Lisa Roberts PhD MCSP
Arthritis Research UK Senior Lecturer in Physiotherapy / Consultant Physiotherapist
University Hospital
Southampton

• The challenge of communication
• Issues of truth telling
• Current research
• Opening clinical encounters
• Implications for practice

‘The most important aspect that health
professionals have to master’
Weatherall (1998)

Importance of:
• Verbal communication
• Non-verbal (55-97%)
• Patient-therapist relationship

80% of patients’ complaints arise from a breakdown in communication
Towles BMJ;1998:301-4

• Touch
• Showing interest (Hawthorne effect)
• Professionalism
• Actively listening
• Environment
• Technical equipment
• Placebo effect ….

The most important thing in communication is to hear what isn't being said.
Peter Drucker

• To reduce fear
• To tolerate stress
• To gain control over uncertainty
• Superstition
• To enhance well-being
• To protect privacy / confidentiality
• To help others
• To be malicious

…of the most important factors in successful treatment
• patient-therapist relationship
• patients’ resources
More important to success than treatment techniques
Stenmar & Nordholm. Physical Therapy 1994;74:1034-9.

To measure the content and prevalence of the verbal and non-verbal communication that occur between physiotherapists and patients with low back pain in an outpatient setting.
Roberts L & Bucksey SJ. Communicating with patients: what happens in practice?
Phys Ther 2007; 87: 586–94

Patients (n = 21) Physiotherapists (n = 7)
Video recording: Initial treatment session (n=21)
Key findings
1. Verbal & non-verbal communication can be measured with valid and reliable tools
2. Affective behaviours were more prevalent among experienced physiotherapists
3. Video camera was perceived to influence communication, planning and treatment
Roberts & Bucksey
Physical Therapy 2007;87(5):586-94

• Funded by Arthritis Research UK
• 'What communication and clinical decision making takes place in consultations between physiotherapists and people with back pain?'

Home visit
Observation of initial back pain consultation
Physio interview
Patient interview

Wessex Medical Research:
Student Innovation Grant 2009
“Piloting an analysis of verbal communication using
Synote in consultations between physiotherapists and people with back pain.”
Christopher Whittle
University of Southampton

http://www.synote.org/synote/

• Grounded theory approach
• Data managed through ‘Framework’
 27 home visits
 25 initial consultations
 25 interviews with physiotherapists
 25 interviews with patients

• Knowledge:
Technical
Life
• Skills:
Technical
Interpersonal
• Personal attributes:
Appearance
Manner

• ‘How can I help you today?’
• ‘Do you want to tell me your story’
• ‘I’ve had this referral through. Tell me what’s happened’
• ‘What problem are you having at the moment?’
• How long have you had back pain for?
• It’s your back pain that you’re here for is it?’
• The referral says you’ve got back pain. Is this correct?
• ‘What we’ll do today is just have a bit of a chat about your back pain I believe it is. All right?

• How do you open your clinical encounters?
• How often do you interrupt your patients?
• Do you tailor your communication to take account of gender and age?
• When was the last time you told a ‘little white lie’?
• Have you spent time evaluating your communication skills?
• How will you maximise your non-specific treatment effects?