1. Start with open questions – how, why, where, what eg “How can I help you today Mrs Jones?” This style of questioning will allow the patient to discuss vital aspects about their problems that will help develop your diagnosis, differential diagnosis and management plan. Allow plenty of time with open questions before progressing onto closed questions (Do you, have you, would you) that end with a Yes/No answer eg “Do you have pain into your hip as well?”.

2. Follow up initial answers with “Then what…, and then what….” (open questions) to extract more information.

3. Pause after a patient answers to allow them to add more information. Most people are uncomfortable with spaces more than 4 seconds, and will try to fill these with more (often helpful) detail.

4. Always ask your red flag questions – saddle area paraesthesia, night pain, unexpected weight loss, etc. One day you will have someone with serious pathology and these symptoms that you will miss if you don’t ask. Refer for medical attention if these red flag questions come back positive.

5. Don’t dismiss any of your patients symptoms, even if it appears completely unrelated to the problem they are presenting with e.g. Patient reported “no sense of smell”, is this a sign of a brain tumour, or something else. These may alert to potential medical/red flag problems you need to refer for follow-up medical attention.

6. Validate your patients pain whether it is acute or chronic. Understand pain is a very important part of their experience as a human being – their pain is always real, never imagined. Avoid expressions like “I know your pain feels real, but we know pain is actually just an output from your brain”. Whether it is acute or chronic, your patients pain is real, just like your pain is real when you jam your finger in the door.

7. Do not catastrophise patients problems e.g. this is the worse case of tennis elbow you have ever seen, you have the back of an 80 year old, “Oh my god”, “Your disc is probably ruptured”, “You have bone on bone”. Because pain is an output from the brain, catastrophising will sensitise the brain to impulses from the painful area, and increase pain levels. Use non- threatening language to avoid increasing fear in patients such as “it is like wrinkles on the inside – a perfectly normal part of getting older”

8. Have a plan for your patient’s recovery and book them in for follow-up sessions, do not leave them with “See how you go over the next week or two, and call me to book in for another appointment”. If you do not book your patients in, they are likely to forget to do their exercises, ring you for a follow-up or get better. You are helping your patient’s recovery by booking them in for further sessions.

9. Avoid telling patients that do not respond to your treatment “physiotherapy won’t work for you”. Patients often need different approaches, experience or a different type of connection from another therapist, or may need 6 different therapists to tell them the same thing in different ways, and that is ok. If you are unable to help them, refer them to someone with more experience or a different approach to you.

10. Discuss the pros and cons of surgical intervention, but leave recommendations that patients require surgery to medical staff, eg ‘you need an arthroscopy/total knee replacement’.

Bonus tips
11. Leave the room while your patient gets changed to help increase your patient’s comfort.

12. Dress appropriately to your patient population e.g. a suit and tie on a building site looks out of place, as does a polo shirt, shorts and runners when treating professionals in a capital city CBD. If unsure dress up rather than down. Professionals wearing a suit are more likely to take advice more seriously from a Physiotherapist dressed similarly than someone wearing shorts and runners.

13. Understand the line between professional and social boundaries. You are in a position of authority as a person’s therapist, so avoid abuse of this authority by avoiding socialising with patients outside of the clinic.

Provided free by David Pope @ Clinical Edge