Whilst on orthopaedic inpatients placement I came across a situation that disappointed me regarding patient compliance. I was going to see a patient with an ankle injury who simply needed motivation to ambulate. The patient was in her sixties, overweight, had a right ankle splint, and a history of left knee pain. She was weight bearing as tolerated and previously used no walking aids prior to admission. I was informed by another physio that the patient was able to ambulate independently with elbow crutches.
After introductions, when asked to ambulate, the patient was reluctant to get out of bed. The patient was not in pain, however, simply didn’t want to come for a walk. I found this frustrating, but eventually convinced the patient to get up for a walk. What disappointed me more, was that once up, the patient refused to walk with elbow crutches and insisted that if she was to go for a walk that she would only go with a walking frame. This annoyed me as I knew she was capable of using the elbow crutches and that she didn’t use walking aids at home, yet she wouldn’t use the more appropriate aid.
Since the patient made it abundantly clear that no frame meant no walk, after trying my best to convince her to at least try the elbow crutches, I just accepted the situation and ambulated her with the frame. The patient had no problems with the frame and elbow crutches were clearly the more appropriate aid in her situation.
I later found out that since injuring her right ankle, the patient was starting to develop a fear of falling or injuring her left knee that she had a history of pain with. Because of this the patient said that they now felt as though they needed to use the frame so to prevent loosing independence if something were to happen to her left knee. I tried to explain to the patient that elbow crutches were more appropriate for her, especially if she wanted to maintain independence and return to her previous function, however, she simply purchased a frame and no elbow crutches and refused to listen to my advice. This frustrated me as I know that if the patient was to try a little harder with her rehabilitation that she would be far better off than simply settling for the easy option and expecting everything to take care of itself.
Later on in my placement I started to notice when patients would refuse treatment or make up childish excuses to get out of a treatment session. It made me start to think, and upon further reflection I realised that as long as they are properly informed, there is no point in getting frustrated and angry with a patient if they are stubborn and refuse treatment, or if they don’t push themselves for the best, simply settling for an easier option. If they know the benefits of treatment, and negative effects of poor rehabilitation, and you have tried your best to persuade them into undertaking treatment and trying their best, then they can make their own choice if they want to do it or not. And if they don’t want to, then our time is better spent on other patients who are more motivated. Through this experience now when I am in a similar situation instead of getting frustrated and angry, I accept the patient’s choice and concentrate my energy on treating patients who are willing to participate in treatment.
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I think you are completely correct with your approach to the uncompliant patient. At the end of the day if the patient has refused to listen to your recommendations despite you have educated them on it being the best option for them it is completely their decision and a decline in mobility is completely their fault. I had similar patients on a gerontology ward who would throw tantrums when i suggested we go for a walk or do some balance retraining. Towards the end of the placement i found that the more you bargain with them the more reluctant they will become. When i reiterated the consequences of their lack of compliancy and the prospect of spending more time in hospital if they do not reach a certain level of mobility that proved to be a good motivator. Also if a patient has a fear of falling talking them through it encouragement and reassurance of their abilites would improve their confidence. Often its good to start with smaller milestones i.e. walking 5 m before trying 10m.
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