Tuesday, November 18, 2008
Patients who 'battle the bulge'
Many postural loading disorders, especially of the lumbar spine, can be attributed to a patient’s excessive weight. To treat their condition in a holistic manner to ensure the condition does not become chronic, the weight loss issue must be addressed. I often do not feel comfortable talking with patients about this, and often tip-toe around the topic, just hoping for the patient to realise what I am getting at, and identify the issue themselves. I have incorporated it into my explanation of why they have back pain, and usually make a comment in the third person, such as “if you’re carrying extra weight around the abdominal area…” as a feel that this is least confronting, and I feel more comfortable saying it. Of course the rapport you have built with you patient is very important, and this may allow you to discuss more complex or sensitive issues with your patient in a better way, especially for those patient who require a bit more of a ‘push’ in the right direction. In the future (especially when I have my own patients that aren’t passed between students and physios) I will take time to build a good rapport with the patient in the first few sessions, and then approach the topic in a way that is appropriate for that patient, as I will have gauged what type of person they are during those sessions
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2 comments:
Hey kg, I think a good way to talk about this issue is maybe try and steer the conversation in a way that they bring it up themselves? For example, when someone joins a gym, and they discuss their goals with a trainer, it’s really really common for someone to list “weight loss” as 1 of their top 3 goals. And that’s because that’s what they have in mind in joining the gym, and they’re not offended in this being discussed.
Maybe after your examination, you could sit down with the patient and explain what you found, so “weak ___, tight ___, poor posture of ____, general deconditioning of ____ , poor muscular control of ____” all those physio findings, and leave out the weight issue for now, if you feel uncomfortable discussing it. Explain that to provide the appropriate intervention, it involves a lot of self management, some lifestyle changes like doing regular strengthening physical activity. Maybe ask them to list some goals they have for themselves, not JUST for the complaint they present with, but also thinking outside the square at other factors that would help the complaint in terms of their general health. If they don’t bring the weight issue up, they’re probably not comfortable discussing it. If they do, then you’re only following onto what the patient is bringing up.
obviously your not going to state it on the first session but once you have built some rapport with the patient then i think it is fine you just need to find a subtle rather than blunt way of saying it, most of the time the patients bring it up themselves
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