Hello everyone,
Hope the second week of prac went well for everyone! Mine was definitely less stressful, thanks for all the suggestions for time management. It’s nice to hear that I wasn’t the only one stressed that week :)
This week we were asked to go through our file of patients and call those who had not been seen yet to see if they wanted a follow up session. One of the patient’s I contacted was rather abrupt and not planning on coming back for any further sessions. He had reported that his ankle, which had been fractured, was not good at all when I asked him at the beginning of the conversation. I then proceeded to ask if he was interested in coming back to have more sessions to improve his ankle condition. His reply to this was, “what are you going to do for me?” He said that physio didn’t do anything for him the first time he came, that’s right, he only came ONE time, and he doesn’t feel physio helps at all. I proceeded to tell him we can do techniques to help his ankle move easier and easy any pain as well as provide him with exercise to stretch and strengthen his muscles. I was caught a little off guard, not expecting to have to defend physiotherapy. I was also rather annoyed that his expectations of physio were so unrealistic! He expected to go to one session and be fixed; when this didn’t happen he turned his back on physio treatment completely. I suppose this is a frustration that will continue on throughout my career since there will always be people who want to be better immediately and don’t want to do any work themselves. Does anyone have any suggestions as to how I could have better handled the situation? I didn’t get a chance to explain that it would take a long time and a lot of work on both our parts to get his ankle back to normal, or as close to normal as possible, as he was quiet abrupt and ended the conversation quickly. I should probably accept that there will be many patients like this, but I’d like to become comfortable enforcing the effectiveness of physio and the importance of patient compliance.
Good luck on your 3rd weeks :)
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Hello Leslie!
It’s definitely hard when we are caught off guard indeed! I always go away thinking “I could have done better if only…” I am not sure if this applies to you but I believe it does - I think that having more of such exposure will help train us to be sharper and our responses will eventually get better! When patients are ‘quick’, I tend to try to match up to them. But now I figured this is not optimal, what I should do is to ‘calm’ / ‘slow’ them down by modifying the speed and tone in my replies (Buying more time in a way! So as to think of a more substantial and organized response and hopefully they will be less ‘agitated’). I do agree that there are patients who question what PTs can do and how our treatment helps... we will probably encounter more of these.. Can be quite disheartening at times when I can’t defend strongly. I believe this is one reason why Evidence-Based Practice is so important. To make ourselves more confident in defending physio, I think one solution is to equip ourselves with some sound literature / evidence at the back of our head (not easy though..!). Your experience got me thinking what I will do if I face such a patient – guessed I will explain to him that the aim of the first session is mainly to perform a comprehensive ax so as to plan an individualized treatment program for him. Hence, it is important for him to attend follow-ups before gauging if PT can help. I will state the usual timeframe for ‘recovery’ with PT from the literature (but I don’t know at the moment… ha…) and also ‘quickly’ educate him on what we can do to improve his condition just like what you did. I will then end with asking him to re-consider, affirm that it’s alright if he can’t give a response immediately or still decide not to come, but do keep the physio option open and give us a call anytime if he decides to follow-up again and that we will be more than happy to help :D By doing that, I believe we have done our part already so we need not feel bad about anything!!! So the rest is just up to him!! :D
Cheers, Peiying ~
Hi Leslie. That is a good example how important is to ask patient’s expectations from treatment, their goals, what they think will help them and what they think is their problem right in the first session. In this case, probably the previous physio didn’t make the treatment plan in the short and long term clear, therefore, the patient had unrealistic expectations and got frustrated. I think communication is the key in physio. We need to make really clear all the aims of our techniques, home program, use Ax and ReAx and give the patients realistic prognosis. I think you did the best you could do at that stage. You tried to explain how physio could help him (and knowing you I am sure you did that kindly and professionally), but if he didn’t want to be patient to listen and try to get better, then it is not your problem anymore. You did your job. Just don’t take it personal, remember that there will be many other patients that will comply with the treatment and will need your help. Just learn the lesson from this case: always ask the patient expectations and educate them from the beginning on if they are not realistic!
Hey leslie
That sounds a bit tough by that patient. I probably would have questioned him regarding his first treatment session (what he expected, what he was told, what treatment did he receive, what was the immediate response to treatment, what HOME EXERCISES did he receive...and DID HE DO THEM???). I would inform the patient that a physiotherapist's role is also to facilitate rehabilitation, and to give the patient ownership over his rehabilitation process, so he can continue his rehab at home and fast track his recovery.
It has to be a 'two way street' les, if the pt doesn't want to hold up his share of the bargain, then there is very little that we can do. Well, thats how I see it. Well done.
Good luck
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