When I think back over all the times me and my colleagues assessed a new patient, and how we mostly collected data within the narrow confines of our questions, I reflect on how that might not have been the best course.
We thought assessment forms were essential, the modern way to quickly collect the information we needed about the case so we could move on to treatment planning. We liked the line drawings of the body, back and front, so we could put areas of pain and other sensations in different shadings, all the ‘x’s and ‘oh’s.
The forms constrained us into asking questions in a particular order and in the style of data collection, as if the patients were passive holders of the data we needed and we just had to get it out.
Fact Gathering Can Get in the Way
Fact gathering can seriously get in the way of getting to the heart of why the patient is experiencing their problems. We don’t need loads of info. At least not at first. Some facts have to be gathered, such as red flag questions, but they will intrude on the process of engaging with the patient’s experiences unless we take steps to avoid this.
Asking many questions, especially if they have yes or no or just factual answers, puts the patient into a passive role. As the patient is the only person who can help themselves, they need to be active collaborators. And they can’t be if we pursue the data collection course.
Professionals such as physiotherapists (or any health worker) can easily fall into this controlling trap, asking closed questions or multiple choices. Either way, this closes down the potential answers and reduces the chances of finding out what’s really bothering the patient.
Dr. William R. Miller, one of the founders of motivational interviewing, says: “If you listen to patients, they say more things about why they want to get better”. And about what is bothering them and how they think they might improve things.
Open Questions Promote Engagement and Share Power
The range of potential responses to a closed question is very limited but to an open question it is extremely broad.
A good approach might be “I’m really interested to hear your story about your back pain, could you tell me about it?”. And then sit back in the chair and listen, without interrupting, for as long as the patient’s flow of their story continues. This allows them to choose any angle and to start at any point in their case history, and it’s likely they’ll start with the things that feel most emphatic for them at that moment.
You’ll find that many of the facts you wanted to gather come out in their story anyhow, and you only need to fill in the gaps at the end.
Open questions mean you’re interested, gives the patient a share of the talk time, a share of the power and changes the depth and complexity of the interaction. Open, evocative questions gives them a chance to open up about their fears, beliefs and experiences which will give you invaluable guidance as to where you need to target any interventions.
If you let them, patients will tell you how to help them get better.
If you’re interested in better questioning, really listening and finding out what patents are thinking and feeling, motivational interviewing training is a great place to start. I did a course on www.psychwire.com and found it very enlightening. I have no financial or other connection with that organisation except as a satisfied customer.