of the things I try to keep in mind when speaking with patients.
During the initial evaluation and the subjective/history/interview (whatever you want to call it), I try to say something like “How can we help you?” This question lets the patient know you are there to help them and it gives them some freedom to tell their story and want they want help with the most. Obviously, you as the clinican are still in charge of this process and have to direct them where necessary, but I like this as a good starting off point. Think of it as an easy ice-breaker into the conversation you’re about to have. After you have gained the information you need and the patient is satisfied with what they want to tell you, I usually say something like “Is there anything else we haven’t mentioned that you think we need to discuss or talk about regarding why you’re here?” That way, it again gives them a chance to bring up anything they feel is important to them. It also helps myself in the case that I forgot to bring up something important to their case. Lastly, it shows the patient that you are genuinely interested in learning as much as you can about them and what the two of you can do together to help them the most.
During objective testing, there is one big point I want to make that has been impressed upon me during training with one of my mentors. That is, when you are doing objective tests and want to know how a particular movement, over-pressure, stress test, manual muscle test, etc. affected their pain… DO NOT ask them “does/did that hurt?” For most of our patients coming in with chronic pain, of course it hurts! Almost everything hurts! The most important thing to ask instead is “does/did that change your pain (or symptoms)?” You really have to keep some patients on task with this question because they may want to qualify their answer and go off on some tangent. Be a stickler here and make sure they commit to either a “yes” or “no” response. Next, ask them HOW their pain/symptoms are different. Is it better or worse… if so, in what way? That way, you can genuinely gain a better understanding for how their pain/symptoms respond to different objective measures/tests. I know it seems ridiculous that I’m mentioning such a thing, but this is really key, and a mistake that I see lots of students and inexperienced therapists make on a routine basis.
At the end of this initial encounter, I try to mention to the patient something positive based on what we’ve seen so far and say so. Usually it is something like “I really think we can help you” or “we can help you get back to _________ much better than what you’re doing now” or “if you can put in the work, we can help you get better”. Statements like these are meant to again give the patient hope that they can get better, that you DO care about them getting better, and that you have confidence in your own abilities to get the job done. I don’t overstate the facts though. I don’t give someone false hope if their prognosis is not such as mentioned above. However, for the overwhelming majority of our patients, we CAN help them and get them better… no matter what our skill levels are. If nothing else, placebo can be a powerful thing for patients sometimes!
Those are some of my suggestions. This is one area that we could ALL get better at, so I would certainly like to hear your thoughts. Please share with all of us and comment on this blog post below!