Apparently you can give a pt too much information!

I was treating a man who had recently been diagnosed with bowel cancer and consequently undergone surgery resulting in a permanent stoma bag. The pt had complications which sent him to ICU for 2 weeks and this prolonged bed rest had lead to marked deconditioning and balance problems, which is what I was seeing him for.

He was very inquisitive and asked a lot of questions, so I made sure I gave him all the information I could and when I explained the functional reasons behind tests/exercises we were doing, he was always compliant and sometimes even enthusiastic. During the early stages he was so deconditioned that we would only be able to do a few items on the Berg and this would take half an hour or more, as his exercise tolerance was very limited. He required prolonged rests and water breaks before continuing. It was during this time that I thought I was doing a good job building rapport with the patient and answering his many questions. He was often upset with his condition and was very frustrated with his current abilities – he’d entered hospital, seemingly well and now couldn’t self transfer. He needed a lot of reassurance and emotional support.

As the patient’s exercise tolerance rapidly increased, his rest periods were not required as frequently, but as I had set a precedent of talking through his condition and our treatment, there seemed to be more chatting than exercising. I tried multi-tasking but he concentrated so hard on his exercises that he wasn’t able to do them as we talked. The patient really appreciated the explanations and the support, but it really wasn’t conducive to achieving the physical outcomes of our sessions. I was a bit disheartened when my supervisor suggested I wasn’t being very effective, as this was in stark contrast to the feedback the patient and his family had given me. Though I appreciate that my supervisor has a lot more clinical expertise than the family and realise now that he was, of course, right.

I decided to give the patient a ‘home exercise program’ (though he was still an inpatient!) and only after quite a lengthy discussion about the merits of doing unsupervised exercise.. As he got stronger I was able to give him more tasks to do unsupervised and eventually he seemed to be doing more exercises outside our sessions than in them! I thought this worked really well and the patient progressed quickly, without compromising the support I was giving him.

My reflection is about finding a balance between achieving our goals and those of the patient, and also about realising our limitations not only as students, but when we are physios. I think in this situation, whilst I got along well with the patient, I should’ve utilised other allied health professionals to assist in achieving our common goals, rather than trying to do it all myself!