According to Fruth (2014), “the initial patient interview, also known as the health history or the subjective history, is undeniably the most important component of the patient examination” (p. 12). This initial interview acts as a base on which the therapist can perform physical examination and subsequently plan the intervention (Fruth, 2014, p. 12). Being a novice, it is important to perform a self-appraisal after completing patient interview.
This self-reflection can help to improve patient examination skills and may take the therapist to the expert level (Fruth, 2014, p. ). Linterviewed a 30 years old male whose chief complaint was pain on the outer side of the left great toe. The patient complained of having pain since one month. While interviewing the patient, I felt really comfortable as I was able to communicate very easily about the issue the patient was facing. I was very friendly and was showing lot of interest during the interview. I was surprised to see how quickly the patient opened up all his concerns in front of me. I had proper eye contact with the patient all the time.
While describing any medical ideas to the patient I tried to use lay man language (easy to understand) and made an effort to explain and educate the patient. For instance, I wanted to ask the patient to flex his great toe so instead of saying flex I said bend your great toe (Fruth, 2014, p. 12, 13). While listening to the response, I was trying to pay attention and maintain eye contact and at the same while I was trying to note down the points. I felt it a little difficult to do multi-tasking.
For example, when the patient was telling his family history I was trying to look at the patient and therefore, I couldn’t note down all the important details. And after the interview, I could not remember the exact detail of the family history. I could have definitely done it better. In future, I should tell the patient to wait for a moment and explain them the importance of family history and how important it is to note down all the details. Also, I noticed that when I was interviewing I was coughing a little. I think that made the patient a little bit uncomfortable.
I should have taken the interview some other day or I could have told the patient at the beginning of the examination about my cough and taken an excuse. Before starting the interview, I asked the patient if he is comfortable sitting on the chair or the table. I provided the patient with a pillow to support his back. I made sure we both sit at the same level. Other thing I noticed was, the patient was searching for his jacket which made me ask him if the room was too cold. I later realized, I should have asked him this question initially. Patients comfort should always be the priority.
The other thing which surprised me is that I was able to identify the distractor while interviewing the patient. When I was asking the questions the patient saw a Mustang wall clock and started talking about Mustang cars. I then, politely asked the patient to concentrate on the topic and told him that we can talk about the cars later. During family history, the patient mentioned death of his mother and how it affected him in a long run. When I heard that, my facial expressions changed and I showed condolence to the patient by saying “sorry to hear that”.
I also asked the patient if he wants me to continue to ask questions. It’s really important to respect the patient’s feelings to develop trust and rapport (Fruth, 2014, p. 18). I wasn’t judgmental when patient described his daily routine and mentioned he doesn’t do much physical activity. However, I somehow missed to advise the patient to exercise regularly and maintain a healthy lifestyle. I think it was my responsibility to educate the patient about the importance of healthy lifestyle. During physical examination, I assessed range of motion of ankle and toes.
While performing toe movements the patient complained of pain and I saw that from his facial expression. However, according to Fruth (2014) dint ask any further questions about where the pain was coming from, did the pain come every time the patient performed this kind of movement or did the pain disappeared after reaching the starting position (p. 19). If those questions were asked, I would have got the source of pain and that would have helped me in planning the intervention. Overall, I felt interviewing a patient in real life is very much different from reading the guidelines from text.
In summary, I think developed a trusting relationship with the patient. I tried to understand the patient’s problems. I briefed him on importance of physical therapy and its outcomes. What I should have done better is I should have been an active listener, I should work hard on doing multi-tasking and I should have been more curious in asking questions. I should have even considered patient education. And, patient comfort and safety should always be the first priority (Fruth, 2014, p. 24, 25, 26).