Tea or coffee... to drink or not to drink?

I am currently on a RITH placement (rehab in the home). Given the nature of this type of service, a lot of the patients tend to be quite elderly, and often living on their own. As a result, they are commonly quite lonely and starved of good conversation!

Whilst building up a good rapport with the patient is very important, I am finding it difficult at times to maintain an appropriate balance between letting the patient converse socially with me and actually completing the treatment in the required time-frame.

One patient in particular loves to chat, but isn't so keen on doing her exercises... The patient has very reduced exercise tolerance and balance/mobility following a long hospitalisation after a car accident. Whilst subjectively examining her, asking a simple question like "Can you tell me how the accident occurred?" often leads to a very long-winded, detailed answer along the lines of "Well I was travelling down this street heading to my friend's new house at this exact address... or was it this address? Hmm no definitely this address, then I turned right onto this road and took the next left onto this road, and because the time was exactly 5:46pm, the sun was directly in my eyes, etc, etc" (you get the idea!). Time was quickly being eaten up by unnecessarily long answers and it was very hard to get a word in and interrupt the patient without coming across as being rude.

The patient, who was German, then offered us a tea or coffee and we had to decline as time was getting on and we had other patients to see. The patient seemed quite offended by our refusal, so we told her perhaps if there was time on our next visit... The next time we saw her she invited us in and told us to have a seat around the table and again offered us a tea or coffee- explaining that in her culture, that is just what they do- as a good host you always offer visitors a drink (and they always say yes!). We hadn't even begun her exercises yet so we politely declined and again, the patient seemed quite offended. In the end I confessed to her that I actually don't drink tea or coffee anyway- so she offered us a soft drink. Accepting was the only way we could get her to move on and start exercising!

I spoke to my supervisor about the scenario and she explained that such situations are very common. She suggested that in the future, if I suspect the patient might be a chatty one, to say something right at the beginning (before subjective questioning) like "I'm going to ask you a few questions about your accident/injury, etc- sometimes I will want very detailed answers but for some questions it is not as important to go into detail, so if I do have to interrupt at any stage because time is getting away from us, please do not think I am being rude". She also suggested that I let the patient know at the beginning that I do not have long, because I have to get to my other patients.

The next time I saw the patient I suggested we get straight into her exercises so that we had time at the end to have a drink. Once she had done all her exercises, and the patient asked (predictably) if I wanted a tea or coffee- I simply asked for a water, and got the patient to pour herself a cup of coffee so that I could simultaneously assess how well she was handling basic functional tasks at home.

Often patients do not realise how precious our time is and that we are there for physio, not for a social visit. The skill of EFFICIENTLY extracting the right amount of information from the patient is a difficult one, especially with geriatric patients. The key is to build appropriate rapport with the patient without letting yourself (or the patient) forget that you are there, more importantly, as a physiotherapist.