[Mauzyjm]

Hey Everyone! Sorry, I’m a bit late…life is a bit crazy right now and balance is…difficult.

However, I am extremely glad that this weekend series has placed such an importance on the subjective exam from all aspects of biopsychosocial driven care, as I have fortunately been taught in school, and definitely come to find out in practice, that a first patient interaction definitely sets the tone for the plan of care and, sometimes, make or break a case.

In regard to that, I felt Wodsford’s “On Opening A Clinical Encounter” and the Chester et al article referenced was interesting. Like Dave, I read Chester questions and I was like “Pretty much all of these questions are really awkward…Idk if I’d use any of them as an opening line”. They seemingly came off oddly worded, abrupt, or(to me) could give a patient the impression the PT didn’t really note any of the potential intake forms or referrals they were given. However, it does re-enforce that patients favor open ended questions that allow them to share their experience/perspective with minimal to no interruption. My experience being primarily rooted in pediatric sports med, I find many of my kids come into the evals nervous/anxious/don’t want to be in PT and almost all have never been to formal PT before. So, I tend to break the ice focusing my first 2-3 minutes on LEARNING ABOUT THEM. Where do they go to school, what sports/hobbies do they have, brothers/sisters, pets, fun facts, yada yada. 1) It puts them at ease, 2) You can gather a great deal of contextual data, living situation/support system information, and learn about the patient’s general personality even prior to them talking about the injury, MOI, or SINSS 3) It shows you care about them as humans versus the body part they are here for. Then, sort of like the winning question “Do you want to tell me your story?” I usually will usually say something along the lines of “I’ve read your intake forms/docs referral/etc, but, when you’re ready, I want to hear about exactly what happened and what’s going on from your perspective/view…” and then, like O’Sullivan, I SHUT UP until there’s an awkward silence:) By doing that, they usually tell you so much of the info need to know and helps your funneling questions be much more direct and efficient. Some kids/parents need a little guidance or encouragement if they don’t talk, but I’ve found that they can give you quite a bit of info with 3-5 minutes of uninterrupted talking :) So, tbh, this kind of just further pushed me to keep doing what I’m doing. I will admit I am someone that usually writes quite a bit while the subjective is being given; so, I do admit that I could be better about solely listening and maybe reflectively responding to better help me summarize the situation, help it stick in my head, and reassure the patient I’m fully present.

I think Dave and Sarah have covered O’Keefe and Louw articles really well (kudos, you two!). So, I’m going in a slightly different direction for the second and clinical case reflection aspect of my response and do so with the Rossettini article. Nerding out a little, I actually found the approach this article took to be quite fascinating. Noting the ubiquitous quality of pain and macro level concerns of the PT-patient interaction and session as well as the micro neurobiology/physiology of parts of the brain/pathways/chemicals are influenced by these interactions…just so cool. While this article has quite a number of takeaways/clinical pearls, I think the BIGGEST one that I could pull was outcomes of MSK Tx were heavily due to patient’s perspective of expectation toward PT, TX history, and baseline pain severity and that our behavior, beliefs, verbal suggestions, and therapeutic touch influence the patient’s perspective. So, we need to be fully aware of who our patient is, what experiences they’ve had, and utilize their goals/experiences/and perceptions in a way that guides our treatment to empower them in a personable and empathetic way…and provide ethically sound evidence based education starting at eval that benefits them vs placebo/nocebo your way to gain the outcomes you want. Clinically, I had a patient that came in with 2-3 years of persistent pain for a condition that shouldn’t have that persistence…further exacerbated by out of clinic contextual factors within her sport, internal pressure to perform, and self-doubt. So, as I’ve approached her care, I’ve made sure that my behavior meets her where she is, reflecting my beliefs and rationale behind my treatments to both her and her mother each session, and provide reassurance so I knew that I would establish the most beneficial and empowering setting I could. Her GAD-7 scores were also slightly concerning, so plug for referring to mental health professionals to further enhance the patient’s ability to handle and perceive out of clinic contextual factors too.

Hopefully that wasn’t too long. Apologies, not quite sure how these work quite yet haha :) Have a great night!

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