I am currently on my musculoskeletal placement and have encountered the problem (on a number of occasions) of the patient who likes to talk... and talk... and talk... and talk!
We are taught at university the importance of taking a thorough subjective assessment and how important it is that you don't let the patient ramble, otherwise it can be a very time consuming procedure. Until this placement I did not realise just how important it is. When you have patients booked in back to back a subjective assessment that takes too long can really put you behind schedule.
I have found that with some patients trying to keep them on your current line of questioning, and trying to get them to answer your questions as briefly as possible is next to impossible! At first I felt rude interrupting a patient if they were telling a story (albeit irrelevant) or if they were not giving me the information that I had asked for. After a number of extremely long subjective assessments, however, I have realised that it is necessary.. no matter how rude you feel.
I now try to keep my questioning as direct as possible and try to redirect any stories a patient is telling back to their presenting problem.
Although I feel that I am getting better at shortening my subjective assessment, I think I have a long way to go. It is particularly important to fine tune this skill if I go into private practice after graduation as the time available with a patient is much more limited than what we are given on prac. It is one of my aims for this placement and I hope to be much better at dealing with the "chatty patient" by the time I have finished!
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2 comments:
I agree with you! A consise, effective subjective examination that obtains all the relevant information and establishes rapport with the patient is important. It is also a skill that will continue to develop as we progress in our careers.
haha, yer i think that "tricking" the patient into talking about what you want is an art form. Ive actually found it harder in hospitals and the public setting, as these people always seem to be a little toucher if you try turn there focus to were you want tp go.
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