As physios we spend much of the working day talking with patients (and colleagues!) and consider it one of our core skills, whatever field we work in. These interactions are unique and personal, and have the ability to make or break the outcome of any and every treatment. If communication is the most important skill that health professionals have to master, are we really as good as we like to think we are? I wonder how much time you´ve invested in developing these skills compared with honing your technical skills?
In a research project looking at communication in back pain consultations, we observed and audio-recorded 42 initial consultations between musculoskeletal physios and patients in Southern England. The patients were referred to the service by their general practitioner and allocated a 45-minute appointment, with further 30-minute treatment sessions, if necessary. We made a point to include the four gender combinations of: male therapist / patient; male therapist /female patient; female therapist /male patient; female therapist / patient and to ensure variety, we also made sure no more than four patients were seen by the same physiotherapist. We then analysed all the talk that went on in these consultations and this blog post has arisen from looking at how the consultations started.
So often, we give little thought as to how to meet and greet a patient for the first time. Do you tailor your approach and if so, what’s this based on? Taking a moment to smile and welcome a patient can go a long way to helping them feel at ease, providing of course it’s genuine. Patients value this highly, even to the extent in our research where one participant said “As long as there’s a big smiley face I’m quite happy… [The] smiley face is more important than clinical skills.”
Equally, we can blow it with a flippant comment or some small talk that was not taken in the spirit in which it was intended. It was fascinating to watch a new consultation unravel for a patient with back pain in our research when the physio greeted him in the waiting room and, as they walked into the treatment room, casually asked “How are you today?” This was met with “Well that´s a stupid question because if I was OK I wouldn´t be here!” When I asked the patient about this in a later interview, he said “I hate it when people say that… It’s one of those statements people should avoid. But you’re better off saying, you look crap! You know what I mean? At least you’re making a statement!” This interaction was unravelling before they even entered the room.
You only get one chance to make a first impression and according to the literature, it only takes 39 milliseconds for this to happen – well before you´ve greeted the patient. Then there’s the issue of how you introduce yourself. Do you give your first name and surname? Do you indicate your level of experience eg. with your job title? In undertaking work in our department, it was interesting that patients most wanted to know not only the name of their physio, but also their level of experience – or as one patient put it: “Are they any good?”
After the pitfalls of social niceties and small talk, then comes an even greater challenge – the clinical questions and complexities of history-taking. These early stages are when patients present their problems and it requires great skill to enable them to do this without interrupting or hijacking their agenda, especially when you´ve only just met. There is no formula and no two consultations are the same, as you rely on your skills to ‘read’ the patient. One of my most memorable opening encounters was with a man whom I later found out had walked out of a consultation elsewhere because the clinician asked “too many questions“. After our introductions, his opening gambit to me as he waved his pointed finger in the direction of my face was “I´m not answering any of your bloody questions!” Several thoughts went through my mind as I said “Well in that case, do you want to tell me what you think I need to know?” On this occasion, I was thankful no two consultations are the same!
In our research, we found 11 examples of opening questions the clinicians used to get their patients talking about their back pain. We used the data to carry out a survey with UK physios to rank these 11 questions to identify their preference. The top choice from this UK sample for the new consultation was: “Do you want to just tell me a little bit about your back pain first of all?” Although these findings are a snapshot of opinions from a small sample, it can be a great in-service training topic to discuss how you open your encounters, or better still, ask a colleague to watch a consultation (with the patient´s permission) and focus their feedback on your verbal and non-verbal communication skills.
So having read this blog, what do you think is the ideal opening question? Let´s start an international discussion and see what the favourite opening question is among physios. To start the ball rolling what about: “Would you like to start by telling me about your back pain?” [Prompts if needed: “How you’ve got to this point and how it affects you”.] Please tweet your thoughts: @LPhysioprof
Do you have a favourite opening question? Please share it with us as it’s time to focus on talking the talk….
About Lisa Roberts @LPhysioprof
Lisa is a Clinical Professor of Musculoskeletal Health and Consultant Physiotherapist in Southampton, UK and leads a research programme in communication. Outside of work, she loves spending time with her husband and teenage daughter, whether it’s local history, historical re-enactment, music or theatre, and she’s a qualified ballroom dance teacher!
 Roberts L, Whittle C, Cleland J, Wald M. Measuring Verbal Communication in Initial Physical Therapy Encounters. Physical Therapy 2013;93(4): 479-491
 Bar M, Neta M, Linz H. Very first impressions. Emotion 2006; 6(2): 269-278.
 Emily C Chester, Natalie C Robinson, Lisa C Roberts. Opening clinical encounters in an adult musculoskeletal setting. Manual Therapy 2014;19:306-10.