In the previous post I had hoped to serve you by discussing some basic information and perspectives on the Interosseous Membranes. This section will be a discussion on having a genuine interest in your patient and their complaint(s).

Over my 18yrs as a manual therapist, I’ve found that Patients are not thoroughly investigated either with various types of testing or questions into their past from medical practitioners. Quick assumptions are made, quick treatment plans are implemented and the result is the same… if the patient is not “cured” within a specific short period of time, then it’s the patients fault.

I’ve heard various medical practitioners say, “I had these 2 patients that were the same…” This is completely impossible. No two patients are the same ever, nor is the same patient the same from one day to the next. Once a change has been made to a tissue, it responds differently. I’ve found that having a general “interest” in the patient is lacking in these situations.

Too often I have students ask what is the correct or best sequence of questions, which questions should come before others, which questions should I ask? There are many books that offer sample history questions and having had a good look at a few, it can be quite overwhelming thinking or strategizing which and when to ask these. There are literally hundreds to choose from. So what to do?

Have Empathy, be Caring & be Genuinely Interest!

With most patients I’ve treated, they have never had anyone be completely interested in their past. You must allow the time to attempt to get to the source of their complaint. This most likely will not happen within the first treatment so remove that stress from your expectations.

Typically I allow 60mins for an initial appointment and 20-40mins of this time may be utilized as assessment time. The skill of being calm, quiet, taking your time and being thorough is a lost art in the medical community.

Initially, I sit and listen attentively making NO notes! You can honestly do one thing well at a time, attempting to make notes, listening to the patient, processing the info coming to you, planning your assessment, planning a hypothesis to their pain, planning a possible treatment plan and visually assessing them with out them knowing all at the same time makes you less likely to listen and hear what they are saying.

You need to listen to your patient so that you are able to help them. When you do this patients will value you more.

Many times patients have been through the referral circuit. They’ve been told different things from different practitioners, and are continually not getting better or are not healing ineffectively from their injury/ condition. They can feel uncertain, unsure, lack confidence, may be feeling confused and possibly emotionally not as stabile as normal. They usually feel lost and are not sure what to do.

Be Present

Life these days is very busy for all of us. There are always outside influences that have the ability to make it into your treatment room and become large distractions. If you allow distractions to become a primary focus in your sessions, you wont hear a word or any of the clues your patients are telling you concerning their complaints.

Shut off your cell phone, get off facebook, shut down twitter, stop searching for more linkedin connections, texting will still be there when you are done your day. The world will go on if you are not online somewhere, somehow for a little while.

I find one of the biggest gifts I can give someone coming to me either for advice or treatment is my complete undivided attention and presence! Really be there and connect with them! Presence is everything to a patient.

Acknowledge and Appreciate Their Emotional Reality.

When a patient is really upset about their condition, injury, accident, work, husband, wife, kids, crappy day… don’t tell them how to feel. Listen quietly and acknowledge how they are feeling. Don’t discount it. Don’t try to transform their emotions.

We are not educated in being clinical councillors/psychologists, and for the most part many times this is far from being within our scope of practice, but often we are asked for our advice or for help. I make it clear to the patient that I am not asking questions as a therapist and that it is far outside my scope, but that I am human and want to help them as best I can during that time.

Attempt to ask intelligent clarifying questions. Don’t ask questions that help you understand their situation. Ask questions that help them understand their own situation better. It’s not about you the manual therapist, it’s about them! Help them talk through it more. Ask questions to elicit their own perspective rather than arbitrarily giving yours.

Perspective

Most times when patients ask for help or assistance in figuring out something that’s troubling them, really don’t want “the answer!” What they really want is perspective. They want to know more about what their choices and options are to choose from. This is where you can use your experience from what you’ve gone through in your life, what others (patients, family members, friends) have gone through, share a story about someone else who has possibly been in a similar situation that may help them feel less alone and more connected. Help them synthesize the information and allow them an opportunity to discover the answer in their own way.

Help them to feel more secure so that they can regain the ability to be able to handle the situation or problem. Ensure that they leave knowing that they are capable of figuring it out.

