For one reason or another, I have been inspired to write about the importance of patient interaction and the effect on outcomes this month, specifically regarding the initial interview. A little breakaway from my usual pelvic health topics. After I began writing this article, I noticed that another contributor to PT Haven, Ryan Balmes, had a similar idea with discussion of the subjective portion of an initial evaluation. Obviously, a topic that many (at least two) of us are passionate about. Hopefully, we can all take away something different and helpful from each article.
Outcome: the way a thing turns out; a consequence.
Aside from the pressure placed upon us by insurance companies (I won't name any names), outcomes are otherwise, and more importantly, known as someone's quality of life. We have the honor of playing an important role in changing a special human being's quality of life. The quality of life of a mother, father, daughter, son, uncle, sister, friend. This is why we do what we do. Right? #Qualityoflife
In my experience, our influence over this transformation begins the moment we introduce ourselves and begin the interview.
The Interview (not the Seth Rogan-controversial-film kind):
"The medical interveiw is the practicing physician's most versatile
diagnostic and therapeutic tool. However, interviewing is The medical interview is the also one of the most difficult clinical skills to master. The demands made on the physician are both intellectual and emotional. The analytical skills of diagnostic reasoning must be balanced with the interpersonal skills needed to establish rapport with the patient and facilitate communication." (1)
At CSM in Las Vegas last year, I had the pleasure to listen to physical therapists Karen Brandon and Susan Clinton, along with clinical neuroscientist, Lorimer Moseley, speak about how to effectively interview patients specifically in pelvic rehabilitation, though I feel their message is relevant to all physical therapists. They began with a quote from Steven Covey: "Most people don't listen with the intent to understand, but listen with the intent to reply." A pretty profound statement which made me examine my approach to communication in all of my relationships, inside and outside of patient interaction.
They spoke about becoming a master of clinical practice by improving efficiency during the interview by streamlining and making immediate associations. I learned we have five-seconds to impress the patient (our introduction), that active listening is a skill, and patient motivation, compliance, retention, satisfaction and outcomes are linked to our influence (verbal, non-verbal, affective responses) over them. No pressure.
Lorimer Moseley then defined what our objectives of the interview should be:
I think the most important part of what he said is that we need to identify what the patient actually wants. Revealing to the patient that we understand what they desire to achieve from physical therapy intervention opens the door for trust, which is followed by rapport to result in a successful course of treatment and positive outcomes.
As I mentioned in a previous article, the psychosocial aspect of physical therapy don't play. Especially in regards to pain and healing. If you've never listened to Moseley's TED Talk (shout out to Shane Irgens for telling me about this gem of a video), you must absolutely click here. Fifteen minutes of your PT life you won't regret. What he discusses in the video reminds us of the fact that our brain controls everything. Most importantly, it produces every pain we feel, our memory and associations with our experiences that create our emotions and/or pain. Aren't our bodies amazing? Understanding this concept then allows us as physical therapists to proceed with interaction and treatment to aid in reshaping the pathways that are triggering our patients to feel pain.
These are just a few among the many reasons why we must spend a considerable amount of time with the patient, actively listening to their concerns about their symptoms and becoming aware of their learning preferences and limitations, their fears, goals and expectations in order to positively influence their (all together now) quality of life.
In conclusion: Listening. It does a (patient's) body good.
Lacey graduated from the University of Central Arkansas in 2010 with a Doctor of Physical Therapy degree. She then moved back to her roots in Texas to practice in outpatient physical therapy. In 2011, she accepted a position to facilitate the development of a women's health program, which is where her passion lies. She seeks opportunities to educate the community and other healthcare providers on the availability and importance of pelvic rehabilitation and women's health physical therapy. Check her out at: LinkedIn and Twitter.