On my neuro placement i have encountered a patient who is incredibly difficult and would like to share my experience with her in hope of some advice to handle this particular patient in the next upcoming week
This particular patient had a bilateral pontine infarct almost 2 years ago and has had intensive physiotherapy rehabilitation since. She is 31 years old, wheelchair bound and requires 1 x moderate assist to transfer from chair to bed. She has increased extensor tone in her LL, decreased muscle length globally in LL esp PF, and has no functional use of her L UL. Her balance in sitting is poor as she does not have the trunk control and muscle activation to adopt good posture and alignment. Aims of treatment have been to maintain muscle length in her LLs, improve functional staus of the L UL, and improve the efficency of her transfers. This is particularly important as her carers are finding it difficult to transfer her.
The first two weeks of treating this patient have been fine as my supervisor has provided me with lots of support as this patient generally is very uncompliant unless encouraged by physios who have had a lot to do with her in the past. So last week was the first time i independantly treated this patient. Until then we have got along just fine, i actually was surprised to read in her notes that this patient dislikes students and has "behavioural problems."
To begin with the patient was half an hour late and seemed not to care, she generally is absent for at least one of her PT sessions a week and frankly has made no progress for quite some time. As we began treatment i could see a change in the patient's response to me being on my own. She complained about her streches being to extensive and had the nerve to ask me.." are u sick? coz you look like absolute s@#* today" of course i was shocked by this and remained professional replying that i had a lot on atm and was really tired. She then continues to say " Yeah and when your ass starts looking fat in those pants i wont be afraid to tell you." Again i remained professional and laughed off that comment. As we continued with the treatment i thought id challenge the patient to increase her muscle endurance with reciprocal knee bends on the tilt table, we progressed to 2 x 10 resps and asked the patient if she could do 2 more. The response i received was "NO!" I then continued to bargain with the patient assuring her that this was for her benefit and again i received," What part of NO dont you understand, the N or the O?" By this stage i had had enough of being completely disrespected that i remained professional and finished the treatment session whilst the patient smuggly drove away in her wheel chair.
This situation has demonstrated to me that sometimes you need to be firm and more assertive with patients who are difficult. How this patient treated me was completely inappropriate and rather than taking control of the situation and demanding more respect i let the patient walk all over me. Now looking back at this experience i think i would approach the situation differently by subjectively questioning the patient on whether something had upset her that day, ask her to be more punctual in the future, and if she does not want to continue with PT that she best say so now so her treatment timeslot be taken up by someone else. Also i think i would explain to her that students obviously do not have the experience and knowledge base of other more experieced senior physios who have treated her in the past. We are just learning so inevitably at times we will take longer to do things and make more mistakes.
Any thoughts??
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2 comments:
From your comments I think you handled an extremely inappropirate patient very well. I don't believe you 'let the patient walk all over you' as you still managed to complete at least a portion of your treament. As you mentioned we don't know what has happended that day for the patient, and unfortunately sometimes we happen to be the person they take this out on. I had a similar patient whom was an extremely difficult inpatient, whom called the police a number of times, abused the nursing staff etc. Following these incidents no one was allowed to go into her room alone and all treatments were countersigned. In an outpatient setting this is a little more difficult, but i agree with you in terms of subjective questioning, and reminding them that phsyio is not a requirement, but probably wouldn't mention that there is a waiting list as it may just aggravate them further! Good luck with next week, hopefully they were just having a difficult day, but if they continue to act in that manner I feel further action is required, particularly if they are depressed. And always remember that it isn't appropriate for them to treat youself or others in that manner.
I think this patient would have some form of mental illness such as depression so I definitely wouldn't take their actions/words personally. I also think that patients sometimes take advantage of the fact that we are students and so eager to please them, making us easy targets. More then likely they are directing all their frustration and anger onto you. That said I don't think you should have to put up with this verbal abuse and maybe referring them onto a psychologist may help...although it is unlikely they will attend appointments.
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