By simon
Something I’ve been encountering a lot lately, since I am now working with inpatients, is compliance with treatment. The hospital I am currently at, patients have the right to decline treatment. I mean, I guess patients in all hospitals do but at this one we have to document that we obtained consent in the notes. Anyway, I’ve realized that when you see a patient you don’t just ask them straight out “can I do a treatment with you?” because they will almost always say “no, but come back tomorrow, we’ll do it then” or “no, I really don’t feel like it now”. I’ve learned that a fair bit of persuasion and rapport building with the patient before asking for consent plays a pivotal role in getting their consent. This may involve a short chat about the weather, how did they sleep, what was their lunch like, etc. it may also involve highlighting to them the various benefits of physiotherapy intervention for them(in layman’s terms).
I’ve also learned that some patients need a lot more of this pre-treatment banter and persuasion before the question of consent is presented, to gain a positive outcome. Some patients need only the very brief “hi, how you going?” before requesting consent, whilst others I would chat with for a few minutes before asking for consent, and then I would have to persuade them by outlining the various physiological, and even psychological, benefits of the intervention, before they finally consented. From my experience I believe that most patients have got a point at which they can be persuaded to consent, if the therapist is skillful enough in building rapport and persuasion. There do seem to be some though, that will not consent whatever the therapist says.
The reason I bring all this up is that I had a patient on my cardio placement who I was supposed to see for the first time. As I approached the patient, he was shaking his head, and when I began to talk with him, he was very obvious in saying that he did not feel like treatment. I decided not to try and persuade him, I guess maybe because I was too tired to- normally I would have. It was a Friday.
When I returned to the ward on Monday, I was told that the same patient had died over the weekend. That was pretty shocking. I began to wonder- what if I had tried really hard to get him to consent to treatment? Could the treatment intervention have kept him alive? Since then, I’ve been wondering- where exactly should the line be drawn when it comes to trying to obtain patient consent? The patient that I didn’t see on that friday would have taken a lot of time and effort to be persuaded to consent, and when I already had a patient caseload that is overfull it can be hard to justify that much time, just talking, to a single patient.
I would really appreciate any input anyone has on this.
Something I’ve been encountering a lot lately, since I am now working with inpatients, is compliance with treatment. The hospital I am currently at, patients have the right to decline treatment. I mean, I guess patients in all hospitals do but at this one we have to document that we obtained consent in the notes. Anyway, I’ve realized that when you see a patient you don’t just ask them straight out “can I do a treatment with you?” because they will almost always say “no, but come back tomorrow, we’ll do it then” or “no, I really don’t feel like it now”. I’ve learned that a fair bit of persuasion and rapport building with the patient before asking for consent plays a pivotal role in getting their consent. This may involve a short chat about the weather, how did they sleep, what was their lunch like, etc. it may also involve highlighting to them the various benefits of physiotherapy intervention for them(in layman’s terms).
I’ve also learned that some patients need a lot more of this pre-treatment banter and persuasion before the question of consent is presented, to gain a positive outcome. Some patients need only the very brief “hi, how you going?” before requesting consent, whilst others I would chat with for a few minutes before asking for consent, and then I would have to persuade them by outlining the various physiological, and even psychological, benefits of the intervention, before they finally consented. From my experience I believe that most patients have got a point at which they can be persuaded to consent, if the therapist is skillful enough in building rapport and persuasion. There do seem to be some though, that will not consent whatever the therapist says.
The reason I bring all this up is that I had a patient on my cardio placement who I was supposed to see for the first time. As I approached the patient, he was shaking his head, and when I began to talk with him, he was very obvious in saying that he did not feel like treatment. I decided not to try and persuade him, I guess maybe because I was too tired to- normally I would have. It was a Friday.
When I returned to the ward on Monday, I was told that the same patient had died over the weekend. That was pretty shocking. I began to wonder- what if I had tried really hard to get him to consent to treatment? Could the treatment intervention have kept him alive? Since then, I’ve been wondering- where exactly should the line be drawn when it comes to trying to obtain patient consent? The patient that I didn’t see on that friday would have taken a lot of time and effort to be persuaded to consent, and when I already had a patient caseload that is overfull it can be hard to justify that much time, just talking, to a single patient.
I would really appreciate any input anyone has on this.
2 comments:
I wouldnt worry if i was you. Everyone has patients who die and even though its very sad, you shouldn't feel that its your fault in any way. I believe that if patients are really strongly against treatment then there's nothing you can do to make them comply. Sometimes no amount of persuasion is going to help and you're right in suggesting that this time could be used better by actually treating other patients.
I think you did all you could in this situation and it shows that you are using good time management skills if you are aware that you have a full caseload and have strategies in your head to build a rapport with your patients to get treatment up and ready. I had a few cases of very uncomplaint patients and approached them by taking the "im on your side approach" and found a common interest. Good one is to sus out what nationaltity they are and ask questions about any famous sporting teams, celebrities, current affairs to do with that country....just makes things a bit more interesting.
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