I’ve been encountering a behaviour from some patients that is a little frustrating and a little hard to deal with whilst being on my musculoskeletal outpatient placement; some people coming into the clinic for outpatient physiotherapy have very set ideas about what they expect to get from treatment. I can recall a few patients who were of this type. It seems to happen more with those who have chronic conditions.
Some patients seem to want very specific things from physiotherapy, and if they do not get this they can sometimes get very upset. For example, after carrying out a treatment in fairly normal time (i.e. subjective time 5 mins, objective time 10 mins, treatment time 10 to 15 mins) a patient might complain that they were getting too much assessment and not enough treatment. A patient might also complain that the treatment for them is wrong- they may say after an ultrasound treatment, for example, that “what I need is actually just a really good massage”- that last comment seems to recur a lot.
At first I didn’t really know how to deal with these comments, and I found it a little frustrating. After a bit of thinking I realized that it’s a pretty complicated issue. On one hand, the patient has a condition, which is often chronic, which they will have figured out how to manage it in their own way, which can be helpful for the physiotherapist. We are, after all, big on promoting self management. This downside to this is that a patient’s opinion of their condition is totally subjective: it does not include any objective reasoning. They will talk about their pain and what they think makes it better, and they will often try to sound objective about what they are telling you, but ultimately it is all just subjective.
That where the physio comes in, and I guess this is the other side to the story. Yes, we do want patients with chronic conditions to ‘take the reigns’ of their own conditions, and so we really try and encourage self management- we do this because a patient cannot objectively assess themselves, and they do not have the knowledge of a PT. However, patients with chronic problems still need some PT management, and often we have to ‘take the reigns’ back off them and resteer them in another direction. I understand that this can be very upsetting for the patient- especially those who do not like taking advice. If the changes to their management are quite drastic, then this can also be very upsetting for the patient.
The thing that makes it really hard is this; we want the patient to give up a degree of their autonomy and let themselves be guided by the PT; however, sadly it is true that there are health professionals out there that really might be making a wrong decision with their management choices for a patient, and therefore it is necessary for a patient to always be on guard with health professional management and maintain some degree of autonomity- enough that if they feel they are getting managed in a totally incorrect way, that they will seek another professional.
I guess the bottom line is that, with any questions or queries that patients might have, we make sure that we address them, and keep the patient informed. We should endeavour to explain ourselves and the decisions that we are making as much as possible. That way we can persuade patients to follow their given management plan, whilst also keeping them informed enough so that they do not feel that they have lost their autonomity in managing their condition.
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I completely relate to what you have gone through. On my neurology outpatients placement i had a patient who had been receiving physio from students for the last ten years and had got into a set routine on what treatments he prefered and basically dictated how the treatment session would unfold. I think i felt like id lost a bit of control when i had this patient telling me how long i should be holding his stretches, how i should transfer him, how all of the students in the past had performed his treatment. I decided to add a few new components to the treatment which challenged the patient and found he was very uncomfortable because he preferred his usual routine and how the treatment was more of a social outing. In a sense because i progressed him and mixed things up he appreciated that i was trying to make the most out of the treatment and gave me more respect. The following sessions he was more prepared to work and became more open to new ideas even if initially there was a bit of troubleshooting.
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