The dynamics of the patient-therapist relationship

At the start of my cardiopulmonary prac I sometimes found it difficult to get patients to comply with my treatment. Their favourite show had just started, or they hadn't had a good sleep last night, or they were going to have visitors in 10 minutes or they were just about to have a nap...I heard many excuses. While I think it's important to attempt to fit around other things in order to keep the patient on side, it is a balancing act.

I was treating a patient who had a sleeve gastrectomy and when I came to see her complained of nausea and stated she was unable to get out of the bed. I then arranged with the nurse to get her some antiemitics and decided to come and check later. Next time I checked on her she was watching days of our lives and it would be finished in 20 minutes. As I had another patient I could see I decided it wouldn't be a problem. Finally I came into her room after days of our lives would definitely have finished and she was sound asleep, refusing to open her eyes and just groaning at me. She was 3 days post and had gotten up the two days before, and while I came back to check frequently for the rest of the afternoon I was unsuccessful.

In a perfect world we would always be able to treat our patients and they would understand the benefits of getting out of bed. However, clearly it is very unlikely to have such a situation and we are competing for the patients time with a myriad of other health staff and the patients own complaints. As an undergrad it is harder to be really tough on patients and instill the fear of god into your patients, however from this experience I learnt that you have to establish the 'dominant' position as the treating therapist in the relationship from the start, otherwise the patient will never do what you say. I should have been firmer when I saw her and told her that once the tablets had kicked in/her show was finished we were going for a walk no matter what. It is difficult to assert yourself once the patient thinks they are in control and you have given them the upperhand. In future if I allow a patient to have a later treatment (as long as it is a valid reason) I will be stricter in gaining a promise from them that they will be compliant when that time comes, and ensure they follow through.