3 Keys to Subjective Examination in Physical Therapy

Make sure you’re providing the patient care your clients deserve with the right tools by your side.

For physical therapists, the inclination is often to fixate on the physical aspects of our clinical practice. For example, diagnostic tests, manual therapy, and at-home therapeutic exercises.

Don’t get me wrong: these elements of physical therapy are crucial… in fact, they’re what largely define the field. However, one paramount element of the clinical process is often overlooked:

The power of subjective examination.

Dr. Ryan Haven from Physical Therapy Haven writes, “Your subjective interviewing skills are the first aspect of clinical practice that happens between you and your patient.”

Indeed, subjective examination provides the most direct insight into your patients’ history and needs. As Dr. Jim Heafner writes for TSPT, “A good clinician should obtain 85-90% of their information from the subjective history and initial interview.”

improving patient experience
Wait, woah…. That’s a lot of information!

Do you want to learn how to make the most of your subjective examination? If so, you’re in the right place.
Let’s dive into 3 basic steps that can help you take your subjective examination to the next level.

1. Approach every interview with an open mind.

As Dr. Haven puts it, you can approach every meeting with one of two mindsets: the “it will be” mindset and the “could it be” mindset.

The “it will be” mindset leads with assumptions and bias, working to fit a unique patient experience into your preconstructed mold. 9 times out of 10, this will only lead to frustration and sometimes even misdiagnosis.

The “could it be” mindset actively strives to set aside bias and understand your patient’s experience. As a matter of fact, the “could it be” mindset may even get you to an accurate diagnosis and/or treatment plan faster than the “it will be” mindset, as it allows you to open your mind to the full picture and put pieces together organically.

In short, don’t assume you know what’s going on with a patient until you know the full story. Listen to everything they have to say and then connect the dots.

2. Format your interview questions intentionally.

Each question you ask should provoke a thorough but concise answer, lead you to a follow-up question, and prompt answers that correlate to physical exam measures. As a whole, ask questions that “funnel down” from most open-ended to least open-ended. Once you’ve asked your question, sit down, listen, and build rapport to encourage your patient to speak freely.

For example, try the following sequence:

a. What brings you in today?
b. When and how did these symptoms commence?
c. What is the nature of your pain?
d. What aggravates and/or alleviates your pain?
e. How is your function of this and the surrounding areas?
f. Have/how have your symptoms/pain changed since onset?
g. Are you experiencing pain or lack of mobility elsewhere in the body?
h. Do you have any relevant medical history? (i.e. has this area been previously injured? Have you had related surgeries?)

3. Understand your patient’s goals.

All you have to do is ask and listen.

What do you hope to get out of physical therapy?

What is your goal for treatment?

Only when you know what your patient wants will you be able to manage expectations, achieve patient buy-in, and deliver valued care. This information will inform your treatment plan and give your patients hope in knowing that you’re working together towards a common goal.

expectation setting for cash-based physical therapy clinics

5 Tips to Build Rapport in Telehealth

Make sure you’re providing the patient care your clients deserve with the right tools by your side.

“Our minds are together when our bodies feel we’re not. That dissonance, which causes people to have conflicting feelings, is exhausting. You cannot relax into the conversation naturally.”

These words from Insead professor Ginapiero Petriglieri explain why virtual interactions can take so much more out of us than in-person ones.

Telehealth is a TREMENDOUS blessing. It has allowed countless physical therapists to remain employed during the COVID-19 pandemic, and greatly expanded patient access to quality care.

Still, Zoom fatigue is legit.

According to BBC Workplace, “Being on a video call requires more focus than face-to-face chat… [requiring that we] work harder to process non-verbal cues.”

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What’s more?

A 2014 study revealed that delays as slight as 1.2 seconds led people to “perceive the responder as less friendly or focused.”

This can make it especially challenging for PTs to build rapport through telehealth technologies.

Bearing all of this in mind, here are 5 simple but effective tips to facilitate meaningful connection between you and your patients… virtually!

New to the world of telehealth? Check out “Preparing for the Only Certainty: Digital Transformation in PT” to learn how PtEverywhere makes telehealth a breeze. Now, onto the main course:

1. Cultivate a conducive environment.

Set yourself up in a well-lit, private space. Feel free to position yourself in front of artwork or intentionally selected objects to create an inviting atmosphere, but be mindful to avoid clutter and distractions. Be sure to introduce your client to any other consultants present in the room.

3. Establish a disconnection procedure.

Clear planning and expectation setting can seriously reduce telehealth anxieties. At the beginning of your call (or even beforehand), tell your patient what to do should you be disconnected. It can be beneficial to have your patient’s telephone number on hand as a backup option.

3. Look at the camera, not the screen.

While the inclination is to look at your patient while she’s speaking, looking at the camera is what allows your client to feel like you’re making eye contact. You needn’t stare at the camera the entire time, but do your best to make it a habit.

4. Inform patients of off-screen activities.

Tell your patient ahead of time if you plan to take notes or look at medical records. While these are reasonable things to do, you may appear distracted if your patient doesn’t know what you’re up to.

5. Don’t forget reflective listening.

When you’re looking at a screen, it can be easy to neglect practices you’d normally adhere to during in-person meetings. Check that you’re nodding your head along with what your patient is saying, offering affirmations where appropriate, and re-summarizing your patient’s main points. Follow up with open-ended questions to deepen your understanding.

