Gaining a patients' confidence

On my neurology outpatient practical, I had a patient who suffered a pontine stroke two years ago. She currently mobilises independently in an electric wheelchair, and requires x1 assist with chair to bed (to chair) transfer and bed mobility. She has been known to be abrasive with her therapists, and has a history of poor attendance. Prior to treating her for the first time, my supervisor warned me that she may be difficult, and that it was best not to joke around with her. Some may be grateful for such a warning, but for me I think I focused on this too much and as such I seemed to lack confidence to the patient.

The technique to transfer this patient from chair to bed is tricky, and was demonstrated by my supervisor on this first session. She has decreased voluntary control of the left lower limb, and a positive support reaction in standing causing her left ankle to plantarflex and invert. As such, the transfer is to the patients’ right, and she must weightbear only through her right lower limb. The therapist blocks the lateral border of the patients left foot and her lateral knee to prevent her ankle rolling over, while assisting her into standing by facilitating through the left upper limb. The patient then pivots on the right foot while the therapist looks after her other leg. During this first session she told me that she had been coming to outpatients for over a year, had seen many students, and did not rate most of them. She also rolled her eyes at me as I battled against her severe tone while trying to apply stretches. I am usually confident with most patients, but I must admit that I was rattled by her attitude toward me. The following session, on attempting to transfer, I appeared apprehensive prior to the transfer, and as such she would not let me transfer her, requesting that my supervisor do so. The following three sessions she did not attend.

At this point I felt like the patient had no confidence in me, and as a result I had lost confidence in myself. I decided that the next time I saw her, I would show no apprehension and appear confident to transfer her myself. I clarified the finer points of the transfer with my supervisor, as I knew that she was very particular, and if I did not get my foot placement right that she would not let me transfer her again. When she came in, I didn’t hesitate, immediately placing my feet in the correct position and as such I performed the transfer myself. The patient appeared impressed by this, and she turned up to the next three sessions (very unusual)!

From this situation I learnt that if we do not appear confident, the patient will have no confidence in us as therapists, and in the treatment we provide. A physio once said to me that it is amazing what a difference the transition from blue shirt to green shirt can make. This patient did not rate students in general; however once I gained her confidence she was much more compliant to physio. Hopefully I changed her mind about students too!