In my gerontology placement, I encountered a patient who just loves to talk. On our first session, she kept talking until the session finished and even until after I said goodbye to her. It was tough to handle especially because English is not her first language and therefore her diction and accent make it hard for me to understand what she is saying.
Most of the time she would talk about things that were not really relevant, like what she thinks about crayfish and other seafood in Australia (her Abbreviated Mini Mental Exam score is 10/10, which is good), so it was very tempting to dismiss most of what she was saying and concentrate on getting her to perform exercises instead. However, she tends to mention very relevant details sporadically, which were completely different to her answers that she gave me earlier during subjective.
After seeing her, I reflected on what the session achieved and realized that apart from good rapport, there was not much. So then I spent some time reflecting on what had gone wrong. Obviously one of these was that the patient was talkative and I don’t have lots of experience in dealing with such type of patients. Secondly, I realized that I found it difficult to interrupt people when they speak mostly because in my culture it is always perceived as rude. That made it even trickier with this patient because, with her, there were no pauses at all. Lastly, I did not put enough structure into our session that day. I had a list in my mind of the things that I wanted to do but I did not spend much time organizing them in terms of the sequence.
So next time I have to face a situation like that, I will make sure that I will inform the patient about the aims of the session and make sure that they understand it as well as making sure that the patient understands my questions. Also it will be very helpful to be firm about telling the patient to refocus on the task at hand. Building rapport can be limited to rests in between exercises. My clinical tutor told me that situations like these really need active listening and that I could also repeat the last sentence the patient said and quickly re-route the topic back to the exercise or task at hand.
1 comment:
I know what you mean about not meaning to be rude and interrupt! Especially on an initial assessment/session, building rapport is so important, and you dont want to come across as someone strict or forceful.
I found it difficult at the beginning of my msc placement to limit the time it took for a subjective (in very talkative patients) and quickly learned that i needed to be more structured, otherwise ran out of time and spent all night writing up progress notes!
It is probably especially hard on a gero placement, as these people may not have many visitors or people to talk to in general. You need to find that balance of being both a treating physio and a listener! Its not as easy as a msc prac when you just practice asking closed questions!
I think the advice you got was good in that you could re-route the conversation. Informing the patient at the start of the session about the importance of getting the exercises done, and that they can chat in between times could be good, to avoid awkwardess during the session when trying to get back on track!
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