BIG LIST OF WEBSITES

List of Top Websites on Dropped

Top 250 Websites on DROPPED

Download the Top 250 Websites to PDF

Last updated on Sep 1 2020.
Here are the best websites we found: abcnews.go.com • freshdrop.com • erehr.wordpress.com • feelingwoolly.co.uk • pricedroppedbooks.com • adroppedstitch.net • thatnerdsoul.com • mickhollickandsons.co.uk • biozshock.com

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ABC News – Breaking News, Latest News, Headlines & Videos. Your trusted source for breaking news, analysis, exclusive interviews, headlines, and videos at ABCNews.com
Alexa Rank
1,332
FreshDrop.com | Expired or Dropped Domains | Domain Name Search. Looking for expired or dropped domains? You''ve found the perfect domain name marketplace-all domains on one site-FreshDrop.com, since 2007.
Alexa Rank
98,886
Erehr Nah | Random stuff will be dropped here. Mostly LN PDF's. Random stuff will be dropped here. Mostly LN PDF's
Alexa Rank
1,000,001
Feeling Woolly - The Chronicles of a Dropped Stitch. The Chronicles of a Dropped Stitch
Alexa Rank
1,000,001
Price Dropped Books | Receive daily updates on all of the best price-dropped books for Amazon Kindle. More than 50% reduction on every title.
Alexa Rank
410,193
A Dropped Stitch - Kratom Near Me, Jourdanton RV Park, Electric Contractors Binghamton
Alexa Rank
1,000,001
NERDSoul • Video & Podcasts on Geek | Pop Culture | Film | TV News | Reviews & Dropped Jewels
Alexa Rank
1,000,001
Driveways, Dropped Kerbs, Patios, Drainage, Tarmac, Paving & Concrete – Council Approved Contractor. One of the leading providers in Driveways and Drop kerbs, Block paving, Tarmac, Concrete, Patio in Swindon and surrounding areas. Family run business.
Alexa Rank
1,000,001
You have just dropped to BiozShock''s home. My stub page
Alexa Rank
1,000,001
“‘A man I knew who had been to Siberia and returned, told me that he himself had been a witness of how the very most hardened criminals remembered the old general, though, in point of fact, he could never, of course, have distributed more than a few pence to each member of a party. Their recollection of him was not sentimental or particularly devoted. Some wretch, for instance, who had been a murderer--cutting the throat of a dozen fellow-creatures, for instance; or stabbing six little children for his own amusement (there have been such men!)--would perhaps, without rhyme or reason, suddenly give a sigh and say, “I wonder whether that old general is alive still!” Although perhaps he had not thought of mentioning him for a dozen years before! How can one say what seed of good may have been dropped into his soul, never to die?’
Alexa Rank
1,000,001
Ink Drops stationery subscription boxes UK | inkdrops.co.uk. Delightful stationery, dropped through your letterbox! Stationery subscription boxes & limited edition themed stationery boxes, based in the UK, shipping worldwide. Perfect gifts (who doesn't love new stationery?!) or treats for yourself. Come on in!
Alexa Rank
1,000,001
Mobile Phone Signal Booster | Best Signal Boosters in Ireland. Forget about dropped calls and bad mobile network reception! Get one of our incredible phone signal boosters on irelandboosters.com!
Alexa Rank
1,000,001
Phone Claim - File a Claim for Your Device | Phoneclaim.com. Dropped your device in water? Cracked your screen? Lost your phone? File your claim online and you could receive a replacement in 24 hours.
Alexa Rank
48,136
Odstock Medical Ltd (OML) | Leading rehabilitation through technology. Welcome to Odstock Medical the leading manufacturer of Clinical Functional Electrical Stimulation systems (FES) together with the associated treatments for patients who are effected by a dropped foot or upper limb disability.
Alexa Rank
1,000,001
ALOT. Alot publishes enlightening articles, slideshows, and infographics on topics like health, travel, finance, home, education, and careers.
Alexa Rank
9,926
Detroit Local News - Michigan News - Breaking News - detroitnews.com. Get the latest local Detroit and Michigan breaking news and analysis , sports and scores, photos, video and more from The Detroit News.
Alexa Rank
12,750
Phone Junkies – Phone Junkies Taunton, Bath
Alexa Rank
1,000,001
Home - itmeJP. itmeJP is an online personality, YouTuber, Twitch streamer, and creator of popular shows RollPlay, Dropped Frames, State of the Game, and Real Talk.
