Symptoms and patient identified problems

I didn't formally grasp the concept of patient-identified problems until my early thirties. Like many clinicians, I may have had an intuitive understanding, but most of what I considered the patient's problem was what I had been taught or read in textbooks—essentially, symptoms.

What are symptoms?

Well, these something you feel and experience when you have a disease. Typically, we assess and treat these assuming they represent the patient's problem. For stroke patients, commonly described symptoms include spasticity, abnormal movements, circumductory gait, weakness, among others. In Parkinson's disease, we're taught to recognize bradykinesia, tremor, rigidity, and festinating gait If you read better more symptoms like swallowing difficulty, freezing, Falls, and others might be added. In case of OA knee or LBP we mostly read about pain and range of motion.

The consequences:

What we think we should treat, assess and the outcome are mostly biased based on these symptoms. This leads us to think spasticity, rigidity, bradykinesia, ROM as important issues. We now know this is not the adequate way of to assess and treat patients.

What’s missing?

Well what’s missing is- what do patients think is there problems because of the disease. what problems do they encounter because of the disease. Those are what is called as patient identified problems. In stroke cases, these issues can be diverse and extensive, extending beyond what clinicians typically recognize. For instance, patients may struggle with tasks like dressing themselves to go to temple. Similarly, individuals with Parkinson's disease may face challenges such as falling when getting up from the toilet or being unable to walk to the parking lot. In conditions like osteoarthritis of the knee, patients may simply aspire to walk with minimal pain or to ascend stairs to their first-floor homes without difficulty. These patient-identified problems offer crucial insights into the lived experience of illness especially they intangible problems.

These are the challenges that patients are eager to overcome and improve upon—the outcomes that truly matter to them. During a consult, we need to listen and understand the patients problem, assess and see if we can help patient manage those and at the end observe if we have changed them.

Even though as time goes by a reflective therapist will intuitively learn to understand and illicit patients problem, we can do better. I think we need train ourselves, in better communication skills and conducting thorough consultations with patients. We need to do more listening, more research, and mature to become a science for the people.