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10 Essential Elements of PT Patient Intake Forms

Make sure you’re providing the patient care your clients deserve with the right tools by your side.

The development of online patient intake capabilities has drastically simplified information management. Paired with EMR, online patient intake forms make record keeping neater, quicker, and less redundant. Don’t forget to include these 10 essential elements of PT patient intake forms in yours!

1. Identifying Information

Identifying information such as name, date of birth, and sex is probably the most obvious element of a PT patient intake form. Not only are these items necessary for you to keep track of your patients, it’s sum provides broad insights into the demographics of your clientele.

2. Insurance

Seeing that most patients pay with insurance, you must confirm they’re insured before conducting an appointment. Collecting this information before a patient arrives for their appointment will allow you to smooth out any kinks ahead of time. For cash-based practices, you can skip this!

3. Referrals

Be sure to ask patients how they heard about your practice and/or who referred them to you. This information will inform your marketing efforts!

4. Reason for Visit and Symptoms

Collecting this information prior to clinic visits will inform the physical therapist(s) and maximize hands-on time during appointments. Remember to be specific when asking about pain and symptoms. For example: “Where are you experiencing pain? What sensations are you experiencing? What is your pain level? What alleviates or worsens your pain?”

5. Pre-Existing Conditions, Injuries, and Medications

Asking about pre-existing conditions, injuries, and medications is a safety necessity. Not only will this knowledge directly inform your care, it may provide insight into the root of the condition and/or pain your patient is currently experiencing.

6. Electronic Signatures

Because they’re HIPAA compliant, E-Signatures allow you to keep patient check-in touchless!

7. HIPAA Acknowledgement

Speaking of HIPAA, don’t forget to attach HIPAA acknowledgement to your patient intake form.

8. Consent Forms

While not always applicable, certain services do require written consent. For instance, consent forms are required for dry needling. Obtaining consent (or the lack thereof) before an appointment will make the process more seamless if services requiring consent are prescribed.

9. Financial Policy

The last thing you want is for your patients to be surprised at billing. Clearly state your PT practice’s financial policy on your patient intake form to prevent hiccups and manage patient expectations.

10. Anything Else?

It’s important to include an open-ended question on your patient intake form, where patients can add any information that didn’t fit elsewhere. For example, try asking “What else would you like for us to know?” Phrasing the question as “what else” rather than “is there anything else” will encourage patients to write and speak freely.

10 Reasons to Shift from Paper to Digital Record Keeping for Physical Therapy

Make sure you’re providing the patient care your clients deserve with the right tools by your side.

Does switching to digital record keeping seem like too much work? We’ll admit, it takes time and effort to transition from paper to digital. In the long run, however, the initial investment is more than worth it.

Why is this, you ask?

Well, you’ve come to the right place! Here are 10 reasons why the team at PtEverywhere believes your physical therapy practice should switch from paper to digital record keeping:

1. EMR saves you time.

physical therapy practice management
EMR (Electronic Medical Records) make patient information accessible within a few keystrokes. Digital record keeping eliminates time spent sorting through papers to help you simplify your practice management and ditch the “Overworked and Underpaid.”

2. EMR exponentially improves organization.

Paper filing systems make for a great big mess. A single misplaced file can send the entire system into disarray. With EMR, every file is stored securely in the same place and can be accessed without dependence on maintained alphabetization.

3. EMR reduces paper redundancy.

Digital record keeping eliminates the need to create notes outside a patient’s file. This prevents the loss of information and, once again, improves organization. With PtEverywhere’s charting and EMR software, you can even use our voice-to-text feature to dictate notes directly into patient charts.

4. EMR improves customer service.

Less time shuffling through papers makes it easier for you to deliver speedy and personal care to your clients. Further, patient experience is streamlined and enhanced through the potential for embedded patient intake forms, online billing, and an integrated HEP platform.

5. EMR increases efficiency.

Paper record keeping is a huge job in and of itself. Organizing and filing can easily take hours! EMR kills multiple birds with one stone. Not only do you save time, you gain the ability to work from anywhere! This kind of flexibility makes life a heck of a lot easier.

6. EMR saves you money.

Time is money… and we’ve already discussed how time-consuming paper filing systems can be. Healthcare providers have found that EMR reduces transcription, chart-pull, storage, and re-filling costs.

7. EMR elevates your professionalism.

Organization + streamlined delivery = professionalism. Simple.

8. EMR helps you maintain compliance.

It can often seem like regulations are constantly changing. EMR allows you access to software that can seamlessly keep you in-line with regulations and update you when things do change, so you never miss a beat.

9. EMR reduces your environmental footprint.

Switching from paper records to EMR is one of the most effortless and intuitive shifts your company can make to care for the environment. The U.S. uses approximately 68 million trees each year for paper, contributing to deforestation and related emissions. While it may seem like your PT practice’s paper consumption is only a drop in the bucket, lasting change starts at the individual level!

10. EMR improves marketing capabilities.

By storing all your data digitally, you have easy access to the sum of your patient demographics and KPI variables. With the help of the proper software (even as straightforward as Excel) you’re equipped to better understand your clientele, practice growth patterns, and pressure points.

PT practice management