People need time

Time is important. Giving people the time to express what they want and explore their issues is the key to developing that important therapeutic relationship. This in turn is the key to finding out what their issues really are and avoid applying your solution too quickly.

There is no substitute for sitting down and listening to a story. Humans love stories. We all do. A patient always comes with their story. Sometimes they are well formed, pouring out in clear patterns, other times they are confused and chaotic, jumping from subject to subject and from time to time. Still more difficult is the story which won't come out even with prompting.

But you've gotta get that story, however you do it. You may just need to say hello and then you get the whole thing, just like that. Wow, it's amazing when that happens. You may need to prise every answer out, explaining everything twice. That's hard work. Mostly you pick your way through a mass of facts, looking for patterns which fit.

It doesn't always do to lead the interview too closely. Apparently, a patient will feel he or she has been heard if you let them talk for two minutes initially. I like to ask, after a very short preamble, "Tell me about your pain problem". That usually does it.

As people talk it is important to clarify the things they say, as misunderstanding is very unhelpful to the overall view of what is going on. You can pick up on small facts mentioned in passing which may be important in the picture. You have to chase those small threads, they can lead to interesting places.

Typical refrains from patients with spinal and pain problems are "Nobody listened. Nobody believed. Nobody understood". If you avoid those traps and really listen you will be rewarded with interesting stories, clearer views, devoted patients and improved outcomes.

Next I think I'll move on to the importance of always believing. Yep, always.