Alexa Rank
191,508
Sportex Safety - Personal Protective Equipment - Safety Recognition Programs - Screen Printing - Embroidery - Signs Banners and Decals - We Do it All!. Personal Protective Equipment - Safety Recognition Programs - Screen Printing - Embroidery - Signs Banners and Decals - We Do it All! Cut and Sew, Laser Engraving, Digital Printing, & Promotionl Products. We do it all! Dropped Object Prevention Products
Alexa Rank
312,687
Wilson Cell Phone Signal Boosters | Cell Boosters | WilsonPro. WilsonPro's high performance commercial cell phone signal boosters and accessories increase cell coverage and reduce dropped calls in your office or home.
Alexa Rank
424,410
Tool.Domains - SEO, Expired Domain Tools, Whois Research. The ultimate domain tool for finding dropped names with SEO value and researching Whois, owner relations, SEO&Social metrics and website content.
Alexa Rank
702,657
DAVID SOMMERVILLE. David Sommerville Rouler #bikelife - "Retired" in 2012 after 26th season, having pinned race number on over 1800 times, which is 5+ consecutive YEARS of daily racing! Cranked out more than 200,00 miles with fair share of victories, defeats, getting dropped, hundreds of flats, spills & mishaps, and spent thousands of hours on the bike. "I''ve been dropped in more races than you have done..." #dadlife - married to Lori Sommerville, father of Devin Sommerville, resides in South Slope, Brooklyn, NYC. #joblife - Director of Verge Sport and Director of Technology for Verge Global, basically slinging shoe covers, which come in pairs....and implementing code. #pastlife - Master stylist to the stars at John Dellaria Salon in Soho, NYC for 17 years. Grand Master of Pyrametrics cutting system while also known for premium highlighting ability. Retired in 2012 to enter the Bicycle Industry.
Alexa Rank
1,000,001
Tech Zone 24 – Just another WordPress site. While browsing the internet I came accross an amazing article from Semrush that I would like to share with you. If you enjoy this article then you can visit the original article using the link to the bottom of this page. You’ve heard people telling you that you need to write in-depth content because that’s what Google wants. And it’s true… the average page that ranks on page 1 of Google contains 1,890 words. But you already know that. The question is, should you be writing 2,000-word articles? 5,000? Or maybe even go crazy and create ultimate guides that are 30,000 words? What’s funny is, I have done it all. I’ve even tested out adding custom images and illustrations to these in-depth articles to see if that helps. And of course, I tested if having one super long page with tens of thousands of words or having multiple pages with 4,000 or 5,000 words is better. So, what do you think? How in-depth should your content be? Well, let’s first look at my first marketing blog, Quick Sprout. Short articles don’t rank well With Quick Sprout, it started off just like any normal blog. I would write 500 to 1,000-word blog posts and Google loved me. Just look at my traffic during January 2011. As you can see, I had a whopping 67,038 unique visitors. That’s not too bad. Even with the content being short, it did fairly well on Google over the years. But over time, more marketing blogs started to pop up, competition increased, and I had no choice but to write more detailed content. I started writing posts that were anywhere from 1,000 to a few thousand words. When I started to do that, I was able to rapidly grow my traffic from 67,038 to 115,759 in one year. That’s a 72.67% increase in traffic in just 1 year. It was one of my best years, and all I had to do was write longer content. So naturally, I kept up with the trend and continually focused on longer content. But as the competition kept increasing, my traffic started to stagnate, even though I was producing in-depth content. Here are my traffic stats for November 2012 on Quick Sprout. I understand that Thanksgiving takes place in November, hence traffic wasn’t as high as it could be. But still, there really wasn’t any growth from January to November of 2012. In other words, writing in-depth content that was a few thousand words max wasn’t working out. So what next? Well, my traffic had plateaued. I had to figure something else out. Writing longer, more in-depth content had helped me before… so I thought, why not try the 10x formula. I decided to create content 10 times longer, better, and more in-depth than everyone else. I was going to the extreme because I knew it would reduce the chance of others copying me. Plus, I was hoping that you would love it as a reader. So, on January 24, 2013, I released my first in-depth guide. It was called The Advanced Guide to SEO. It was so in-depth that it could have been a book. Literally! Heck, some say it was even better than a book as I paid someone for custom illustration work. Now let’s look at the traffic stats for January 2013 when I published the guide. As you can see my traffic really started to climb again. I went from 112,681 visitors in November to 244,923 visitors in January. Within 2 months I grew my traffic by 117%. That’s crazy!!!! The only difference: I was creating content that was so in-depth that no one else dared to copy to me (at that time). Sure, some tried and a few were able