Erik,
I think that the subjective is more important than the objective in the first visit. You can always continue to test and check different objective measures, but you only have one opportunity to make a first impression to begin the rapport process with your patient. I would actually argue that the objective aspect is the least important aspect of the initial eval. Sometimes I find myself rushing through my assessment, education, and prognosis with the patient because I spent all of my time on the objective. I am trying to make a conscious effort to stop doing this, because I think the most important things to do in the initial eval are:
1. Build rapport with the patient by showing that you care and listening
2. Reassuring the patient that they are going to be okay
3. Providing them with brief education about what you think is going on and how PT, and their participation in PT, can help their problem.
Many times my opening line which is “what brings you to physical therapy today?” seems to backfire quickly, with the patient immediately spewing off a poorly understood but highly detailed and anatomically-driven reason why they are in pain. I have the same dilemma in my mind as Erik does. Do I interrupt the patient because I don’t want to validate their false understanding of pain? Or do I let the narrative continue and gather my information on their understanding of pain, to therefore educate them later? I think there is a middle-ground somewhere, but I’m leaning towards the latter. When it gets out of hand and the patient goes on and on and doesn’t stop, I’ll sometimes (gently) interrupt and mention that I have access to their images, so I can look at that later, but I would like to know more about their experiences and pain from their perspective. This seems to work well, because then the patient knows I will look at their image findings (I don’t always look) but then allows them to begin actually telling their story. My hope is that it gives them validation that I care about them as a person more-so than their MRI.
Something that surprised me was the stark contrast between how long the average time is until a PT interrupts their patient (23 sec) vs how long the patient will usually talk for if interrupted (92 sec). That is a huge difference! After reading that, I thought about how long I wait before interrupting my patient, and I honestly don’t know the answer (maybe AJ can tell you). I hope I wait more than 23 sec, but I definitely don’t wait over 1.5 min. The blog post seemed to allude that not interrupting the patient was the correct way to approach the subjective interview, but I wonder if there is any evidence beyond expert-opinion to confirm this? I don’t even know how they would test for that, but its an interesting thought for me.
The blog post stated that the most commonly used opening phrase was ‘Do you want to just tell me a little bit about your problem first of all?’ Does anyone else think this is strangely worded and too passive? After reading all of the opening lines in the picture, the one that I liked the best was “how can I help you today?” It doesn’t pigeon hole a specific body region, its open-ended, but also direct. Does anyone else have a different opinion? I’m also curious as to what your guys’ opening lines are?