Listen Up: When Listening is Therapeutic

The last time you visited a medical practice, what was your experience? How much time did you get with the practitioner, and how much of that time was spent getting to voice your concerns? 
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It is my experience that most patients don't feel their practitioners fully understand their problem, and that statement doesn't seem to be unfounded. One study from Family Medicine in 2001 showed a typical primary care visit lasts on average 11 minutes with the patient only speaking for a total 4 minutes of that time. More of a issue is the fact that those patients only averaged 12 seconds before interruption by the practitioner. Although this study was in primary care, it also happens with specialists and even physical therapy.

Another study from the British Journal of Medicine showed a physical exam was completed in 88% of encounters, and of those who got a physical examination, the after exam lasted 1.5 minutes. So as practitioners, how are we supposed to be able to fully understand the intricacies of our patients problem without listening to understand and performing a thorough examination?

​The examination is one of, if not the most, crucial components of a patient's care.

1. It allows us to gather the history of the current problem and strategize our physical exam.
2. It allows us to understand past history as it may impact the course of care. 
3. It allows us to understand why the patient has sought out our services, and what their goals are.
4. It allows us to identify pain generators/relievers (nocicepetive, peripheral neurogenic, and central sensitization) 
5. It assists in our prognosis and setting patient expectations.
6. It helps develop a therapeutic alliance with our patient, which has been shown to predict and improve outcomes in patients with musculoskeletal and chronic pain.

For more information on conducting a comprehensive examination, I highly recommend Listening is Therapy: Patient Interviewing from a Pain Science Perspective from the journal Physio Theory and Practice.

Diener, I., Kargela, M., & Louw, A. (2016). Listening is therapy: Patient interviewing from a pain science perspective. Physiotherapy Theory and Practice, 32(5), 356–367. https://doi.org/10.1080/09593985.2016.194648