to create some great content, but it wasn’t like hundreds of competing in-depth guides were coming out each year. Not even close! Now, when I published the guide I broke it down into multiple chapters like a book because when I tested out making it one long page, it loaded so slow that the user experience was terrible. Nonetheless, the strategy was effective. So what did I do next? I created 12 in-depth guides I partnered up with other marketers and created over 280,000 words of marketing content. I picked every major subject… from online marketing to landing pages to growth hacking. I did whatever I could to generate the most traffic within the digital marketing space. It took a lot of time and money to create all 12 of these guides, but it was worth it. By January of 2014, my traffic had reached all-time highs. I was generating 378,434 visitors a month. That’s a lot for a personal blog on marketing. Heck, that’s a lot for any blog. In other words, writing 10x content that was super in-depth worked really well. Even when I stopped producing guides, my traffic, continually rose. Here’s my traffic in January 2015: And here’s January 2016 for Quick Sprout: But over time something happened. My traffic didn’t keep growing. And it didn’t stay flat either… it started to drop. In 2017, my traffic dropped for the first time. It went from 518,068 monthly visitors to 451,485. It wasn’t a huge drop, but it was a drop. And in 2018 my traffic dropped even more: I saw a huge drop in 2018. Traffic went down to just 297,251 monthly visitors. And sure, part of that is because I shifted my focus to NeilPatel.com, which has become the main place I blog now. But it’s largely that I learned something new when building up NeilPatel.com. Longer isn’t always better Similar to Quick Sprout, I have in-depth guides on NeilPatel.com. I have guides on online marketing, SEO, Google ads, Facebook ads, and the list goes on and on. If you happened to click on any of the guides above you’ll notice that they are drastically different than the ones on Quick Sprout. Here are the main differences: No fancy design – I found with the Quick Sprout experience, people love the fancy designs, but over time content gets old and outdated. To update content when there are so many custom illustrations is tough, which means you probably won’t update it as often as you should. This causes traffic to go down over time because people want to read up-to-date and relevant information. Shorter and to the point – I’ve found that you don’t need super in-depth content. The guides on NeilPatel.com rank in similar positions on Google and cap out at around 10,000 words. They are still in-depth, but I found that after 10,000 or so words there are diminishing returns. Now let’s look at the stats. Here’s the traffic to the advanced SEO guide on Quick Sprout over the last 30 days: Over 7,842 unique pageviews. There are tons of chapters and as you can see people are going through all of them. And now let’s look at the NeilPatel.com SEO guide: I spent a lot less time, energy, and money creating the guide on NeilPatel.com, yet it receives 17,442 unique pageviews per month, which is more than the Quick Sprout guide. That’s a 122% difference! But how is that possible? I know what you are thinking. Google wants people to create higher quality content that benefits people. So how is it that the NeilPatel.com one ranks higher. Is it because of backlinks? Well, the guide on Quick Sprout has 850 referring domains: And the NeilPatel.com has 831 referring domains: Plus, they have similar URL ratings and domain ratings according to Ahrefs so that can’t be it. So, what gives? Google is a machine. It doesn’t think with emotions, it uses logic. While we as a user look at the guide on Quick Sprout and think that it looks better and is more in-depth, Google focuses on the facts. See, Google doesn’t determine if one article is better than another by asking people for their opinion. Instead, they look at the data. For example, they can look at the following metrics: Time on site – which content piece has a better time on site? Bounce rate – which content piece has the lowest bounce rate? Back button – does the article solve all of the visitors’ questions and concerns? So much so they visitor doesn’t have to hit the back button and go back to Google to find another web page? And those are just a few things that Google looks at from their 200+ ranking factors. Because of this, I took a different approach to NeilPatel.com, which is why my traffic has continually gone up over time. Instead of using opinion and spending tons of energy creating content that I think is amazing, I decided to let Google guide me. With NeilPatel.com, my articles range from 2,000 to 3,000 words. I’ve tried articles with 5,000+ words, but there is no guarantee that the more in-depth content will generate more traffic or that users will love it. Now to clarify, I’m not trying to be lazy. Instead, I’m trying to create amazing content while being short and to the point. I want to be efficient with both my time and your time while still delivering immense value. Here’s the process I use to ensure I am not writing tons of content that people don’t want to read. Be data driven Because there is no guarantee that an article or blog post