Some More Great Questions to Ask Your Patients

As a follow up to my last post I thought I might suggest another couple of questions that are worth asking your patients. Once again, these are not questions that I have devised myself, but rather have been suggested by me to other clinicians. I find them exceptionally useful in my clinical practice.

1. Do you think you can get better? or Are you positive or negative about getting better? Plenty of variations….

In essence what research shows is that patients who don’t think they are going to get better probably won’t. Pretty simple. I have written about this in other posts here and here, but for those wanting a quick refresher here are some of the key research findings:

Patients who expect their back pain to last a long time, who perceive serious consequences and who hold weak beliefs in the controllability of their back problem are more likely to have poor clinical outcomes 6 months after consultation.

Patients with very low baseline recovery expectations were 3 times more likely to be off work at 6 months.

Within 3 weeks of the onset of non-specific low back pain, low recovery expectations can identify people at risk of a poor functional outcome up to 6 months later.

The odds that adults with acute or subacute non-specific low back pain and negative recovery expectations will remain absent from work due to progression to chronic low back pain are two times greater than for those with more positive expectations.

Patients’ perceptions that the problem will last long, that many symptoms are related to their back problem, their weak beliefs about self-control and low confidence in their own ability to perform activities despite the pain, are even better predictors of disability at 6 months than fear avoidance, catastrophizing or depression.

Often you will need to explore this further, particularly if they tell you they are not going to get better. This may be as simple as:

17B1_but_why

Now often the answer will revolve around three similar situations as what I discussed last post:

  1. The patient who is correct (we are not going to get all patients better and sometimes patients have done and tried everything possible).
  2. The patient who doesn’t know.
  3. The patient who has a belief that is completely incorrect and inaccurate.

Once again, as discussed last post, at least this follow-up question lets you know what you are dealing with and what you might need to “treat”, in particularly if they fall into option 3.

Onto the next question I find useful:

2. What do you think needs to be done to improve your (insert injured area)?

Sometimes they are correct and our job is then pretty easy:

wrong-answer

Other times I will hear something like, “you need to push my disc back in” or “my spine needs re-alignment”:

bush-huh

These are obviously the more difficult patients to treat, but now that you know their beliefs it makes it far easier to target these in order to attempt to create change and then improve the patients situation. Of course it isn’t always possible to create this change, but I would suggest that unless you do this you are not going to improve them. I do know some physiotherapists that, just for the sake of not annoying the patient and having them not see you again will just agree with them:

“Yes your spine is out of alignment!”

thumbs

But is that really fair to the patient? We will ALL be a patient at some point of time…..

Thanks for reading.

About the Author:

Mark is a Specialist Musculoskeletal Physiotherapist who consults at both Insight Physiotherapy and Pain Options, in Perth, Western Australia. He specialises in the assessment and management of persistent/chronic musculoskeletal pain. In addition to his clinical role he maintains regular involvement in education of the profession having held a Teaching Fellow position at the University of Western Australia for 10 years and regularly presenting at courses and seminars through the Australian Physiotherapy Association and private education sector. Mark is also a Facilitator for the Australian College of Physiotherapists Specialisation Training Program and a Branch Councillor on the Western Australian Branch of the Australian Physiotherapy Association.

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