Last week on my neuro placement I was asked to help one of the physios treat a woman who had recently come in with right sided hemiplegia as a result of a stroke. She has expressive aphasia, and was in a much earlier phase than the other patient I had seen with this condition. She answered 'yes' and 'no' to direct questions, but sometimes didn't answer at all. She would sporadically say an actual word, but for the most part was very uncommuncative, which made me glad I wasn't alone to treat her.
The physio told me to go in and introduce myself and have a look at her tone and voluntary movement and she would catch up with me. So I went in, started chatting to her, remembering to ask lots of closed questions to give her a chance to communicate. However, she didn't say anything in reply and her face was expressionless, which left me feeling more than a little bit stupid. As the treatment session progressed she answered two of the physios questions with 'yes-no' answers but had not yet said anything to me. Even though I knew she had expressive aphasia I found myself getting quite annoyed because I felt like she was ignoring me and I wasn't used to this sort of treatment from patients. I decided to just concentrate on getting the most work done in the treatment session, and while I was focussing on this I made a silly joke about the patient getting her foot in the right position on the step (we were practicing step-ups). The patient looked down at me, smiling with one eyebrow raised, and for the first time I could see the personality hidden behind her diagnosis.
As the session continued I elicited many more smiles and even laughter from the patient, which coincided with an increased effort on her part to get the exercise right. This has reminded me that there is always still a person somewhere behind the condition you are treating, and it's unfair to the patient when you forget that they're human too. It's very easy to judge patients or not put in the effort to build a relationship, especially when on your first meeting they are sullen and unresponsive (even if you know they have good reason to be). However, in the future I will definitely persevere with patients and remember that they were a person before they suffered their stroke, or whatever it was that brought them into the hospital.
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That’s so true. I’ve also found that when working on a hospital ward and moving from patient to patient, it’s so easy to become focused on giving optimal treatment in the allocated time that you actually forget how the patient must feel. Quite often, in the patient’s room, I notice photos of them with their family, prior to their admission to hospital. This really reminds me that not so long ago, these were generally healthy, independent individuals, and how difficult it must now be to be in such a dependent state. It’s also really easy to forget the impact it has on their family. I found patient families were really grateful if I kept them up-to-date with patient progress and what we practiced in the physio session, as these gentle encouragements not only increase compliance to participate in physiotherapy, but also give both the patients and their family hope in returning to a somewhat normal life.
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