will do well, I focus on writing amazing content that is 2,000 to 3,000-words long. I stick within that region because it is short enough where you will read it and long enough that I can go in-depth enough to provide value. Once I release a handful of articles, I then look to see which ones you prefer based on social shares and search traffic. Now that I have a list of articles that are doing somewhat well, I log into Google Search Console and find those URLs. You can find a list of URLs within Google Search Console by clicking on “Search Traffic” and then “Search Analytics”. You’ll see a screen load that looks something like this: From there you’ll want to click on the “pages” button. You should be looking at a screen that looks similar to this: Find the pages that are gaining traction based on total search traffic and social shares and then click on them (you can input URLs into Shared Count to find out social sharing data). Once you click on the URL, you’ll want to select the “Queries” icon to see which search terms people are finding that article from. Now go back to your article and make it more in-depth. And when I say in-depth, I am not talking about word count like I used to focus on at Quick Sprout. Instead, I am talking depth… did the article cover everything that the user was looking for? If you can cover everything in 3,000 words then you are good. If not, you’ll have to make it longer. The way you do this is by seeing which search queries people are using to find your articles (like in the screenshot above). Keep in mind that people aren’t searching Google in a deliberate effort to land on your site… people use Google because they are looking for a solution to their problem. Think of those queries that Google Search Console is showing you as “questions” people have. If your article is in-depth enough to answer all of those questions, then you have done a good job. If not, you’ll have to go more in-depth. In essence, you are adding more words to your article, but you aren’t adding fluff. You’re not keyword stuffing either. You are simply making sure to cover all aspects of the subject within your article. This is how you write in-depth articles and not waste your time (or money) on word count. And that’s how I grew NeilPatel.com without writing too many unnecessary words. Conclusion If you are writing 10,000-word articles you are wasting your time. Heck, even articles over 5,000 words could be wasting your time if you are only going after as many words as possible and adding tons of fluff along the way. You don’t know what people want to read. You’re just taking a guess. The best approach is to write content that is amazing and within the 2,000 word to 3,000-word range. Once you publish the content, give it a few months and then look at search traffic as well as social sharing data to see what people love. Take those articles and invest more resources into making them better and ultimately more in-depth (in terms of quality and information, not word count). The last thing you want to do is write in-depth articles on subjects that very few people care about. Just look at the Advanced Guide to SEO on Quick Sprout… I made an obvious mistake. I made it super in-depth on “advanced SEO”. But when you search Google for the term “SEO” and you scroll to the bottom to see related queries you see this… People are looking for the basics of SEO, not advanced SEO information. In Conclusion If you would certainly such as to check out even more short articles on search engine optimization after that feel cost-free to search our various other articles. We have many more curated write-ups from semrush as well as I wish you delight in reading them. link to original source
Alexa Rank
1,000,001
A Cooks Tale. At 25 I dropped everything to move to Austin, TX to become a cook after being a high school music teacher. I wanted to share my experiences and some stories along the way.
Alexa Rank
1,000,001
Slippery when wet.. 21yr old man living in Australia. Ask me anything :) Exploring my sexuality at the moment, dropped a few kilos and I'm feeling sexy again, Help me explore? ;). Sorry chaps but I am straight. 18+ only...
Alexa Rank
1,000,001
Deep 6 Marine/Dive Services/ Table Rock Lake. Hull cleaning, salvage diving, underwater tree cutting, dock maintenance and more! Dropped a cell phone or other items in the lake? Call us! 417- 339-1836
Alexa Rank
1,000,001
cherished property. cherished-property is now cherishedproperty. I dropped the hyphen, y'all.
Alexa Rank
1,000,001
Aesthetically. "I hit a wall, I never felt so low, so low, like a waterfall, my tears dropped to the floor."-Rihanna
Alexa Rank
1,000,001
JERRY FOUST | Artist in Exile. Future Primitive POP - Artist in Exile - Jerry Foust. This Dallas born,  old-school 1990's NYC transplant dropped all of his personal possessions 11 years ago and decided to pick up a paintbrush instead.  With no former art training, Jerry Foust's unique painting style came to life in 2002 during his stay at the art…
Alexa Rank
1,000,001
Stem Cell Information & Regenerative Cell Therapy In Ohio For Joint Pains. Stem cell therapy costs have dropped. Regenerative Cell Therapy shots. Get knee, shoulder, back, spine, hip, hand & wrist, foot & ankle, and elbow pains treated effectively. Avoid surgery.
