Patients with Too Many Problems!

For those of you who have had your musculo placement, you would know that it is important to set time limits when performing the subjective and objective examinations. I remember I once had a new patient who was referred to the clinic with shoulder pain and headaches. As a “good” physio, I questioned her about her pain and started to fill out her body chart. As I questioned further, it became very clear this lady was a chronic pain patient. She had pain everywhere! Not only that, the pain she experienced was very severe, quite often close to 10/10. Of course, I tried to figure out the relationships between the different pains, and the aggravating/easing factors for each pain, which as you could imagine, the list became very extensive. As a result, it took me around 40 minutes just to do the subjective!

When I went to tell my supervisor what I had found, he told me that it is ok with patients like these to simply question them only about their initial presenting complaint (i.e. her shoulder pain and headaches), rather than any other associated pain. By doing so, it should help with time management. Then, over the next coming weeks, it is ok to question further about the other pain they are experiencing to better determine relationships.

She was definitely an interesting (and somewhat difficult) patient to see. I guess it’s a good learning experience though, as it is very easy to approach an initial consult as a tick box process. Quite often, I find I will know most of the questions that could be asked, and I will tend to ask them all, simply to have a thorough assessment sheet. Rather, it’s important to consider the absolutely vital parts of the examination that must be determined on the initial consult, and gather the rest of the information over coming sessions. I definitely will be trying to do this, but I guess the more I see patients, the easier this will become as our clinical reasoning process will also develop.