Dealing with Difficult Patients

Doing clinical placements made me more comfortable dealing with lots of different patients in terms of diagnoses, impairments, personalities, cultures, etc. I could say that my attitude and confidence when dealing with patients is better than year four started earlier this year.

 

So during my final assessment of the musculo outpatient part of my rural placement, my supervisor and I were both feeling confident that I wouldn’t have any difficulties with my exam patient. She had a ® hip replacement and I felt that it was quite straightforward and that I would be ok. The patient, who’s in her 50s, handled herself in a very calm and pleasant manner and came in with an obvious limp during walking. I introduced myself and my supervisor to her and gave her an overview of what’s going to happen. As soon as I asked her to tell me to describe her complaint, she looked at me, frowned and asked, ‘Doesn’t in say what’s wrong with me in the referral?’ So I explained to her that it is important to get her to describe to me when it happened, how it happened, and so on, so we get a clearer picture of the nature of the complaint so we can address it properly. After my explanation she complained to me about every joint in her body and the nature of pain for each continuously became even more inconsistent as she kept talking. Time and again I tried to redirect the conversation to the presenting complaint, which is the ® hip pain, but she just refused to listen to me and my supervisor was very aware of that. I was getting light headed that time already because there was no way I would take charge of the situation appropriately if she kept talking and not listen to a word I say. So I excused myself and took some really deep breaths outside the room and thought about how to handle the situation. So I went back to the cubicle after a while and decided to let her talk and rant about every pain she’s had in her life. At one point she mentioned nobody would believe that she has leg length discrepancy, so I took that opportunity to ask her about it and even measured her leg length and confirmed that there actually is a discrepancy. She was so glad that someone believed her this time and since that moment, she listened to everything I said and the treatment session went well in the end.

 

I learned from this experience that it is quite important to be observant of the personality of the patient and use that for the better of the treatment sessions. It is important to take charge of the treatment session but it is just as crucial to tone it down or crank it up as needed. I learned that patient assessment and treatment don’t stop at just doing the SOAPIER parts because patients are people too and unlike diagnoses and impairments, people are a lot harder to predict (in terms of attitude, personalities) so physios have to be ready for that, after all our profession is all about dealing with people everyday.