‘Tell Me About Your Troubles’: Description of Patient-Physiotherapist Interaction During Initial Encounters

Communication skills are critical in physiotherapy practice. It has been shown that patients, particularly those with chronic pain problems, are more satisfied with services when therapists communicate sufficiently. The goal of this study was to explore how French-speaking physiotherapists and patients with low back pain investigate and assess the patient’s pain experience during initial encounters. The initial consultation of six consenting patients with low back pain and two physiotherapists was videotaped. Conversation analysis was used to describe and analyse the communication practices associated with pain assessment. When physiotherapists explored patients’ pain experience, they specifically focused on the effect of pain on function. The observed physiotherapists used the following communication strategies: 1) using yes/no questions and ‘okay’ as a resource to shift to a new topic; 2) following documentation quite stringently without allowing digression; 3) building the next question on the basis of the patient’s discourse; 4) inviting the patient to talk using formulations such as ‘tell me about your troubles?’; and 5) using gaze and nodding as continuers. The physiotherapists used two different approaches to close the encounter. While one therapist chose to summarize the consultation, including a prognostic assessment, the other one ended the consultation by organizing the follow-up consultation.

This exploratory study examined the interaction between patients and physiotherapists during initial encounters and identifies assumptions underlying pain assessment that shape the therapists’ exploration of patients’ pain experience. It also exhibited evidence of the physiotherapists’ challenges in inquiring about the patient’s perspective.

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