Calgary-Cambridge Guide to Communication in the Physical Examination
Original Editor - Mariam Hashem
Top Contributors - Mariam Hashem, Merinda Rodseth, Kim Jackson, Shaimaa Eldib, Ewa Jaraczewska, Tony Lowe, Tarina van der Stockt and Olajumoke Ogunleye
Introduction[edit | edit source]
Good communication is an essential practice that has shown to improve the patient's willingness to engage in the treatment[1].
Clinical examination is facing a challenge concerning its accuracy and importance. The advancement in research has proven low reliability and validity of many clinical tests with higher rates of accuracy associated with imaging and scans[2]. However, when the subject is approached from cost-effectiveness and availability point of view the perspective changes. Access to advanced medical diagnostic tools geographically and the affordability of such tests differed from a place to another. Therefore, clinical examination is still a valuable tool in clinical practice.
Despite being the golden standard, laboratory testing and imaging if misused could be harmful[3] and could be contributing to overdiagnosis, leading to further psychological and behavioural harms[4].
A thorough and effective physical examination is considered to be an art that is not only important for proper diagnosis but also builds the patient-healthcare relationship. Lack of physical examination is perceived by the patients as insufficient attention [3]. Interpersonal aspects and good communication increase the patient's satisfaction[5].
A study by Hinchliffe and Lavin [6] found the physiotherapist's communication with the patient to be a key factor in patients satisfaction and compliance with the treatment.
Unline the subjective history taking, where the patient plays an active role, during the physical examination the patient's role changes[2]. The clinician can make this process easier by guiding the patient's throughout, knowing that patients start the examination with some uncertainty. Your patient needs to understand the process and follow your train of thought. This is achieved by providing a structure, to signpost.
Signposting: refers to informing your patient what you are about to say or do to help them feel less anxious and give them a sense of control. By providing a concise summary of the last step and the following step of the assessment[7],
Example:
Following the subjective history taking of an MSK condition, the clinican can signpost by saying:[2]
With all the information you have given me, I've a couple of ideas what might be the cause of your discomfort. We will now move on to a physical examination to try and narrow down the underlying structures responsible for your symptoms. I firstly want to assess how you move in general and then simultaneously check for the possible involvement of your vertebral joints, muscles, and nerves in your back pain. I'm going to guide you into doing a couple of movements and whenever you feel your familiar pain, I would like you to tell me and then move out of the uncomfortable position.
Resources[edit | edit source]
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References[edit | edit source]
- ↑ Kourkouta L, Barsamidis K, Lavdaniti M. Communication skills during the clinical examination of the patients. Progress in Health Sciences. 2013;3(1):119.
- ↑ 2.0 2.1 2.2 Fourie M. Communication in the Physical Examination. Physioplus Course 2021
- ↑ 3.0 3.1 Asif T, Mohiuddin A, Hasan B, Pauly RR. Importance of thorough physical examination: a lost art. Cureus. 2017 May;9(5).
- ↑ Singh H, Dickinson JA, Thériault G, Grad R, Groulx S, Wilson BJ, Szafran O, Bell NR. Overdiagnosis: causes and consequences in primary health care. Canadian Family Physician. 2018 Sep 1;64(9):654-9.
- ↑ Jalil A, Zakar R, Zakar MZ, Fischer F. Patient satisfaction with doctor-patient interactions: a mixed methods study among diabetes mellitus patients in Pakistan. BMC health services research. 2017 Dec 1;17(1):155.
- ↑ Hinchliffe NC and Lavin N (2018) Why do patients with low back pain choose not to engage with physiotherapy following assessment? International Journal of Therapy & Rehabilitation. 25(3): 120-127.
- ↑ Nursing on the Move. Communication Tips- Directive Skills: Signposting. 2016. Available from: https://www.goinginternational.eu/wp/de/communication-tips-directive-skills-signposting/#:~:text=A%20signpost%20is%20an%20explicit,what%20is%20going%20to%20happen.
