non problematic patients

Whilst on my musculoskeletal outpatient placement, I discovered an interesting phenomenon among several patients. There were several patients who I would be following up on (from the previous student) that seemed to not really have any problem, and yet would still think that they need physiotherapy. I can recall a few patients who had been treated for a condition by the previous student, but upon subjective exam did not appear to have any of their former pain or any functional limitations. And I found myself wondering- what did this patient even come to the clinic for?
The subjective assessments were in particular pretty frustrating. When asking a direct question (e.g. “what is your main problem?”) the patient would answer with a vague and rambling answer where he/she might talk about a few previous injuries that they’d had, or something that they used to have trouble with, which upon further questioning has completely resolved. After ten minutes of subjective assessment you might have only gleaned one functional activity that the patient is getting a little bit of pain with, but which is not really anything that serious.
Objective assessments with people like this are pretty similar to subjective. Patients might report generalized pain throughout their body but nothing that is connected to what they reported in the subjective assessment. By the end of the subjective assessment a problem which could use physiotherapy intervention may have been identified, but it might not have anything to do with what was gleaned from the subjective assessment.
I found that the kind of patients who presented like this were those who were of the more elderly age group, and usually retired. Without trying to infer too much about this group, it seems that they have much more time, and that they see attending physiotherapy as possibly another way to fill their day. Or perhaps they just like the company.
It’s a stark contrast to the majority of patients who attend outpatient physiotherapy. Most are very busy, and often many patients miss or cancel their appointments due to work, family, or other commitments. Most patients are also very straight to the point i.e. “this is my pain, and this is what I’m having trouble doing- fix me”.
These treatments are not really a waste though. As most of these patients are elderly, they were often started on a general program of strengthening and balance, and given a regular walking program, as a maintenance and prevention measure. This can be pivotal in preventing falls and subsequently fractures. I guess the important thing is to identify these patients early so that you don’t tie yourself in knots and waste a lot of time trying to figure out what their problem is. As most patients like this are elderly, we can always give them general geriatric maintenance programs. And I guess we shouldn’t forget to be as friendly and talkative as we can- because one day we are going to be old too.