In my rheumatology outpatients placement, an elderly lady was referred to me regarding core stability exercises and balance. This needed to be addressed because she had previous falls and because lived by herself and wanted her independence. Because she was a new patient, a full subjective and objective assessment was carried out but just the subjective alone took 45minutes!! Every question I asked was answered with a story and she tended to loose concentration and talk about another topic. I did interrupt her once or twice, but did not want to appear rude so just smiled and nodded. I understand that she was lonely because she did not get out of her house often but her objective and treatment time was shortened because of the lengthy subjective assessment.
When asking questions, I found it hard to ask specific questions that wouldn't confuse her but at the same time are not leading questions. It made me feel a bit helpless because I was not really in control of the assessment, instead was listening to a story about her pet cat! It probably occur ed because I need more practice in politely interrupting, or maybe asking more concise questions. This experience taught me that the questions that we ask our patients are important. We don't want to be rude but at the same time we do want to give the most optimal treatment to our patients. In the future I will try and guide the conversation and take control of the session by changing the questions I ask. If anyone has any ideas on how to steer the conversation onto the right track please let me know!!!
Yes, I agree the subjective assessment can sometimes be a hard thing to do well. On occasions I have spent way too much time talking with someone during the subjective and then later realised that I had obtained very little relevant information! I found it useful to think of the details I needed to obtain in a flexible flow chart format rather than as left to right top to bottom points. That way I could keep myself on track while listening & catch the conversation and steer it in my direction. However sometimes even with the best techniques there are patients that will be difficult. I think being assertive – even if it seems rude is the thing to do. After all, this will be our job and we have a responsibility to gain relevant subjective details and it is in the patient’s best interest that we do so.
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