Building Rapport with your Patients

The most up to date research shows how effective the patient to practitioner relationship is. The greater the level of trust, confidence and understanding time and again results in:

• Increased efficacy of treatment

• Increased return to prior function

• Greater mood relating to state of injury

• Increased compliance with home exercise program

• Greater level of job satisfaction

• Increased response to hands on and exercises based methods in individual sessions

Things to avoid

• Technical jargon: although this was drilled into us all at university it only builds a barrier between two people and many people find it pompous when a person overuses jargon.

• Checking or taking notes during subjective: flat out disrespectful and shows your attention is elsewhere. Our patients are paying to be here and deserve our full attention. During the objective it is perfectly acceptable to check imaging and scans or previous notes to confirm information.

• Having physical barrier between yourself and the patient (i.e desk): works to create a separation during the subjective and can impede general conversation. Many say it feels like the barrier acts to protect one person and expose the other. This worsens the power dynamic between to patient and practitioner.

• Speaking more than listening: this should be obvious but most of our speaking should be based around questions to find the information we are looking for to build a clinical picture. Wait for breaks in conversation to ask these questions unless you need to rule in/out any serious or sinister line of questioning.

• Closed off posture: works similar to a physical barrier but also shows how disintreseted a practitioner actually is.

• Forgetting important events during subjective: small things such as specific range on motions can be forgiven especially in an initial when a lot of information could be seen as important. Some things much be committed to memory and repeated to confirm. Such as date of injury, side of the body, recent family events that impact the injury/condition, sports, goals ect.

• Lack of or too much eye contact: not enough shows you don't care, too much can be intimidating/creepy.

Strategies to Employ

• Make it a conversation: To start your subjective will be quite rigid, which is good to make sure you find a pattern to make sure you get the information you are needing. Over time your standard and special subjective questions will be weaved throughout the conversation. Make sure to clear any red flag questions and then discuss how if clear this is a positive to help put the patient at ease.

• Have open a relaxed body language: This can be a fine line. Avoid cross arms/legs and keep comfortable amount of eye contact. Be aware of your facial expressions especially should the patient divulge something shocking. Try to avoid leaning too far forward as this can be overwhelming for some patients.

• Show that you care but not pity your patient via facial expression: Try to not overthink this as most often practitioners end up pitying patients instead of just showing empathy. Avoid extra sad faces as patients may become frustrated that they are being pitied or latch on a become attached to their own victim mentality. We should care about our patients pain but not too much as it stops us from performing our task.

• Acknowledge the information presented by nodding and/or confirming verbally: So simple but so effective in showing you are present and actively listening to your patient. Just don't over do it.

• Read the room: This involves basing the mood of the session around how the patient is presents. If the patient is positive about their condition/injury then so long as they are still taking the situation seriously then there is no need to make the session all doom and gloom. On the flip side should the patient be very nervous and pain focused being able to bring some levity to the session may be helpful or it could make the patient believe you are not serious about your job.

  This will take practice but go with your gut as it is normally a good place to start.

• 'Follow the patients lead': This goes along with making the subjective more of a conversation. If the patient goes on a bit of a tangent don't immediately pull them back to a rigid form of questioning. That tangent could provide key information about why they are currently in pain. Over time you will be able to catch and confirm pieces of information as the patient talks through all sorts of seemingly 'unimportant' information.

• Find common points without divulging your private life: Simple things such a mutual sports teams, favourite movies, hobbies ect. These all make a huge impact on the patients level of trust and comfort. Avoid obvious personal information such as a specific home address, phone number and previous relationships.