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.”
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 patient 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.
