Guest Post: Improve Your Subjective Interviewing Part 2

Dr. Ryan Balmes is back with a follow up to his original post on one of the most important parts of the initial visit. To review, that post is here.

This is Part 2 of the Improve Your Subjective Interviewing post, which is my way of saying this:

I messed up.

After catching up with my mentor from residency, she told me she loved my first post, but she said I missed the final part of an excellent subjective interview. You gotta love a good mentor - the mentoring never stops!

So we’ll talk about the final part of an excellent subjective interview.

(If you haven’t read the original post, then click here to read it. From there you can continue reading part 2.)

So the final part of any good subjective interview is reviewing what you’ve covered!

Got it? Okay cool. Now go out there and be awesome.

I’m kidding. So here are the details on how to review with your patient your subjective interview.

You’ll want to quickly summarize the main points from your subjective data. These include, but not limited to:

Mechanism of injury
Aggravating factors
Easing factors
Pain descriptors
Relevant past medical history
Previous and current treatments
Patient’s goals with PT

Consider this the Sportscenter highlight version of what you covered in you subjective interview.

When reviewing the information with your patient, you’ll make sure you have everything covered. Plus, your patient will definitely appreciate this review portion. One reason for this is because your summary will demonstrate that you were actually listening to your patient. Second, your patient will be able to fill in any other pertinent information they may have missed. Most often, patient will add a few more things they may have forgotten. My guess is because most patients have never seen a physical therapist before, and so they are likely nervous and have no idea what’s going to happen.

Trust me when I say that your patients will be very appreciative of the time you have taken with the subjective interview.

Working on our previous patient, Ms. Alberta, let’s take a look an example of what a summarized subjective may sound like:

“So Ms. Alberta, your goal with physical therapy is to be able to reach overhead with your R shoulder to reach items on the cupboard, and you want to be able to pick up your grandchildren. I think those are excellent goals, and depending on what we see during our objective exam, we’ll see how much work we’ll need to get to.

I want to quickly review what we went over if that’s okay.”

Ms. Alberta quickly replies, “Of course!”

“So you say that your R shoulder pain began about 3 months ago with no acute injury. Your R shoulder is particularly painful when reaching overhead, but you have no R shoulder pain at rest. The pain is sharp at times, but thankfully no numbness or tingling through your R arm. You have a history of osteoarthritis in you knees, but otherwise you’re one healthy lady!

Your primary physician has prescribed you some pain medications, which has helped somewhat, but you’d like to see what physical therapy can offer because you’ve heard from your friend that physical therapy could help.

And again, your goal is to be able to reach overhead with decreased pain and still be able to pick up your young grandchildren.

Ms. Alberta, is there anything I may have missed?”

Ms. Alberta smiles and quickly replies again, “No, I think you covered it all!”

“Neat. Well, we can get started on the objective exam and see what’s going on with that R shoulder. And Ms. Alberta, if you have ANY questions or any more information you remember, please don’t hesitate to stop and tell me okay?”

As you can tell from this example, you've made a narrative story of the patient's entire problem. Doing so reminds you that you're working with a person and that person's life, not a glenohumeral joint.

I do want to point out that last part of the example there:

“And Ms. Alberta, if you have ANY questions or any more information you remember, please don’t hesitate to stop and tell me okay?”

I feel that that last part is excellent patient care. Gathering subjective information never stops. I’d recommend that you encourage and foster an open relationship between you and your patient so that there is a constant dialogue of information.

Now I will admit to you that incorporating improved subjective interviewing skills takes practice! Here are some action steps you can take today to make your subjective interviewing the best that it can be:

Before taking back your new patient in clinic, write on top of your note taking paper (you do take notes right?!) reminders of what you want to improve during your subjective interview. Here are some common ones I’ve written myself. I like finishing them off with exclamation points to replicate my inner super-critical self yelling at me to be the best PT for my patients:

Aggs and eases! (aggravating and easing factors)
Funnel down!
Review subjective info!

Here are other action steps you can use today:

Practice with a colleague a mock subjective interview. Aim to use at least 15 minutes to gather subjective data. This will force you to cover everything and be thorough. Have your colleague be brutally honest with you for feedback. Even better is if you videotape yourself, so you can see for yourself how you present yourself to your patients.

Look back at your previous new patient experiences. Think critically and ask yourself, what information did I miss? Was there something you found in your objective exam or a piece of data you found later during your return visits that you may have been able to screen out during your initial examination’s subjective interview?

Look at your upcoming week of patient, specifically your new patients. Prepare yourself in recognizing common subjective signs your future patient may say. Be careful to avoid the “It will be” mentality though. You’re just preparing and anticipating what “it may be”. Remember that your subjective information will explore further, and your objective exam will definitively determine the patient’s diagnosis.

After you work on these skills, let me know how your subjective interviewing, and ultimately your patient care, improves! Leave a comment below or email me directly. I read and respond to every email.