5 things I notice in the first 5 minutes with a new patient

Before I’ve said more than hello, I’m watching how a patient rises from their seat. Do they push off the armrests? Do they rock forward first? Do they hesitate? A smooth, controlled sit-to-stand tells me one story. A labored, compensated movement tells me another. Chair transfers are one of the most functional things an older adult does dozens of times a day — and one of the most revealing windows into their strength, balance, and confidence.

Most people don’t realize they do this, but many older adults with balance concerns look down at their feet when they walk. It’s a compensatory strategy — the brain is trying to gather more visual information to feel steady. The problem is that looking down shifts your center of gravity forward and actually increases fall risk. When I see it, I know we need to work on vestibular confidence, not just leg strength.

This question matters less for the words and more for what’s underneath them. Some patients tell me exactly what’s wrong with clinical precision. Some deflect with humor. Some look at their family member to answer for them. Some say ‘I feel fine, my daughter made me come.’ Each of these tells me something important about motivation, self-awareness, and who the real stakeholder in this person’s recovery is going to be. Motivation is everything in therapy. I’d rather spend the first session finding out what someone genuinely wants to be able to do again than starting with exercises they don’t care about.

Shallow, effortful breathing during what should be easy movement is something I notice immediately. It can indicate pain being masked, anxiety, deconditioning, or a cardiac or pulmonary issue that hasn’t been flagged yet. I’m not a physician — but I am often the person who sees a patient move through functional activities in a way that a clinic appointment never captures. More than once, noticing a breathing pattern during a therapy evaluation has led to an important referral.

This might be the most telling of all. A patient who asks ‘What are we going to work on?’ or ‘How long do you think this will take?’ is already engaged. A patient who sits quietly and waits to be told what to do needs a different approach — not a lesser one, just a different one. Therapy is not something that happens to a person. It’s something they do, with our support. The patients who make the most progress are almost always the ones who are curious, even when they’re scared.