When I was on my neuro placement, I was treating a patient with a left hemiplegia. This particular patient was occasionally difficult to cope with due to the personality changes that occurred following the stroke and was also unable to walk. I went around to the patient’s room to take her to the treatment gym. This particular day the patient was refusing to come to physiotherapy, stating that she wanted to stay in her room. I tried to reason with her and explain how physiotherapy would help her and when she was finished she could come back to her room. Failing this I went and informed my supervisor that the patient was refusing to come to physiotherapy. My supervisor explained to me that sometimes it’s better not to tell them that they are coming to physiotherapy but that you’re just taking them for a ‘wheel’. She came with me and just said to the patient that she was going for a ‘wheel’ and took her to the physiotherapy gym, the patient was relatively co-operative and received at least a half an hour of treatment.
When the patient initially refused to come to physio, I felt that I would be taking advantage of the patient by just taking her anyway, as she had no way to resist apart from verbally. In some ways I felt like what my supervisor did was the right thing to do, as this particular patient really needed physiotherapy and due to her stroke she had a lack of insight into her situation and on many occasions displayed irrational judgment. However at the same time, I think the patient has a right to choose. This situation really raises an ethical dilemma, when is a patient not well enough to make their own decisions and when should we respect the decisions they make?
I don’t think that there is a clear cut answer to this question. From this situation I’ve learnt that to truly make that decision in a case like this you need to know the patient well, and in this way it will give you an indication as to whether their decisions are based on sound judgment or not. My supervisor had been treating this patient long enough to know what to do, and also had enough experience treating patients with strokes to make that call. It’s hard to know what I would do if faced with the same situation as I feel it really depends on the particular patient you’re treating. If it was this exact same patient I think I would try to reason with them first and explain the repercussions of not having physio, if she still refused I would leave her alone for a little while and come back later and try again. However, if the patient still flatly refused treatment, I would respect that decision as long as I felt that they understood what I was saying. I do feel that it’s important to first of all reason with the patient as much as you can, give them the opportunity to make their own decision and not take advantage of their situation.
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Hey bron,
I had a similar situation on my Gero's placement with a pt who would always refuse Rx, or getting out of bed with me or the nursing staff. He had come in from living independantly at home and was quite capable of being rehabed back to an (I) level. I would try several times a day to get him up, i would start off being nice and rationalising it to him, etc etc to no avail after trying several different approaches the only way that worked was to be really bossy and not really give them an option type thing, so dont say do you want to do physio now, but mr. X its time to go and do physio now or let them do physio whilst thinking there going to do something functional eg, its time to have a shower youve been in bed to long, to get them up and walking or its time to go and have a cup of tea, cause once you get them up to start off with they usually become more compliant after, thats what ive found sometimes, i think you have to try even if they decline to get them up because they cant hospital forever and your only trying to do what's in their best interests if there is a specific reason they don't want to do RX like one of my pt's had just been told he was having a bone marrow test to check for cancer and couldnt focus on RX that day so i let him off then i think it's ok to let them off for the day, but if they dont have a proper reason for not wanting to do RX then i dont think its as acceptable, another technique is just to sit down and have chat with them find out whats bothering them, discuss their problems with them and why they dont want to do Rx and often they are more compliant after this and a compromise can be reached
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