Examination and communication: a study of first encounters between patients and physiotherapists

What happens in first encounters between patients and physiotherapists? Videotaped encounters between two patients and their physiotherapists were analysed in depth to try to answer this question. It is advocated that attention must not be restricted to either clinical decision making or communication, but needs to be directed towards the relationship between communication and diagnostic approaches. In other words, in order to understand how a health problem is defined, the complexity and social organization of the process of interaction cannot be ignored. Therapies are chosen and cooperation is built on such socially and professionally constructed basis, and it is suggested that the nature of this construction needs to be grasped. To this end, the author analyses both the therapists' examination and the communication between patient and therapist. Focus is thereby shifted from the 'pure' diagnostic activity to the frame of reference underlying it. The analysis demonstrates differences in the two therapists' practice from the very moment patient and therapist greet one another till they say farewell. The therapists' actions mirror the dissimilar conceptual frameworks underlying their practice, and the therapists' conceptual lenses therefore need to be scrutinized further.