What’s the Primary Focus Today?

Try to compartmentalize their complaints to their top 2-3. Ask them which one is their primary concern for the day. You may have an idea of what you would like to focus on, but you are not the one with the complaints. Now that you have the primary area determined, start making some notes and repeating what your patient has stated. Start with the present and work your way back in time to even before the injury occurred. You’d be surprised at how injuries suffered as a child play a role in the complaint. Remember to be genuinely interested!

I will use an MVA patient for the example of what I normally ask. These can get quite in depth, but we’ll keep it somewhat simple for now.

Female patient complaining of cervical spine pain and headaches 8 weeks post MVA.

In my office I actually have a 2-page questionnaire I make my patients take home. They are to fill this out in a quiet place where they can think thoroughly about the incident. Below is a sample of some questions I ask during the initial interview.

First I want to know if this is the first MVA she has been involved in or are there previous MVA’s, If there are previous MVA’s, I will ask the same questions below for each MVA. Any previous injuries to the areas of complaint I ask about thoroughly also.

Typically I ask about time of day, year, weather, type of vehicle she was in, standard or automatic transmission, type of tyres on the vehicle – all-season, all-weather, summer, winter, bald, type of vehicle that hit her, where is the damage to her vehicle, any other objects that were involved in the MVA – poles, barriers, buildings objects within the vehicle cabin that have the potential to fly around on impact etc…

Once I have a general idea of the MVA process, I want to know about her position in the vehicle; driver, passenger – front/rear, if rear – right or left, seat belted or not, lap belt and or shoulder belt, was she aware the MVA was about to occur, did she brace for impact – if so how – both feet, both arms, or one of each, if no bracing then where were her extremities placed, Which direction was she looking in, what else besides driving was she doing while in the vehicle, was there anyone else with her. Does she regularly wear make-up and if so does she remember having make-up on the window or steering wheel etc…

I never ask a patient to describe their pain. Asking for pain descriptions, implies to the patient that what they are feeling is pain. It might not be pain. I simply ask “What are you feeling?” Depending on what they answer with, directs my questions. Ache, tension, pain, sharp, shooting, referred, dull, burning, direction the feeling travels – up or down, twisted, stretched, loss of AROM, temperature changes and many more description’s are common to hear during interviews.

After history questions are completed for this treatment session, the Orthopeadic assessment section starts. I discussed my thoughts on Orthopeadic Testing in a previous article, please give it a read. I typically restrict my Ortho assessment to the 1-3 areas we chose to focus on at the beginning of the session. Remember that the whole point of an ortho assessment is to cause pain! We want to recreate this complaints and be as specific as possible in doing so.

Informing and educating the patient, providing reassurance that you acknowledge and anticipated their discomfort during the assessment, goes a long way to ensuring not only that the patient returns, but that the feel you have a genuine interest and concern for their health care.

Develop your Perceptive Touch

Perceptive touch is a form of palpation one might call an alert, observational type of awareness for the functions and dysfunctions from within the patient. A perceptive touch is essential because there are subtleties of tissue functioning and dysfunctioning that cannot be explored by any other means than that of a skilled, sensitive, knowing sense of awareness through the use of this type of touch. We bring all of the senses together to more deeply perceive and understand the information available to us.

Divided Attention

It takes time and hundreds of hours to get to a point where you can be still, be quiet in your mind, focus, see the physiology not only where you are but also systemically. Part of developing a Perceptive touch also includes developing a divided Attention. Being able to perceive information in one area and yet be able to see the connection systemically is a constant challenge and priceless skill.

For now, my challenge to you is to be present, slow down, stay calm, and focus on the information coming from the patient. Be thorough and most importantly be genuinely interested in your patient.

Conclusion

As always, I hope that I have been able to serve you in some way with this information, be it a completely new perspective into your patients, be it some new thoughts about how to approach a treatment or provide you with a review and acknowledgement that what you are doing, as far as I’m concerned, is having an amazingly positive impact in improving the quality of life for your patients.