On my present placement, an interesting case has come up regarding compliance w HEP. It has led time to wonder whether we should 'fire' some patients?
In reading the pt.'s first and second transfer summary, it became apparent that this patient never did her HEP X.s; and, aside from some initial progress, her status had plateau’d. Her disorder is a low back postural / loading disorder, so her X.s and behaviour modification re key to resolving the problem.
The obvious thoughts occurred to me: perhaps she did not understand the PT approach (i.e. that pt. involvement is a key part of Mx) or that she did not know that she would have to stick with her X.s for 5-6 weeks to see strength gains and longer to see permanent assimilation of new motor patterns necessary for modified posture to become 'first nature'. Or maybe she was too busy to do her X.s - or they hurt?
So I gently asked her why she didn't do her X.s and she didn't have a reason. I went over the aforementioned concepts and she replied that this was very much what the previous student physios had said. Period.
Admittedly, some of this pt.'s issues are emotional / psychological. I also couldn't help wondering if some of the poor oldies on the waiting list couldn't benefit more from clinic time than this pt. was... So I came to the questions? Should we fire pt.s? My heart says yes, but I am not sure if we have the authority to do this. What are other people's thoughts?
In the end, I asked her if she would be interested in a X rehab class and when she expressed an interest, I signed her up. Perhaps the structure and context will give her some motivation, but in the end I am not sure if 1-2x /week will make enough difference...
Subscribe to:
Post Comments (Atom)
3 comments:
Heya Ed,
This is definately a hard one in the public setting as the patients aren't having to pay for the physio service. I do agree with you though that it become frustrating when you treat patients and give them exercises to complete only to realise that they haven't even been doing them. I have the mindset that if they're not prepared to help themselves they can't expect us to be miracle workers and make them better without their input.
I do concur with you Ed- that we should be able to discharge these patients as they do take up valuable space in which other ppl could take up and use more effectively. I guess in the private setting these situations wouldn't happen nearly as frequently due to the $$$ involved in each of their treatments!!
Debs
Hey Ed,
Thats a great post, I have felt like that too on a number of occasions. It can be quite frustrating to see the potential someone may have in achieveing a full recovery only for it not to occur due to non compliance on the patients behalf. Debs you also make some good points that this is a public setting and there not paying for the service. There fore they are probably not as worried as to the outcome. I think that an intervention needs to be made to the pt pointing out the facts that they are not improving due to non compliance on their behalf and that further PT intervention at this point is probably not going to be beneficial. Prob have to realise it's not possible to help every pt unfortunatly
Cheers
I think there comes a time with every pt when they need to be told that physio can no longer be of any benefit to them. For most patients, hopefully that time comes when the problem they came in with has been resolved... But there are a number of patients that no matter what we do for them and no matter how hard we try, we just don't get anywhere. If this happens because of something lacking with us as physios, we should have no problems referring them onto someone that has a bit more knowledge and expertise in the area. If it is something to do with the patient that's causing the problem (as it is in this case) and the patient isn't listening to your advice, then we should be able to tell them that we have nothing more to offer them and move them on. I guess its a hard decision to make at the moment with very little clinical experience, but i think as the experience comes, we'll get better at doing it.
Post a Comment