Alexa Rank
1,000,001
Home | SueloMOB. Truck Enthusiast Clothing Brand For Dropped Trucks
Alexa Rank
1,000,001
JT Franco - Freeing Millions of Entrepreneurs From Slavery. Hi I’m JT Franco. Most of my life I’ve been labeled as a rebel. When I was 17 I dropped out of high school because I was never good at following instructions. I have always struggled with doing what I was told… the school system was no exception. I never felt like I fit in, and I felt like everyone around me was working so hard just to wind up in a dead end.
Alexa Rank
1,000,001
Podcast Palladium | The craziest podcasts on the net. Welcome to Podcast Palladium. We are very glad you dropped by. To listen to the latest episode in each show we produce, click on the show you are interested in as it appears on the sidebar to the right. The episodes for each show are listed from most to least recent. While you're here, make…
Alexa Rank
1,000,001
River Island Sweatshirt Borg Lined, ASOS Long Sleeve T-Shirt,Zaful Retro Leather Coat. Only & Sons Black Side Pockets Sweat Pant,Mango Oxford Shirt White Regular Fit,Dr Denim Mauro Sweater Dropped Shoulders
Alexa Rank
1,000,001
. I'm so glad you dropped by. You are only click away from some great reading materiel! This is my blog, Fempire Rising. It's dedicated to amazing, complex, brave, intelligent, bad ass women. I mostly focus on fictional ladies because, let's be honest, our media isn't exactly bursting with well written female characters. As a little…
Alexa Rank
1,000,001
Visa. Limited Edition Clothing - Not On The High Street - Free World Wide Shipping - New Designs Dropped Weekly
Alexa Rank
1,000,001
Healthcare Call Center. Healthcare Call Center Service. Our Patient Communication Management® suite of solutions allows our clients to improve their patient satisfaction, efficiency, reduce wait time and dropped calls. Services include Central Scheduling, Appointment Reminders, Answering Service and Chronic Care Management.
Alexa Rank
1,000,001
Suppose U Drive Truck Rental & Leasing | Southern California. Suppose U Drive rents by the day, week, or month, and leases for the long-haul. Our fleet includes pickups, stake bodies, vans, and tractor-trailer combinations of all weight classes. Trucks are fully maintained and can be picked up and dropped off at multiple locations.
Alexa Rank
1,000,001
Data Recovery - Studio Leonardo - Home. Data Recovery - Studio Leonardo - We specialize in professional data recovery (data retrieval) and data destruction (data sanitization) from servers, NAS and RAID volumes, PC (personal computer) and laptop hard disk drives (HDD), external hard drives, solid state drives (SSD), Mobile Devices (smartphones, mobile phones tablets, PDA''s and cellular phones), backup tapes (tape cartridges), CDs and DVDs, memory sticks (flash drives), SD cards and almost all other types of digital data storage devices. This includes data recovery from electro-mechanically failed hard drives, dropped hard drives, data corruption, virus infections, data deletion, formatted drives, data tape cartridges to multiple hard drive failures on your RAID volume - no matter what your data loss situation looks like; we strive to have a solution to help recover your data!
Alexa Rank
1,000,001
tsukikageScans. A scanlation group dedicated to awesome manga that are stalled, dropped or forgotten by other groups. We provide scanlations in English and German.
Alexa Rank
1,000,001
Clean and Fit Mama. In May of 2012, I started my journey of {clean} eating and becoming more fit. To date, I have lost 46 pounds and 40 1/2 inches off my body (dropped four sizes!)- those results are hard to argue with!...
Alexa Rank
1,000,001
Deposed Leader. Someone tell me what to do, please... Pregame Ouma dropped smack into the middle of the killing game. He doesn't know what's going on, or how he got into this weird computer room, or who exactly a...
Alexa Rank
1,000,001
The Clarion-Ledger | Mississippi and Jackson Metro''s News Source. Your one stop shop for news, weather, and activities in the Jackson Metro area.
