3 Tips To A Better Subjective Assessment
Posted By: Andy Barker
Whilst there are many things I now question that I was taught at University, this will always hold true.
I’ll always remember being told that if you don’t do a good job with your subjective assessment it is very difficult to find the right patient diagnosis.
This is true 100% of the time.
If you get to the end of the subjective assessment and you do not have a firm primary hypothesis of what might be happening, then something has gone wrong.
Even with complex cases, or patients with more than one issue, you should be able to identify a probable cause of the patients problem, then you can use your objective assessment to prove or disprove this cause.
Failure to do this causes you to do too many tests in your objective assessment…
Increasing the chances of gaining a false positive…
Irritating your patient for no real reason with special tests that act to provoke symptoms and worst of all…
You get to the end of your assessment and you are unsure what the patients problems are.
The big problem here is that if you are unsure what the patients problems are, you will be unsure where to start with your treatments and rehab.
The subjective is so important, probably the most important part of what you do as a therapist, because everything else you do after this is reliant on a good subjective assessment.
But it is something that many new grads struggle with.
So here are 3 tips to help you nail your subjective assessment to ensure you find the right patient problem, so you can progress with the confidence you are treating the right thing.
#1 Know Your Questions (And Answers)
You should know what questions you will ask a patient as part of your subjective assessment BEFORE they even walk in the room.
You might think how?
How can you do this if you don’t know what problem they have?
Surely some questions for a shoulder injury will be different to a lower back or ankle problem.
Maybe one or two questions yes…
But 95% of your subjective assessment could, and should, be the same.
By having a clear structure to your subjective assessment gives you the clarity and confident about what questions you are going to ask…
To stop you mumbling through and sounding unconfident in front of your patient.
Rather than just asking questions be sure you understand why you are asking a particular question.
This is clinical reasoning.
Do not fall in to the trap of just asking questions just because you were taught that way.
Ask yourself why your are asking that particular question and what the answers you might get actually mean.
How does the answer to that question affect what you do next i.e. how might that answer inform what you test in your objective assessment or what you might want to focus your time and attention to with your hands-on treatment techniques or your patient rehab?
Having a structured subjective assessment ensures you are ready for any patient that walks through your clinic door, regardless of what injury they have…
And gives you the confidence you need to deliver a sound and effective subjective assessment.
#2 Take Your Time
A big misconception for new grads is that have to do everything in the first session.
By everything I mean, the subjective and objective assessments, hands-on treatment work and prescribe rehab all in that initial appointment.
You do not.
The key to a great assessment is ensuring you get the right information from your patient.
This is true for both the subjective and objective assessment.
The aim of the initial assessment is 3 fold…
- Identify the patient diagnosis
- Identify the patients’s problems i.e. loss of ROM or strength
- Identify the patients end goal and devise a treatment plan to achieve this
That is it!
All the above are unrelated, in the sense you can do any of the them irrespective of the other.
So even if you are not clear on a definitive diagnosis for example, you can still identify the patients problems and their end goal.
The key tip here is not rushing.
The subjective part of the assessment is going to help inform your objective assessment and from there everything else you do, including your hands-on work and the rehab your prescribe…
So don’t rush.
Get this wrong and everything else might be wrong too.
Make sure you get the right information before you progress.
#3 If It Sounds Wrong, Ask It Again
If your patients story does not make sense then it probably is not a true reflection of what is actually going on.
You might get a really complex patient that has a lot going on, which makes it hard to make sense of the true problem, but these patients are 1 in 1000.
The other 999 times you should be able to extract the information you need to identify the right patient diagnosis and problem list.
So if you ask your patient a question and the answer just does not sound right, you might need to ask it again.
You might frame it slightly differently the second time around but do not just move on.
The patient may just have misunderstood or misinterpreted what you asked.
If it does not sound right, it is probably not right.
Don’t move on until you are happy you have the information you need from your patient from that particular question.
Simple things done well make your life as a new grad so much easier.
Whether this is your subjective assessment, special testing, the hands-on techniques you use or the rehab exercises you prescribe, the key to any successful treatment plan is in the application.
You can have all the knowledge in the world, but if you cannot apply it in the real world with a patient in front of you then you are always going to struggle.
Want to see how to put together a simple, structured and clinically reasoned assessment?
Learn how to link your subjective and objective assessments together easily so you look and feel confident in front of your patients?
And discover how to take the information you get from your assessments so you know exactly what to focus on first with your patients treatments and rehab?
I’ll be covering all this on my upcoming 1-day lower limb and upper limb courses…
Both course days are taking place at the infamous Emerald Headingley Stadium, the home of the Leeds Rhinos.
I’ll be teaching all this, plus content that I have never taught previously outside of my membership.
There is already a great mix of both students and new grads booked on the course and it would be great to see you there too!
The New Grad Physio Mentor
PPS. You can attend either 1-day course on it’s own, or attend both days and save yourself £50.
You can do that by hitting the link here.