During my last placement (Neuro OPD) I was treating a patient who had had a very large ® TACS, with considerable (L) sided neglect, perceptual problems and decreased awareness of her deficits. She was often late for the sessions, didn’t participate fully in the session-she usually tried to talk her way through the sessions, and didn’t seem to want to come at all. In fact she often remarked that “all you want to do is hurt me”. This was all quite hard to deal with and the sessions became a battle of wills between her and me, which was difficult as she was usually only there for half of the 1.5hrs. Due to her decreased awareness she also developed goals/aims for treatment that were completely unrealistic, i.e. playing tennis (she had no functional use of her (L) arm) and would get very depressed and upset with everyone when she could not achieve this.
I talked to my supervisor about how I could improve my communication and general approach to treating her and improve the effectiveness of her treatment. He told me that I had to remember her diagnosis i.e. she has decreased awareness, perceptual problems and underlying depression, so her behaviour is not her fault; and that I had to improve my communication with her during treatment-she needs to know what is going on. He also told me that I couldn’t take what she was saying personally, as it was not directed at me. So I talked with her about her goals, explained how much work would be required to achieve them and the amount of recovery realistically possible. I tried to be as honest and as gentle as I could be, which seemed to get through to her, and she was a bit more positive after that. I also tried to remain objective in the sessions-trying to include the maximum amount of effective treatment. This was made easier when I involved her in the session-i.e. explaining what I was doing and why I was doing it, and how it would help her achieve her goals.
It is sometimes hard to interact with patients who seem to have a bad attitude towards you or physiotherapy, but it is important that we don’t take everything personally and take into account any internal and external factors that may be influencing the patient’s behaviour. It is also important that we don’t let our annoyance or frustration with our patients negatively influence their treatment-we must remain objective and treat them as we would anyone else.
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2 comments:
I think that you dealt with that patient really well. I have also had to treat a patient with a (R) TACS that was at times difficult to deal with. But like you said it's really important to remain objective and also remember the reason behind their behaviour. I think that patience is also really important in these situations; sometimes placing yourself in the patient's shoes can positively influence the way you communicate with them.
I had a very similar patient last yr on ward 2 (actually I'm wondering that if it's the same lady, as I know for sure that she's attending OP now!!). I also wasn't sure how to keep her motivated to do her rehab. She also often expressed somewhat unrealistic goals. Unfortunately, I really didn’t clarify with her how unrealistic I felt they were… Something I really should have done, and should definitely learn how to approach. Thank you for sharing this Kate.
Over time of building rapport with this lady, I felt the situation gradually became better. I found that the more I could engage her in conversation with me (which really was not hard!), the more I could control the session by going "ok, enough gossiping... A few more reps of this one and then we'll talk about that/her/the weekend/news/etc". A hard-nosed, therapy-focused approach was rarely successful with her as she was likely to do even less. This really showed to me how important rapport building, and showing a keen interest in the patient's life outside of physio can be, if only for the manipulative goal of getting them to do what you want them to do! I think it sounds a little horrible, but… It does also make them feel better, so it’s not all bad.
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