What would you say is the most important aspect of an initial patient interaction? I would argue that it is validating the patients concerns and chief complaint. I suspect this is true for any field of medicine but it is most definitely true in Physical Therapy.
One way we can validate the patients concerns is by demonstrating the ability to reproduce their chief complaint; as well as reduce it. In my clinical expertise, this is the most important aspect during an initial examination (and during many subsequent sessions). Maitland described this as the Comparable sign, which is defined as: “any combination of pain, stiffness and/or spasm, during a specific movement, which the examiner finds on examination and considers to be comparable with the patients symptoms” (Maitland).
Patients need to be reassured what they are experiencing is “real”. In and of itself, that concept has phenomenological undertones, but in reality, their experience is their experience. As therapists, we must simply attempt to understand their experience, demonstrate that we are attempting to understand it and attempt to help guide them in altering it. I suspect many of us can become fixated on looking for so-many variables that “we become overwhelmed by the noise“. This deductive process could easily be refined to a simple algorithm: Rule out major pathology–> Discover the chief complaint –> Reproduce it –> Attempt to alter it –> Check if we altered it by attempting to reproduce again.
Sure we love special tests. But in the process, do the results truly alter our clinical approach as described above (suspecting we truly perform clinical tests in the fashion in which they were validated—if they even went through this process)? For example, if two people present to the clinic with a similar presentation of shoulder pain, but one has a positive Hawkins Kennedy and the other is negative, does the clinical approach change? Don’t get me wrong; special tests have a necessary role in practice and should be utilized to “Rule out major pathology—described above”. I simply suspect an overabundance of unnecessary tests can mutter one’s thinking and stray us away from truly attempting to alter their experience. What would happen if we stopped testing; and simply began interacting (test–>treat–>retest)?
What are your thoughts?
Maitland GD, Vertebral Manipulation, London, Butterworth-Heinemann, 5th Ed, 1986
Categories: Critical Thinking