I was recently treating a 40 year old man who had been diagnosed with transverse myelitis a few months ago and had quite decreased strength of both his lower limbs. I was taking over from my supervisor and she had warned me that he appeared somewhat 'arrogant'. When I got to his room he started ordering me around, asking me to get things for him. Obviously I don't mind assisting a patient when they are stuck in bed and it's clearly easier for me to reach things, but I am used to being asked nicely with some degree of respect, not ordered and expected to obey. When we got to the gym I did a quick assessment of muscle strength then began working on some exercises for his glut meds. One of his glut meds needed assistance to do the exercise with a proper technique, so I was assisting his leg with one hand and keeping his pelvis properly rotated with the other when he said 'let me do it myself'. I told him that his muscle wasn't strong enough to perform the exercise and until it was, he needed assistance. Still, he wanted to do it himself so I thought I might as well let him see that he couldn't. I took my hands off and his pelvis rotated back, his leg barely coming up at all but still everytime I put my hands on he'd tell me to take them off. I tried explaining to him again that it was doing him more harm than good to perform the exercise poorly by himself and he finally, grudgingly accepted my help.
This behaviour continued throughout the session, the patient refusing my help and disregarding my advice. To top it off he kept scratching his groin and talking to me in a disrespectful manner. I was so sick of him I began to feel I didn't even care if he did his exercises right or not, something I have never felt about a patient before.
I endured his behaviour for a few sessions because I didn't want to admit to my supervisor that I was having trouble but in the end I went and spoke to her. She told me not to be afraid of the patient, set some boundaries and let him know that his behaviour was unacceptable and I took her advice. While I perhaps still didn't enjoy treating him, he had at least stopped telling me what to do and dictating the sessions which was an improvement.
Next time a situation like this arises I will tackle the issue straight away so the patient doesn't start to think they can get away with anything. It's also made me realise that as long as you show your supervisor that you've tried to fix the situation on your own but were unsuccessful, if they're a good supervisor they don't mind giving you a few suggestions.
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3 comments:
Sounds like you got caught with a tough patient. I think you are right with the need to set clear boundaries for the patient and make it clear that you are there to help them. Also it can help to have another member of the team, usually a nurse, assist you initially when you are treating a difficult patient so that you are both reinforcing the behavior that is expected.
This happens quite a lot and it is quite important for us student physios to create a balance between being in charge as well as not coming across as arrogant to the patient. Our role often requires us to see the patient on a regular basis. So if things are not going well between the physio and the patient, then the effectiveness of treatment is compromised. So that is the challenge for us.
I can definitely see how you lose interest in treating a patient like this. Often it is hard to convey to the patient that all our motives are in there best interest. If they dont wish to do something it is becasue they are motivated in this manner and we need to manipulate their motives to make our job more beneficial for them.
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