Alexa Rank
53,385
Burlington Free Press. BurlingtonFreePress.com is the home page of Burlington VT, with in-depth and updated local news, sports, things to do, investigative journalism and opinions.
Alexa Rank
54,369
JAMnews. Caucasus News, Politics and Society
Alexa Rank
63,627
Heartland Credit Union Minnesota. Heartland is a member-owned, not-for-profit financial cooperative serving people in Dakota, Scott, Rice, Le Sueur, Carver, Hennepin, Ramsey and Washington Counties, Minnesota as well as employees and retirees of CHS Inc., Land O''Lakes, Inc, Chart Industries, Genex Coopertive and more. We’re here to enhance your financial well being with solutions to maximize your money and your time.
Alexa Rank
226,479
ISHN.com - the magazine for safety & health professionals who direct safety & health programs in high-hazard workplaces.. ISHN is delivered monthly to 71,400 safety and health professionals who direct safety and health programs in high-hazard workplaces.
Alexa Rank
263,619
ABC News – Breaking News, Latest News, Headlines & Videos. Your trusted source for breaking news, analysis, exclusive interviews, headlines, and videos at ABCNews.com
Alexa Rank
291,826
Protecting animals and teaching responsible pet ownership. The HBSPCA is a private non-profit registered charity serving a mixed urban and rural community.
Alexa Rank
289,527
Stefan Grossman's Guitar Workshop. Welcome to Stefan Grossman's Guitar Workshop and Vestapol Videos, offering the best in instructional guitar DVDs, Audio CDs and Books, and the Vestapol series of historic and concert DVDs. We offer a wide variety of DVD and CD audio guitar lessons focusing on various aspects of fingerstyle and flatpicking guitar styles and techniques.
Alexa Rank
306,174
Dramas with a Side of Kimchi | Taking Blogging to the Fangirl Level. Taking Blogging to the Fangirl Level
Alexa Rank
322,888
MySQL High Availability | News from the MySQL High Availability Team
Alexa Rank
448,842
Home | Stillunfold. Stillunfold roofs a fusion of everything right from humor to OMG, travelling destinations to history and latest technology to creative arts.
Alexa Rank
486,429
INFORMATION TECHNOLOGY BLOGS BY TECHYBOY – My Knowledge base about Network Infrastructure and System Administration. My Knowledge base about Network Infrastructure and System Administration
Alexa Rank
608,813
NEWS24XX.COM | INDEX OF NEWS. NEWS24XX .COM is a news portal that presents information in the World, Educate and Entertain - wherever you are, whatever your age
Alexa Rank
797,916
Brown Eyed Raven - Movies. Television. Reviews. Casting. News. Entertainment.. Movies. Television. Reviews. Casting. News. Entertainment.
Alexa Rank
1,000,001
The Bennett Buzz
Alexa Rank
1,000,001
Treasure Hunters Club - Our search for the best of everything. Our search for the best of everything
Alexa Rank
1,000,001
PAINTED LIPS, DIRTY KNEES. FREYA GALLOWS: PRECOCIOUS SLOB TURNED TRAVELING ART NUDE MODEL
Alexa Rank
1,000,001
Associated Press News. News from The Associated Press, the definitive source for independent journalism from every corner of the globe.
