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Beginning a conversation (choosing the right words)

Effective communication between providers and patients is a key component to successful care. Less than effective communication potentially hinders interpersonal relationships, information exchange, and decision-making for both parties. Fortunately, there is a firm body of literature, which can inform both new and experienced practitioners about the art of communication. One such study, conducted by Chester and colleagues was published in the journal Manual Therapy.(1)

Researchers in the United Kingdom observed verbal interactions of clinical encounters between musculoskeletal physiotherapists and patients suffering from low back pain. Audio-recordings of initial and follow-up encounters identified the initial questions asked by 15 physiotherapists. Then 43 physiotherapists responded to a national survey ranking the preferred phrasings of those identified during the audio-recording process.

The highest ranked opening clinical questions for initial and follow-up visits were open-ended; asked in a manner requiring an explanation or description rather than a yes or no answer. Some respondents preferred a few closed-ended questions, such as “The referral says you’ve got [problem presentation] is this correct?” and “Are the [problem presentation] symptoms ongoing?”

The wording ranked highest for the initial visit question combines several communicative elements into a short sentence, “Do you just want to tell me a little bit about [problem presentation] first of all?” The sentence is both question and invitation, open, yet focused on the problem, allowing the patient to decline while communicating further opportunity to talk and explain their problem. Other important elements, such as the importance of “small talk” prior to clinical conversations and how often patients were interrupted by providers in the study are also discussed.

Reference List

(1) Chester EC, Robinson NC, Roberts LC. Opening clinical encounters in an adult musculoskeletal setting. Man Ther 2014 Aug;19(4):306-10.

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