The Question Diverter

[ebusch19]

I have been working with a patient for the past two months now who came in for low back and L hip pain that refers down to his knee. From the start it was difficult communicating with him and getting a straightforward answer from him when I asked him questions. He came in with moderate to high severity and irritability and is the type of person who will say “it’s fine I can handle the pain” when doing exercises. He also always comes in and says that I beat him up at the last visit even though I’m constantly trying to assess his response to treatment. I finally had him come in during mentoring time because I was struggling with him and felt like what I was doing was not helping him. After working together with him, AJ and I talked about the communication afterwards. Since it was difficult to get a straightforward answer from him, I would give up and move on since it could be exhausting at times. We talked about with someone like him, open ended questions won’t work and you have to be more direct, and ask follow-up questions to get the answer. For example, he mentioned during the session that he gets occasional N/T in his L foot which he never mentioned before. I asked him how long he has had that and his response was “I always thought it was my shoes”. Most sessions were like this whenever I asked a question which made it difficult for me to gauge if what I was doing was helping. We also talked about the importance of educating the patient on letting us know about their symptoms during and after treatment to help guide it.

Since that session and educating him, it has been a little easier to communicate to him and he has been better with telling me about his symptom response to treatment. It still is hard at times to get a straightforward answer, but I have learned to ask him more direct questions and follow-up with more questions to get an answer. I also have another patient who is similar to him, which I will be presenting on, and have been able to apply what I learned from this patient. It is more challenging working with patients like this and I’m sure I’ll get more patients like that. Communication has never been a strong suit of mine, and although I have improved a lot on it throughout my clinicals, it is something I still struggle with, especially with people like this.

Has anyone else ever worked with a patient like this before? How did you handle the communication?

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