Alexa Rank
1,000,001
tonight we''ll break the silence. +
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1,000,001
Pain in the Neck | notes from a neck pain clinic. I heard some wonderful opening lines waft through the thin cubicle curtains (as if privacy were just a visual thing) in my time as an NHS physiotherapist, but nothing beats the pain of 'Shall we share a story?' - an intrusive frown to boot I bet - delivered by an eager early adopter of the psychosocial aspects of our work, back in the late nineties. But where and how should we begin our sessions - and does it matter? Is it possible that the first words of the session carry greater import than we care to acknowledge? And do our initial muttered utterances have implications for the trajectory of the entire 'therapy'? Roberts and Langridge (2018) have recently noted that surprisingly little attention has been given in the literature on how 'best' to open the clinical encounter, but one study does at least shed some light on the variety and preferred 'openings' that physiotherapists use. Chester et al (2014) audio-recorded 42 initial consultations (and 17 first follow-up encounters - but we won't be discussing those here, interesting though they are) between qualified physiotherapists and individuals with back pain, in an adult musculoskeletal, primary care outpatient setting. Eleven different opening questions were identified which were then used to determine clinicians' preferences in a national survey from a broad range of physiotherapy professional networks (Sports Medicine, Orthopaedics, Massage and Soft Tissue Therapy, and Pain Management). A selection of the openings used by physiotherapists from Chester et al (2014). The preferred opening question for an initial encounter among the physiotherapists who responded was: 'Do you want to just tell me a little bit about your problem first of all?' Although the survey response in this study was small, the paper apparently generated much debate. I don't know about you but some of these opening phrases sit rather awkwardly with me: talk of a 'bit of a chat' and 'a little bit about your problem' are hardly suggestive of a forthcoming expansive discussion. Personally, I tend towards usually opening with a 'so what's the story?' and then sitting in silence until the narrative has run dry, before engaging with the conversation. Doctor and writer John Launer has also discussed openings in his wonderful book 'Narrative-Based Practice in Health and Social Care' (2018). He suggests there is no reason to avoid one of the conventional questions, such as 'How can I help you?' but does counsel against the use of formulations such as 'What's the problem?' arguing that this 'already closes down possibilities - for example there may not be a problem or there may be several'. He also notes that trained mentors and coaches often start meetings with the question: 'What are you hoping to get out of our conversation today?' Asking this can save a lot of time that might otherwise be spent barking up the wrong tree, and the answer is often quite unexpected, he notes (Launer 2014). In another fascinating piece - 'The Three Second Consultation' - Launer (2009) spends over an hour reviewing the first three seconds of a recorded consultation - concluding that the best conversations, whether social or professional, are unconstrained by any prior expectations of where they ought to go. Rita Charon - in her book 'Narrative Based Medicine' - describes using 'tell me what you think I should know about your situation' followed by 'a commitment to listen and not to write or speak'. Charon describes how foregoing the urge to order the narrative leads to her absorbing what is being said without ' deranging the narratives into my own form of story.' She describes listening 'as hard as I can.' Indeed Charon cites work suggesting that warmth and intimacy between clinician and patient tend not to build over time, but achieve whatever level they will achieve at the first meeting. And what do we do after the initial response to our opener? According to Roberts & Langridge (2018) physiotherapists interrupt the patient whilst they are answering the opening question in 60% of cases! Marvel et al (1999) found nearly half of patients were interrupted whilst describing their problem and - wait for it - patients were given on average just 23.1 seconds to describe their problem before being interrupted. But how long does it take a person to describe their problem? Langewitz et al. (2002) reported that people will take on average 92 seconds to explain their problem in an outpatient setting (if they are not interrupted!). Peter O'Sullivan has discussed the benefits of staying silent after his initial opener of 'tell me your story'. He says 'everyone who comes to me has a story. Usually in that first minute you'll hear something really important about their story - if you just don't say anything - and that will lead you down a path.' (Pain Reframed Podcast 2017). So, whatever opener you decide upon - hush and hold thy tongue dear clinician and LISTEN AS HARD AS YOU CAN! References Charon, R 2006 Narrative Medicine: Honoring the Stories of Illness Chester, E.C., Robinson, N.C., Roberts, L.C., 2014. Opening clinical encounters in an adult musculoskeletal setting. Man Ther, 19, 306-10 Langewitz, W., Denz, M., Keller, A., Kiss, A., Rütimann, S., Wössmer, B., 2002. Spontaneous talking time at start of consultation in outpatient clinic: cohort study. , 325 (7366), 682-3. Launer J (2009) 'The Three Second Consultation' Postgrad Med J 2009;85:560 Launer J (2014)'Good Questions' Postgrad Med J 2014;90:121–122 Marvel, M.K., Epstein, R.M., Flowers, K., Beckmanm H.B., 1999. Soliciting the patient's agenda: have we improved? JAMA., 281 (3), 283-7. Pain Reframed Podcast 'Caring Deeply and Dropping Your Ego' Dr. Tim Flynn and Dr. Jeff Moore with Dr. Peter O'Sullivan Roberts, L. and Langridge, N. (2018) Principles of communication and its application to clinical reasoning. In, Petty, N.J. and Barnard, K.(eds.) Principles of musculoskeletal treatment and management: a handbook for therapists: a handbook for therapists. (Physiotherapy Essentials) 3rd ed. Edinburgh. Elsevier, pp. 209-233. If you are interested in learning more about Narrative-Based Practice in Health Care, John Launer and colleagues are running a three day workshop at the University of Hertfordshire, UK in Summer 2019. Further details here: Conversations Inviting Change
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