The Initial Evaluation is my favorite part of treating a patient. I love setting the stage, educating them, dispelling commonly held beliefs and empowering them with self assessment and treatment.
You can learn a lot from a patient during the history, so here are 5 Questions You Should Be Asking, But Probably Are Not
1) How are you today? - Other than the reason you made the appointment for
- this is part of setting the stage
- let the patient know you are not all business, have some compassion and care for them as a fellow human being
- I would say at least half of my patients still answer - "My neck is killing me!" or something similar because they are so used to a provider get right down to business
- again, most people do not hear the "in your own words part" - answering - well the doctor/MRI says I have "insert thought virus here"
- it's helpful to know how much or little you should be spending on Therapeutic Neuroscience Education based upon what they say
- for example, if you hear "My previous PT/DC said my pelvis was rotated, one leg is longer, and I have muscle imbalances...." - you may want to spend a fair time educating them on the realities of pathoanatomy
- if you hear, "My lawyer told me I need PT" - good luck!
- if you hear PT worked in the past for my low back pain - they already have positive expectation of a successful outcome, perhaps you do not need to lay on the Pain Science so heavily
- this should imply or you should eventually get at both sleep quantity and quality
- poor sleep has been associated with both chronic pain states and recurrent or slowing down injury healing time
- sometimes the patient's stress and pain is affecting their sleep, and other times, their poor sleep habits are not giving them enough down time and healing
4) Do you take the time to de-stress?
- I often ask this to chronic/persistent pain patients, that I am not expecting to be a Rapid Responder
- in this day of twitter, viral videos, and not being able to escape your work and life due to the constant notifications from your phone, many people do not take for themselves
- some of the best advice I have ever given a chronic pain patient was dance - for a dance instructor that had chronic back/foot pain, and had not danced in her own studio for years
- do your exercises while thinking of your children/pet - releasing certain hormones that overall improve well being
- telling a chronic pain patient to listen to their favorite music for an hour a day, de-stress, and practice Mindfulness can go a long way!
5) What makes your symptoms better and worse?
- other than hearing things like bending, slouching, and sitting make my Sx worse, and walking, standing improve it, this also goes beyond finding a directional preference (even though listening and recording these things really help with that)
- you may hear my Sx are worse at work, worse at home/night, worse on Mondays (one of my favorites from David Butler)
- sometimes they can sit as long as they want at home, but at work, sitting > 20-30 minutes is unbearable
- considering they probably slouch in both places it could be something like the stress of the work environment causes a learned breathing pattern disorder that causes them to overbreath and thus lower their pain thresholds
- or maybe it's just their work chair
Bonus and very important
- I often hear about old fractures, previous surgeries that patients did not think was relevant to their current condition
- this is the final question I ask before I start my objective exam and is sometimes enlightening!
Extra special bonus
- you need to prompt this, patients may not ask you questions, but sometimes tell your office manager upon leaving, wait until the next visit, or worse call you when you're busy with another patient!
- I ask this periodically throughout the first visit and on subsequent visits every time I go over a new exercise, treatment, or educational piece
What about you? Do you ask any questions in you evaluations that help you put together the puzzle?