The Communicative Detective

The.. what? The Communicative Detective?
Let me explain.

As a physiotherapist, you act during history taking and assessment as a detective. You’re exploring and analysing the health problem of your patient. That is what you do, don’t you?

A Communicative Detective is doing this in close connection with his patient.
That means that he is telling the patient during the history taking and during the physical assessment what he wants to know or what he wants to test.

And beside that: the communicative detective makes the patient part of the analyzing process by deliberating about the approach, explaining why it is helpful to discuss certain topics before actually discussing the topic, explain certain interpretations of symptoms and signs, etc.

physiotherapist as communicative detective

So not a silent detective, but a communicative one

In this role, the physical therapist unravels the health problem of the patient in consultation with the patient.

Implicitly the patient asks from the physiotherapist if he wants to help him understand what is going on with him. In response to this, the physical therapist assumes the role of communicative detective and explains to the patient what he thinks and why.

Also in the process of analysing and diagnosing the health problem, he shares what the patient needs, to make him capable of carrying out his own process of analysis and determination.

In the end the Communicative Detective comes to shared decision making.

Naturally, the physical therapist uses his specific professional expertise in this role. However, he doses his expertise as well as the degree of being directive and thus tries to preserve and strengthen the capacities of autonomy of the patient.

In the role of communicative detective, the physical therapist:

  • asks open and closed questions depending on the purpose of the question,
  • asks questions on crucial elements,
  • reflects on the meaning behind the patient’s answers,
  • shared (parts of) his analysis with the patient in the interim and at the end,
  • provides information to the patient to enable him to take part in analysing the health problem,
  • structures the conversation with (partial) summaries.
  • and much more….

And how about the teacher?

Probably you ask yourself: how about the teacher? He is providing information to, isn’t he?
Yes he is. In the book, I ‘separated’ these two roles. For educational use.

The teacher provides information en educates the patient in the therapeutic process. The communicative detective is only working in the diagnostic process.